Clifton Dialysis Unit

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This is the first time we have rated this service. We rated effective as good. Staff assessed people’s health needs and provided good care and treatment with positive care outcomes. They monitored people’s nutritional needs and managed pain relief. Staff worked well together and with service partners for the benefit of people who use the service, They advised people on how to lead healthier lives and supported them to make informed decisions about their care.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People who use the service told us staff carried out an initial assessment, with their involvement, prior to admission to the service. People told us the staff assessed their needs appropriately and took into account clinical needs as well as their preferences, such as transport, social and spiritual needs. People told us staff at the dialysis unit and the renal consultants and dietitians routinely reviewed and discussed their needs and preferences and kept them up to date with their care and treatment.

Staff told us people received a holistic assessment by the commissioning NHS trust and were referred to the dialysis unit if they were assessed as eligible for admission. Staff told us they carried out a detailed admission assessment to identify people’s needs and preferences following referral to the unit. They told us this involved the commissioning trust, people who use the service and their relatives. Staff told us people were re-assessed by the dietitians and renal consultants within the first few weeks of their admission to determine if any treatment changes were required. The renal dietitian told us they routinely reviewed people’s blood results, fluid balance, appetite, family circumstances and any educational needs as part of the dietitian review.

We looked at the care records for 9 people who use the service. The records included details of initial referral and assessment details from the commissioning trust. The initial assessment records included clinical and other information such as primary and renal diagnoses and vascular access type, medical history, prescribed medicines and allergies. Care records included the dialysis treatment plan for each person including prescribed medicines. Staff carried out individual risk assessments and took action to mitigate any risks identified. Records showed risk assessments and care plans were routinely reviewed and discussed with people or their representatives and as part of monthly multidisciplinary team reviews.

People who used the service told us they felt staff were knowledgeable and their dialysis treatment was carried out effectively. They told us staff carried out regular monitoring and observations and that they received good care and treatment. People told us the staff asked them if they had any pain or discomfort during their dialysis treatment and they would act to relieve this if required. People told us they were given clear advice on what to eat and drink prior to dialysis treatments and were offered a hot drink and biscuits as soon as their treatment was completed. They also told us they received regular information and advice from the dietitian.

The staff we spoke with had a good understanding of best practice standards for dialysis treatment. They told us they would seek support from their managers or from the commissioning trust if they needed advice when delivering care and treatment. Managers told us changes to clinical practice, national guidance and policies were reviewed and developed nationally by the corporate provider and cascaded to the service for implementation and shared with staff. Staff told us policies and procedures reflected current guidelines and were easily accessible through the provider’s intranet.

Staff followed the ‘Nephrocare Standard Good Dialysis Care’ guide to provide safe care and treatment for people receiving dialysis treatment. Changes in practice and guidance updates were routinely discussed at staff meetings. Policies, procedures and care pathways were up to date and most of these reflected current national guidelines. Staff monitored people’s pain symptoms and could give prescribed pain relief medicines in line with best practice. People’s nutritional needs were assessed as part of their initial assessment. Staff completed fluid and nutrition charts where needed and provided a hot beverage and biscuits to people after their treatment. Staff and people who use the service could access dietitians for advice and support.

People spoke positively about the way their care and treatment was coordinated. They told us the staff across the service worked well together as a team. They told us they were regularly seen by the dietitians and renal consultants.

Nursing staff told us they had a good relationship with the dietitians and medical staff and could access advice when needed. They told us they received good and timely support from the commissioning trust. Dialysis assistants and healthcare assistants told us they received good support and worked well with the nursing staff and managers. Staff told us they had regularly liaised with other professionals such as vascular access teams, community teams, GP’s and social workers to ensure people received appropriate care and treatment.

The renal matron and consultant from the commissioning trust and dietitian told us they had a positive working relationship with the managers and staff across the dialysis unit. They told us they had routine formal and informal communication with staff to discuss people’s ongoing care needs. The renal matron told us there were link nurses that liaised with the vascular access teams if people were being considered for transplant.

There was effective daily communication between multidisciplinary teams across the service. Staff safety huddles were carried out on a daily basis to ensure all staff had up-to-date information about risks and concerns.

Staff held regular and effective multidisciplinary meetings to discuss people’s care needs and to improve their care and treatment. There were routine staff team meetings that involved staff from the unit. People who use the service had a multidisciplinary team review at least monthly with involvement from the dietitians, renal consultants and the service managers. Staff took part in multidisciplinary meetings involving the NHS vascular access team every three months. Care records showed there was routine input from staff at the unit and other professionals such as dietitians and medical staff from the commissioning trust. Staff also liaised with a number of different services when co-ordinating people’s care and treatment. This included GP’s, social workers, community and palliative nursing teams and palliative care teams. The service also had service level agreements for a number of services such as domestic services and laboratory support.

People who use the service told us they received good support from staff and were provided with verbal and written information around healthier living. They told us they received routine advice and guidance from the staff at the unit.

Staff told us they routinely discussed health promotion and lifestyle choices with people who use the service and they could refer to other healthcare professionals. They provided people with advice on how to refer or gain access to external NHS services, such as for counselling, smoking cessation or alcohol liaison services if required.

The service had a range of information leaflets promoting healthy lifestyles and support readily available on the dialysis unit. Care records showed staff assessed each person’s health needs when admitted to the service and they provided support for any individual needs to live a healthier lifestyle. The dietitians provided advice and support to people in relation to maintaining healthy diets. The provider’s website included detailed information and guidance around healthier living for people and their relatives on living with kidney disease. People could also access online services to help them take care of their physical and mental health.

People spoke positively about the quality of the care and treatment they received. They told us their dialysis treatment plans were effective and they felt better after they had undergone dialysis.

Managers told us they collated and reported outcomes data to the commissioning NHS trust and to the corporate provider on a monthly basis. They told us outcomes data was also reported to relevant national and European registries. Staff told us outcomes data was reviewed to identify improvements by the management team and the commissioning trust.

The service was not eligible for and did not participate in any national clinical audits. The service collated monthly data to monitor the effectiveness of dialysis treatment and to monitor compliance with national standards, such as the Renal Association’s clinical practice guideline standards. Outcomes data was submitted to the commissioning trust for inclusion in its overall submission to the UK Renal Registry. Outcomes for most people who use the service were positive, consistent and met expectations, such as national standards.

People who use the service told us they provided written consent prior to commencing treatment and all the risks and benefits of the dialysis treatment were clearly explained to them. They told us staff explained what they were doing whilst providing treatment and asked for verbal consent during treatment.

Staff told us they had received training in and understood how to obtain informed verbal and written consent from people before providing care or treatment. Staff understood the processes for undertaking mental capacity assessments and best interest decisions where people lacked the capacity to make their own decisions. Staff told us they sought advice from the interim clinic manager, the provider’s safeguarding lead and from staff at the commissioning trust if they needed support and guidance around consent to care and treatment. Staff told us ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) status was reviewed when people were admitted to the service and decisions around DNACPR were made by the consultants at the commissioning trust. The interim clinic manager told us there had not been any instances in the past 12 months where a Deprivation of Liberty Safeguards application had been made.

The provider’s policy for consent to examination or treatment provided guidance to staff on how to obtain consent. People who could not give consent were not routinely referred to the service for treatment. People that lacked the capacity to make their own decisions or those with mental ill health received dialysis treatment at the commissioning trust. Existing service users who developed capacity issues were discussed with the commissioning trust so that a suitable plan for future care could be made. All eligible staff at the service had received mandatory training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Staff clearly recorded consent in the peoples’ records and made sure people consented to treatment based on all the information available. We looked at nine consent records. They all showed that written consent had been obtained and the risks and benefits were documented and clearly explained to people who use the service. People with DNACPR orders were assessed at the commissioning trust and DNACPR forms accompanied people’s records following referral to the dialysis unit. We looked at the DNACPR forms in four care records and these had been appropriately completed.