The Hamilton Renal Dialysis Unit has provided dialysis services since 1 June 2010. Fresenius Medical Care acquired this unit in 2011. The service is commissioned by University Hospitals of Leicester NHS trust. A haemodialysis service is provided by the unit through an NHS contract. The contract is a fully managed contract with the building, equipment, consumables and staff all supplied by Fresenius Medical Care.
The dialysis unit is located in north east Leicester and provides dialysis for people in the local area. The service is registered to provide haemodialysis to 19 patients at designated times. The service runs three dialysis sessions a day from 06.00 to 22.30, six days a week with the ability to treat 57 patients a day.
Hamilton Renal Dialysis Unit was selected for a comprehensive inspection as part of Wave one of single speciality inspections of dialysis units. As this was a pilot inspection we did not rate the service.
We carried out an announced inspection of Hamilton Renal Dialysis Unit on 27 July 2015. The inspection team inspected the renal dialysis service.
Our key findings were as follows:
Are services safe at this unit?
- We found systems in place for reporting incidents at the unit. Staff knew how to report incidents and were encouraged to do so by their managers.
- Staff monitored patients before, during, and after dialysis to minimise risks to individual patients.
- Nursing staffing was managed effectively to give appropriate care to patients.
- All patient areas were visibly clean; infection prevention and control processes were in place and equipment had been checked regularly.
- Medicines were stored and administered safely.
Are services effective at this unit?
- Evidence based care and treatment was delivered to patients, which followed national guidance.
- Clinical staff had completed mandatory training and most had received annual appraisals.
- We found an audit programme in place for 2015, which included audits of medical records, medicines management, infection prevention and control and the effectiveness of dialysis treatment.
Are services caring at this service?
- We saw care delivered which was very responsive to patient’s needs.
- Patients were treated with respect and dignity.
Are services responsive at this service?
- We saw a service delivered that was very responsive to patients’ needs. The opening hours catered for patients to complete their treatment after work and at weekends.
- The unit had measures in place to support patients’ differing needs such as interpreters and information in languages other than English.
- We saw evidence of the service responding to patient complaints.
Are services well led at this service?
- The leadership and governance at the unit promoted delivery of high quality care. Members of the management team were well respected amongst both staff and patients.
- There was a shared vision throughout the unit of providing excellent patient care.
- Staff felt valued and an ethos of teamwork was apparent.
We saw several areas of outstanding practice including:
- The data provided to compare services and the effectiveness of services demonstrated thorough analysis of dialysis treatment.
- The provision of extended opening hours catered for patient’s individual needs and gave greater flexibility for treatment.
However, there were also areas of poor practice where the provider needs to make improvements.
In addition the provider should:
- Consider a formal identification process for all patients prior to commencing treatment.
- Should consider a local risk register with reference to concerns that the managers highlighted during the inspection.
- Ensure all bank and agency staff have time set aside for orientation and induction prior to starting a shift and caring for patients.
Professor Sir Mike Richards
Chief Inspector of Hospitals