Eastbourne Kidney Treatment Centre is operated by Diaverum UK Limited. The service has 16 dialysis stations which includes four isolation rooms.

Kidney Treatment Centres offer services which replicate the functions of the kidneys for patients with advanced chronic kidney disease. Haemodialysis is used to provide artificial replacement for lost kidney function.

The centre is on one level and is a purpose built facility for the treatment of chronic kidney failure. The centre has the capacity to dialyze 96 patients however at the time of the inspection 76 patients were receiving treatment. Treatment was delivered across 5 shifts.

The centre operates from Monday to Saturday. On Monday, Wednesday and Friday they operate from 06.30-23.30 pm (3 shifts) and on Tuesday, Thursday and Saturday from 6:30 – 18:30pm.(2 shifts)

Eastbourne Kidney Treatment Centre works closely with Brighton and Sussex University Hospital (BSUH) with weekly visits by the Consultant nephrologists. Monthly multidisciplinary team (MDT’s) meetings take place with the consultant and one of the centre’s senior nurses. The wider multi- disciplinary team include: a counsellor, dieticians, a pharmacist, a transplant nurse, a blood transfusion nurse and the vascular access team who visit at varying times.

Staff within the clinic have direct access to the local commissioning trust data base allowing for ease of access to all relevant patient information and referrals. The Diaverum data base links information with the trust’s database.

The arrangements for emergency patient care e.g. cardiac events are directed via 999 and staff complete the appropriate basic life support training.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 14th June 2017, with an unannounced visit to the centre on 28th 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? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

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:

• There were adequate systems to keep people safe and learn from incidents. Learning from incidents that occurred in other centres was shared. All staff were aware of their roles and responsibilities in ensuring patient safety.
• The environment at the centre was visibly clean and well maintained. There were appropriate measures in place to ensure the spread of infection was prevented.
• There were systems in place to ensure medicines were stored following national guidance. Staff completed competencies according to Diaverum policy to administer medicines correctly.
• There were sufficient nursing staff to ensure patient safety was maintained at all times. Nursing staff had direct access to a consultant who was responsible for patient care. In emergencies, patients were referred directly to BSUH and the emergency services called to complete the transfer.
• Care was planned and delivered in line with current evidence-based guidance, standards, and best practice. Patient outcomes were collected and monitored to improve care. An effective audit programme was in place.
• Patients’ nursing records were secure. Staff had access to all relevant electronic records ensuring patients’ care was planned and not delayed.
•  Patients were monitored and assessed regularly by the nursing and medical staff. Patients and their GP’s were provided with monthly written updates on their condition and treatment plans.
• Staff were aware of their roles and responsibilities to maintain the service in the event of a major incident. Patients were able to continue their treatment at alternative centres.
• Patients nutrition was assessed regularly and patients were referred to appropriate specialist for additional support as necessary.
• There was a comprehensive training and induction programme in place to ensure staff competency.
• Patients were treated with respect and compassion. Staff took care to maintain patient dignity and confidentiality when delivering care and treatment.
• The service met the needs of the local population and the needs of individuals attending the centre.
• There were effective processes in place to monitor risks associated with the service and individual patients. Quality assurance meetings occurred regularly.
• All staff and patients were positive about the service.

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

• The centre should ensure all zipped foam items are inspected regularly and all items are stored off of the floor to allow for effective cleaning.
• There were good effective processes in place for gaining patient consent for treatment.However we identified issues regarding the Do not attempt cardiopulmonary Resusitation orders.
• The Provider should ensure that the resuscitation trolley is not locked in accordance with the Resuscitation Council Guidelines.
• Safeguarding training for children must be implemented in order that staff have a level of awareness should information be disclosed to them.

•     The provider must ensure that Sodium Chloride solution (0.9%) should be prescribed for  use during the dialysis process.

Professor Edward Baker

Deputy Chief Inspector of Hospitals