Archived: Diaverum Dialysis Clinic - Queen Mary's Hospital Sidcup

Diaverum Dialysis Clinic – Queen Mary’s Hospital Sidcup is an independent healthcare location operated by Diaverum UK Limited. The service has 20 dialysis stations which include four bays and four isolation rooms.

The clinic is commissioned through a partnership contract with Guy’s and St Thomas’ NHS Foundation Trust to provide a dialysis service for renal NHS patients over the age of 18 who are considered low risk and did not require dialysis in the hospital. Dialysis treatment is used to provide artificial replacement for lost kidney function. Dialysis units offer services that replicate the functions of the kidneys for patients with advanced chronic kidney disease.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 30 May 2017, along with an unannounced visit to the hospital on 13 June 2017.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led?

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we do not rate

We regulate dialysis services but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• The clinic had effective systems for recording, escalating, investigating and sharing learning from incidents both internally and externally.

• The centre and equipment were visibly clean and tidy, with evidence of effective cleaning regimes and schedules. There were internal and external auditsto ensure staff compliance with local policy and procedure.

• Patients’ records were legible, accurate, thorough and detailed, and were secured at all time.

• Staff were competent and able to recognise, assess and respond to patient risk during emergency situations.

• There was an effective process for the ordering and administering of medicines in line with guidance. All medicine seen was in date and stored appropriately by staff. Staff were 100% compliant with their medications management training.

• Nursing staff were aware of their roles and responsibilities in the escalation of safeguarding concerns.

• The service maintained staffing levels effectively in line with national guidance to ensure patient safety and meet their care needs.

• The service had policies, protocols and proceduresthat were based on national guidance and best practice.

• Staff assessed patients’ pain and nutrition regularly and referred appropriately to specialists for additional support when necessary.

• The clinic participated in local and external audits and used the outcomes to improve care and develop the patient care and treatment pathway.

• The clinic had effective processes for gaining patients’ consent for treatment.

• Staff received induction, annual appraisals and competency assessments.

• All staff had access to all relevant information for patient care and treatment.

• Staff treated patients with respect, kindness, dignity and compassion. Patients we spoke with were consistently positive about the service and support received.

• Staff understood the impact of dialysis treatment and worked especially hard to make the patient experience as pleasant as possible and meet individual patient needs.

• The clinic provided a flexible appointment system that ensured patients’ preferred treatment sessions were met and could be adjusted to meet their social needs and everyday commitments.

• There was a clear and strong local and regional leadership, with accessible managers.

• There was clear vision, values, strategy and prioritieswithin the organisation. Staff were familiar with and worked towards the organisational vision, strategy and priorities to provide the best possible care for renal patients.

• There were robust and effective governance systems to monitor risk and quality and identify trends or areas for development.

• The clinic and organisation sought feedback and engaged effectively with patients and staff. All staff and patients were positive about the service.

• We saw various examples of innovation which included the patient application process that monitored patient’s blood result, mood and weight.

However we also found the following issues that the service provider needs to improve,

• Aseptic non touch technique (ANTT) was not always maintained effectively by staff during the connection and disconnection of patients on the dialysis machine.

• Mandatory training were below the clinic 100% target for Mental Capacity Act (40%) and Equality and diversity (40%).

• Staff were not trained on level 2 safeguarding training.

Professor Edward Baker

Deputy Chief Inspector of Hospitals