The supportive care unit, which is part of the Mary Rankin Dialysis unit at St Pancras Hospital in north-west London, was the subject of an unannounced Care Quality Commission inspection in July - after CQC received anonymous information that patients were being left without proper supervision by qualified nursing staff.
Inspectors found that patients had been left for short periods of time, up to an hour during staff breaks, leaving only one nurse or health care assistant on the ward. However, there was no evidence that patients had been harmed prior to our inspection, but there was an unnecessary risk at these times.
On the day of the inspection the Royal Free London NHS Foundation Trust, which runs the service, took immediate remedial action to ensure that at all times there were two clinical staff including a nurse looking after patients.
CQC has not rated any part of this inspection because of its specific focus which did not include all areas of CQC’s ratings assessment model.
The summary of the key findings of our inspection included:
Nursing staffing levels were maintained in line with national guidance to ensure patient safety. The unit had taken action to address staff cover during breaks.
Staff were aware of their roles and responsibilities in the escalation of safeguarding concerns.
All equipment was maintained according to the manufacturer’s guidance.
There were systems in place to safely manage the ordering, storage and administration of medicines.
Staff were aware of their roles and responsibilities to maintain the service in the event of a major incident.
All policies and procedures were based on national guidance, standards and legislation.
Patients’ pain and nutrition were assessed regularly and patients referred to appropriate specialists for additional support as necessary.
The service monitored key performance indicators. This demonstrated that it performed similarly to other dialysis centres.
Staff had the skills, knowledge and experience to ensure safe patient care.
There were processes in place to ensure effective multidisciplinary team working, with specialist support.
There were effective processes in place for gaining patient consent for treatment.
Patients were treated with respect and compassion.
Nursing staff gave patients adequate time to ask questions and provided written information regarding patients’ conditions, treatment plans and support networks.
Nursing staff provided patients with information and contact details of support networks, which included the Kidney Patients’ Association and Citizens Advice Bureau.
There was evidence that senior leaders were accessible and responsive.
The unit had effective systems in place to monitor risk and quality.
There were however areas where the trust should consider making improvements. These included:
- It should ensure patients and staff use personal protective equipment in accordance with the unit’s infection, prevention and control procedures.
- The trust should ensure the labels on sharps bins are fully completed to ensure the traceability of each container and stored securely.
- It should ensure fire evacuation procedures displayed on the wall provide instructions to staff on actions staff should take in regards to patients that were attached to dialysis machines.
- The trust should ensure that recording of patient competence is complete and the patients’ progress and level of competence is clearly documented.
- It should ensure managers are able to appropriately supervise and support staff at all times.
England’s Chief Inspector of Hospitals, Professor Ted Baker, said:
“During our inspection of the Mary Rankin Dialysis Unit we found patients had been left for short periods of time. There was though, no evidence that patients had been harmed prior to our inspection. However, there was an unnecessary risk at these times."
“On the day of the inspection the Royal Free London NHS Foundation Trust, which runs the service, took immediate action to ensure that at all times there were two clinical staff including a nurse looking after patients.”
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