Site Visit Report

Site Visit Report

The aim of the site visit report is to: identify details regarding the site and to assess the site to ensure that 18WS can provide the contracted treatment and services to patients in the safest and most effective way possible. The site report provides a risk assessment of the site in relation to: Quality Planning, Financial, Pre-Assessment, Books, Covid-19 Management, Admissions, Procedure Room, Recovery/Discharge, Administration, Decontamination, Ongoing Communication & Vanguard Mobile Units
Today's date*
MM slash DD slash YYYY
Speciality*
Please specify*
- General Surgery
- ENT
- Gynaecology
- Oral Surgery
- Orthopaedics
- Pre-Operations Assessment
- Urology
- Vascular
Please specify*
- One Stop Cataract Clinic
- Nurse-led Cataract Post-Op
- Cataract Surgery
- Cataract Surgery GA
- Glaucoma Outpatients
- Medical Retina Outpatients
- Laser Outpatients
- Intravitreal Injections
Please specify*
- One Stop Breast Clinic
- MSK Injections
Trust*
Hospital Site (postal address)*
18WS requires a floor plan of the unit which shows fire exits etc. Has this been shared by the Trust?*
- Yes
- No
Name of the person completing the visit for 18WS*

Trust Staff

Trust Staff - Full Name	Role	Email	Phone	Actions

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18 Week Support Staff

18WS Staff - Full Name	Role	Email	Phone	Actions

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Risk Assessment

After the Site Visit has been completed, any issues identified as a potential risk, which need to be resolved prior to the commencement of the contract are listed here. If a virtual tour has been conducted, please send the recording with the completed site visit report

Risk Assessment

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Section 1: General Information
What is the proposed start date?*
MM slash DD slash YYYY
How long is the contract likely to run?*
What number of ENT clinics are proposed for start date?*
Which element of the pathway requires support?*
- Bookings
- Covid Screening
- Pre-assessment
- Procedures
- Decontamination
- Follow Up
- Outpatient clinics
What is the service requirement?*
- Saturday & Sunday Lists
- Monday to Friday Lists
- 7 day/week lists
- Other (please specify)
Other service requirement*
If a weekend only, is it possible to start later on a Saturday to enable staff to travel to site on Saturday morning?*
How many rooms/lists will 18WS be running each day?*
Will the Trust be running lists concurrently with 18 Week Support lists?*
- Yes
- No
Please indicate if Trust Audiology services are running concurrently on the weekend that will limit use of test booths*
What type of procedures will be booked onto the list? Please give examples.*
Has agreement been reached with regards to the inclusion and exclusion criteria? This will typically require clinician involvement*
Have the Lead Clinicians been in contact/corresponded?*
Please click here to view our standard templates for each specialty - Clinical Staffing Templates
Is the generic staffing template suitable for this site?
- Yes
- No
- Other

What alterations should be made?

Role	1 Room	2 Rooms	3 Rooms	4 Rooms	Actions

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Would the Trust consider the use of Advanced Nurse Practitioners?*
- Yes
- No
Is the Trust happy for 18WS to use suitably trained HCAs?*
- Yes
- No
Is the Trust happy for 18WS to book staff who are also employed by the Trust?*
- Yes
- No
18WS shifts typically commence at 0800 am. Is this in line with local start time?*
- Yes
- No
If not, what time will 18WS be required to start?*
What time will the first patient be booked for?*
18 WS require a 30-minute lunch break to be built into the list. Is the Trust happy to do this?*
- Yes
- No
What eating facilities are open over the weekend / out of hours for staff breaks?*
What parking facilities are there for staff? Do they need coins, or can they use contactless?*
How will 18 Week Support staff access the unit?*
Who will be responsible for informing the Trust site manager about this new activity (particularly weekend activity)?*
How will 18WS staff contact the site manager if they need to over the weekend?*
What business continuity arrangements are in place? Is there a business continuity plan? Lack of water, power, IT etc.*
The Trust is required to provide a local Link Nurse to support the clinical activity. Please confirm the Trust is happy to do this*
- Yes
- No
Please specify*
The Trust is required to provide a receptionist to support the clinical activity. Please confirm the Trust is happy to do this.*
- Yes
- No
Please specify*
If there are DNAs/ cancellations, will the team be allowed (within reason) to call patients forward to take advantage of unused slots?*
- Yes
- No
What is the Trust DNA rate?*
What is the Trust’s cancellation rate?*
The Trust is to confirm that no patients under the age of 18 will be included in the service.*
- Confirm
The Trust is to confirm that no patients identified as not having mental capacity will be included in the service*
- Confirm
Will 18WS see Open / Direct Access patients?*
- Yes
- No
Has it been agreed locally which clinician(s) will follow up results?*
Should 18WS clinicians request CT scans, MDT referrals etc if a cancer is found?*
- Yes
- No
Please specify how these specific requests are made to include whether the process is electronic or manual*
Who is responsible for following up histopathology?*
If an 18WS clinician wishes to list a patient for a repeat procedure, is he/she required to complete a request for that repeat procedure on the day or will this request be vetted by the referring consultant?*
Can the Trust confirm that the patient identifier is the NHS number rather than the hospital number (for labelling etc.)*
- NHS Number
- Hospital Number
What is the escalation process for clinical and operational issues for Trust staff?*
What is the escalation process for clinical and operational issues for 18WS staff?*
Please map out the process for OPC/clinics from dictation of letters all the way through to approving them, so that 18WS staff are clear about their specific responsibilities.*
Are there appropriate patient information leaflets available in the department? Or can these be printed from a Trust computer?
- Yes
- No
Section 2: COVID-19 Management
What area of the hospital will the patients be treated in e.g. Green, Amber etc. Please specify*
How will patients be screened for urgency/ vulnerability (to COVID) before their appointment / procedure*
How are patients screened before arrival for symptoms of COVID?*
How are patients screened on arrival for raised temperature and symptoms?*
The Trust must confirm that patients will be informed that they must attend the appointment alone, wearing a mask and that sedated patients must be picked up at the main entrance.*
Will the Trust be providing new, clean masks for patients to wear on arrival?*
How will the adequate supply of PPE be checked?*
What PPE will the room staff require?*
What PPE will other staff require?*
What type of FFP3 mask does the Trust use?*
Is the Trust able to fit test masks for 18WS staff?*
Are there shower facilities on site?*
Who will be documenting that PPE is donned appropriately/doffed appropriately and then disposed of appropriately for each patient?*
How and where will this be documented?*
During Covid – 19, 18WS staff must use Trust scrubs to reduce the risk of infection transmission – will these be available to all staff?*
Please confirm airflow and times as per Trust current guidance*
Section 3: Quality Planning
18WS requests electronic copies of the Trusts policies and nursing documentation as per the list provided.*
- Select All
- Complaints and Incident Reporting Policy
- Chaperone Policy
- Patient Confidentiality Policy
- Operational Policy for the Department
- Specimen Handling Policy
- Copy of TCI Letter
- Copy of Consent Form
- Copy of Care Pathway
- Copy of Post Procedure Discharge Advice/Patient Leaflet
- Copy of Other Relevant Documentation e.g. Drug Chart, Nursing Observation Chart
- Cancer pathway
- Copy of Medicines Management Policy
- Pre Operative Assessment Checklist and Documentation
- Copy of WHO Safety Checklist
- IT/Email Policy and Process
- Complex Polyp Policy (Endoscopy only)
- Decontamination Policy
- Audiology Protocols (ENT only)

Patient of concern report will be left with the Trust Link Nurse and also emailed to the Trust. Trust to specify Names(s) & Email address(es) of staff to receive Patient of Concern Report:

Trust Staff - Full Name	Email	Actions

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Would the Trust lead clinician like to vet consultant CVs and performance data?*
Please document the agreed contract KPIs and how they are going to be measured and reported?*
Are Trust patient satisfaction questions/Friends and family survey in use?*
Is the Trust happy for 18WS to use our patient satisfaction survey (we are very happy to share the results with you if you so wish)?*
Please specify who 18WS should contact in the Trust for quality data relating to this contract? E.g., JAG/Ophthalmology Cataract data etc.*
Are the Trust happy for 18WS to carry out training of their staff whilst undertaking the contract?*
- Yes
- No
Section 4: Governance / Patient Safety / Incidents & Complaints

Please note that 18WS treats NHS patients who are the responsibility of the Trust with whom we are contracted. The Trust is CQC registered, therefore when 18WS staff are treating patients in the Trust, those staff must comply with Trust Policies in relation to clinical protocols, incidents & complaints etc. Therefore, the overall responsibility for managing complaints & incidents relating to patients treated by 18WS fall to the Trust. However, 18WS will gladly contribute towards the investigation of that incident/complaint and identify individual learning, making recommendations where appropriate. 18WS utilise Datix to record incidents and complaints. If an incident occurs then it is the responsibility of the Trust Link Nurse to enter details onto the Trust Safety Management System and the responsibility of the 18WS Nurse in Charge (NIC) to enter details onto the 18WS Datix system
Who will be the contact person for 18WS regarding: • Patient Safety Incidents • Health and safety +/- security / violence & aggression incidents*
Email*
Phone
Incidents
In the event of an incident, please alert 18WS Governance team via the generic inbox: complaints_incidents@18weeksupport.com (complaints underscore incidents). Please do not include patient identifiers in this email. 18WS Governance team will contact the Trust via secure NHS email addresses for the details of the incident and to request the following paperwork: 1) All referrals/procedural records/consent forms/nursing and medical 2) Medical and nursing documentation/discharge paperwork and letters with any radiology reports and images 3) Any discharge/follow up letters. 4) If an SI is declared, then additional details regarding STEIS numbers and deadline dates to be included. A review and investigation can only be commenced upon receipt of the medical records. The clock starts for requested deadline dates when all the medical records and incident details are received. 18WS request that documentation be forwarded within 3 working days from when the Trust was first notified of the incident
Who will be the contact person for 18WS regarding any complaints raised and to whom response will be sent to?*
Email*
Phone
Complaints
In the event of a complaint, please alert 18WS Governance team via the generic inbox: complaints_incidents@18weeksupport.com (complaints underscore incidents). Please do not include patient identifiers in this email. 18WS Governance team will contact the Trust via secure NHS email addresses for the details of the complaint and to request the following paperwork: 1) All referrals/procedural records/consent forms/nursing and medical 2) Medical and nursing documentation/discharge paperwork and letters with any radiology reports and images 3) Any discharge/follow up letters. 4) Please include the PALS or complaint reference with the original complaint A review and investigation can only be commenced upon receipt of the medical records. The clock starts for requested deadline dates when all the medical records and incident details are received. 18WS request that documentation be forwarded within 3 working days from when the Trust was first notified of the incident. (In line with the Complaints process). 18WS do not interface directly with the patient, so ask that the Trust agree to ensure that formal / statutory duty of candour, as required is met at a local Trust level. Who will hold the overall responsibility for this? If the patient/family has additional concerns/questions regarding the incident/complaint please send using any reference number to: complaints_incidents@18weeksupport.com (complaints underscore incidents)*
18WS do not interface directly with the patient, so ask that the Trust agree to ensure that formal / statutory duty of candour, as required is met at a local Trust level. Who will hold the overall responsibility for this? If the patient/family has additional concerns/questions regarding the incident/complaint please send using any reference number to: complaints_incidents@18weeksupport.com (complaints underscore incidents)*
Email*
Phone
Before a final incident or complaint response is sent to a patient, family or the associated CCG, 18WS require a final review and sign off. Who will be the contact person for this process (if different to the Compliant or Incident leads identified above)?*
Email*
Phone
Feedback Reports
Feedback Reports will be shared, monthly by the SDM, to give an overview of learning and actions taken; this will capture all incidents and complaints ‘closed’ within the 18WS Datix system for the previous month. 18WS propose this is added as an agenda item as part of the monthly contract review meetings. Should the Trust be aware of any incident or complaint that requires investigation/input from 18WS that was not escalated / reported to or by them at the time we request these are escalated to the SDM who will ensure they are logged on the 18WS Datix and managed accordingly
How does the Trust oversee and monitor compliance with the actioning and monitoring of safety alerts?
18WS Governance and Patient Safety Team can attend “Ad Hoc” Trust meetings, as required, for any incident or complaint review. In order that 18WS can monitor and act to drive continuous improvements where required, we request that any audit findings related to care / service delivered by 18WS are shared with the Governance team at: complaints_incidents@18weeksupport.com (complaints underscore incidents) Where applicable, 18WS request monthly sharing of JAG results & Ophthalmology Cataract data. Fire: in line with fire standards and H&S regulations 18WS rely upon the Trust ensuring: • 18WS are inducted to the local fire procedure (including number to call) • Fire alarm testing and evacuation • Adequate number of on-site fire marshals As 18Ws are delivering services within the Trust’s site we rely on the Trust ensuring maintenance and upkeep of safety measures in relation to: • PAT testing • Calibration • Equipment maintenance • Electrical Installation Condition Report (EICR), for buildings • Legionella/water temperature testing • Monitoring, action, and compliance of safety alerts
Section 5: IT Administration
What IT Systems will our clinical staff need access to? Please list all the systems and what they are used for*
Who will need access to the system?*
What is the process for getting logins and passwords? Please list all the information required*
Is there any IT form that must be completed for getting the logins and password?*
- Yes
- No
Please specify*
What is the turnaround time for getting IT logins and passwords?*
Who will organise these for 18WS staff?*
Email*
Will the IT details be shared with 18WS to forward to our clinical staff?*
Is IT training requested?*
Can training be done via online training modules? (This is preferable to physical attendance)*
How long does the IT training take?*
Does the trust have an out of hours support for IT at weekends? Who should we contact and how do we contact them?*
What contingency arrangements are in place for failure of trust IT systems?*
Who we can request JAG data from as a download on fortnightly basis? Please provide email and phone number*
Section 6: Ongoing Communication
18WS would like to arrange for a weekly wash-up call following each weekend’s activity. When will this take place?*
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
What time will this take place?*

: Hours

Minutes
Please provide names and email addresses of people who will join the washup calls*
18WS would like to put a schedule of (monthly) Contract Review Meetings in place. When should the first meeting take place?*
MM slash DD slash YYYY
Please provide names and email addresses of people who will join the Contract Review Meetings*
Financial (to be extracted for 18WS Finance and excluded from distributed report)
Who will be the budget holder for the contract and will be able to sign off invoices?*
Who is responsible for raising purchase orders?*
Will purchase orders be raised per clinic/per list or will there be a blanket purchase order?*
Who will be responsible for ensuring 18WS is set up as a supplier?*
Who can we contact in your Informatics team for HRG data? Please provide Name and Email address*
Does the Trust have any agreed discounts/preferred rates with local hotels? What rate/discount has been agreed? Who is the contact?*
The Patient Pathway
Does the Trust require 18WS to provide pre-assessment as part of the service?*
- Yes
- No
When would you like this to commence?*
If so, how many patients require pre-assessing each day?*
How many nurses are required, over how many days?*
Could this be done during the working week?
- Yes
- No
How far in advance of the procedure is pre-assessment undertaken?*
How is this done?*
- Telephone
- Face to face
Please share a copy of the Trust pre-assessment documentation with 18WS*
- Yes
- No
Will there be any other Trust staff working in the pre-assessment facility or close by?*
- Yes
- No
If not please discuss with Link Nurse - arrangement in events of emergency situations including resus, fire etc.
What staffing requirements do the trust have? Does the generic POA template fit*
- Yes
- No
Please specify*
Section 8: Booking
Does the Trust have adequate capacity within the booking team to support this initiative?*
Does the Trust require additional booking support from 18WS?*
- Yes
- No
18WS wishes to exclude patients who lack mental capacity unless there is a relative with documented power of attorney or carer who has access to the Learning Disability Passport. Are these patients likely to be booked at the weekends?*
- Yes
- No
Will transport patients be booked unto 18WS lists?*
- Yes
- No
If yes, please book these patients into AM slots
Are diabetic patients routinely given morning appointments?*
Are diabetic patients given pre-procedure advice with regards to the management of their medication?*
Are patients confirmed for appointment by telephone or letter?*
- Telephone
- Letter
It is 18WS policy that patient relatives should not be used as interpreters for patients. Is language line available or are interpreters booked in advance where necessary?*
- Language line
- Interpreters
Section 9> Admission
Where do patients arrive?*
What time will patients be asked to arrive?*
Is there an examination room for the surgeon to see patients pre-operatively?*
- Yes
- No
What happens upon arrival?*
Is the day surgery unit adjacent to the operating theatre?*
- Yes
- No
How many admission rooms are available for day surgery nurses?*
Will 18WS staff have access to POCT equipment (blood sugar, INR, pregnancy testing & urine dip stick equipment?*
- Yes
- No
Will barcode access be required?*
- Yes
- No
If yes, can the Link Nurse facilitate testing until 18WS staff are set up with barcodes?*
- Yes
- No
Are manual and electronic BP machines available? BM machines?*
- Yes
- No
Are patient property bags/baskets provided?*
- Yes
- No
Are non-latex gloves / disposables available?*
- Yes
- No
Describe the patient journey throughout the department*
Are dignity shorts available?*
- Yes
- No
Are patient property bags/baskets provided?*
- Yes
- No
Where do patients get changed?*
Where do patients get consented?*
Where do patients wait for their procedure?*
Are relatives allowed in the assessment area (post Covid-19 restrictions)?*
- Yes
- No
Are relatives allowed in the ward area?*
- Yes
- No
Are hoists available for patients who cannot mobilise? Trust Link Nurse will always be required to facilitate transfers.*
- Yes
- No
Does the trust use wheelchairs to move patients from day surgery to operating theatres?*
- Yes
- No
Please provide 18WS with the example of*
- Complaints and Incident Reporting Policy
- Duty of Candour Policy
- Chaperone Policy
- Patient Confidentiality Policy
- Operational Policy for the Department
- Specimen Handling Policy
- Copy of TCI Letter
- Copy of Consent Form
- Copy of Care Pathway
- Copy of Post Procedure Discharge Advice/Patient Leaflet
- Copy of Other Relevant Documentation e.g. Drug Chart, Nursing Observation Chart
- Cancer pathway
- Copy of Medicines Management Policy
- Pre Operative Assessment Checklist and Documentation
- Copy of WHO Safety Checklist
- IT/Email Policy and Process
- Complex Polyp Policy (Endoscopy only)
- Decontamination Policy (Endoscopy only)
Where is the cardiac arrest trolley / emergency intubation trolley etc. kept?*
Whose responsibility is it to check this equipment at the beginning of the shift?*
- Trust
- 18WS
What is the process for getting a patient admitted if there are concerns?*
Section 10: Recovery/Discharge
Is there a separate male and female recovery?*
- Yes
- No
How many trolleys in each?*
Can they be used interchangeably depending on mix of sexes?*
- Yes
- No
Will the linen stores be well stocked?*
How can 18WS order more linen?*
Where do patients get changed back into civilian clothes?*
Is there a designated discharge room?*
- Yes
- No
18WS normal policy (before Covid-19) is to have a relative present if patients have received sedation. Is this in line with local policy?*
- Yes
- No
18WS policy is to always have consultant led discharge for suspected cancer cases. Is this in line with local policy?
- Yes
- No
Should 18WS commence treatment for new diagnosis?*
- Yes
- No
Are FP10s available or local prescription?*
Where is pharmacy? When is Pharmacy open?*
Is there a room for bad news/ counselling?*
- Yes
- No
What discharge information is to be given to patients?*
- Copy of consent
- Report
- Who to contact for post-op advice
- Other
Please specify*
Will there be any restriction on driving for patients receiving Entonox / local sedation?*
- Yes
- No
What is the sedation policy?*
- 12-hour care post-sedation
- 24-hour care post-sedation
Do patients need to check out with reception before they leave the department?*
- Yes
- No
Section 11: Decontamination
Does the Trust require 18WS to provide decontamination services?*
- Yes
- No
Section 11: Specific Requirements
What specific service does the Trust require?*
- Clinic
- Minor Ops/Surgery
Where will the clinics be held?*
How many clinic rooms are in the department?*
How many waiting areas and how many seats per waiting area?*
How many clinics will 18WS run each day?*
Is there a private space for the nurse in charge to work / talk privately with patients?*
Which rooms will be allocated to 18WS?*
What dermatology clinics are available? i.e. Acne, hair, patch testing, etc.*
What are the waiting times for each clinic?*
Who leads on each clinic for referral letters?*
How do we access liquid nitrogen/ steroid injections/ what topical medications are readily available on the unit?*
Do clinic rooms have hand washing facilities, couch or chair, room for wheelchairs?
- Yes
- No
Is there a dermatoscope/ alcohol gel/ Sterets for each room?
- Yes
- No
Where will the minor ops lists/surgery take place?*
How many minor ops/procedure rooms in the department?*
How many lists will 18WS run each day?*
Will the trust be running lists concurrently with 18WS?*
Which rooms will be allocated to 18WS?*
Are relatives allowed in the clinical area?*
- Yes
- No
Are rooms spacious and well stocked?*
- Yes
- No
Is the room big enough to take a wheelchair or accommodate larger patients?*
- Yes
- No
Where is the stockroom in relation to the minor ops room?*
Where is the local anaesthetic stored and how do we access it?*
What is the procedure when carrying out a minor procedure?
Where do you log the specimen?*
Where are the specimens stored?*
Do we call porters for each specimen or are there specific times they collect samples?*
What provision is there for doing split skin grafts. Is the equipment available?*
Is bipolar available? Is it disposable leads or ones which need sterilising? If latter, what is the process for CSSD?*
Where is the cardiac arrest trolley kept?*
Will the local nurse check the cardiac arrest trolley or should 18WS?*
- Local Nurse
- 18WS
Are emergency teams available at weekends. What is the process for an emergency? please provide the number to call
What TTOs will patients be given?*
What will they have to purchase themselves?*
Where is the pharmacy located?*
What hours is this open over the weekend?*
Can you please share your Dermatology Formulary with 18WS?*
- Yes
- No
For surgical activity, can 18WS issue antibiotics to take home from within the department if pharmacy is closed?*
- Yes
- No
What is the process to getting a patient admitted if there are concerns?
Is there a separate anaesthetic room?*
- Yes
- No
Are patients allowed to be induced in the operating theatre?*
- Yes
- No
Is there specialist equipment available to transfer unconscious patients from the anaesthetic room to the theatre table?*
- Yes
- No
What transfer methods are used?*
- Pat slide
- Canvas
- Sliding Sheet
- Other
Please specify*
Is a difficult intubation trolley available?*
- Yes
- No
How will the trust ensure that there are sufficient anaesthetic gases and anaesthetic drugs available for the weekend?*
Will enough opioids be available for the weekend?*
- Yes
- No
How will 18WS staff access additional stock over the weekend if required?*
Are O2 cylinders available in the trolleys?*
- Yes
- No
Is there a facility to print recording of intra-operative vital signs?*
- Yes
- No
What airway adjuncts are used when transferring patients to Recovery?*
Will the patient travel a considerable distance from theatres to recovery?*
Is suction equipment available on the trolleys?*
Is a transfer bag used when transferring patients?*
Are there porters available to transfer and collect patients?*
What is the process of patient collection?*
Will a trust ODP be allocated to support the 18WS ODP Team?*
- Yes
- No
How many operating theatres are in the department?*
Is there a specific theatre allocated for the 18WS list?*
Is there a prep room available?*
- Yes
- No
Is CSSD on site or off-site?*
- On Site
- Off-side
Will adequate staff be in place to support the weekend activity?*
- Yes
- No
Are there enough surgical sets to support the surgical template?*
- Yes
- No
Where will surgical sets be held/collected from?*
Is there a WHO safety checklist in use? Is this paper based or on the IT?*
What diathermy machine is used?*
Will Botox be available for Urology cases?*
- Yes
- No
Will adequate irrigation fluids be available for weekend activity?*
- Yes
- No
Is the theatre register hard copy or on-line?*
- Hard Copy
- On-line
How many C-arms are available for theatre?*
Will entry passes and badges be available to staff?*
- Yes
- No
Is there a separate male and female recovery?*
- Yes
- No
How many bays in total?*
What documentation system is used in recovery?*
- Paper
- Electronic
If electronic access fails, will paper documentation versions be available or acceptable?*
- Yes
- No
What type of patient trolley is used in the department?*
- Electric
- Manual
Where are the trolley stored or charged?*
Are porters available to transport patients?*
- Yes
- No
What is the patient monitoring system in recovery?*
- Capnography
- ECG monitoring
Are vital signs recording printable?*
- Yes
- No
What analgesia is available for recovery?*
What opioids are available?*
What is the protocol for administering opioids?*
Are opioids diluted?*
What is the prescription and administration documentation system?*
- Electronic
- Paper
How do we get access?*
What oral analgesia is available in Recovery?*
Will sufficient stock be available for weekend activity: Analgesia, opioids, IV fluids, TTOs etc?*
- Yes
- No
Will sufficient O2, CO2 and anaesthetic vapourisers be available for weekend activity?*
- Yes
- No
How will 18WS staff access additional drug/fluid stock over the weekend if required?*
Will a trust recovery member of staff be allocated to support the Recovery Team?*
Will sufficient stock be available for weekend activity: Analgesia, opioids, IV fluids, TTOs etc?*
- Yes
- No
Will sufficient stock be available for weekend activity: Analgesia, opioids, IV fluids, TTOs etc?*
- Yes
- No
Is there a resuscitation trolley in recovery?*
- Yes
- No
Who is responsible for checking them?*
Is there an anaesthetic machine specifically used for malignant hyperthermia?*
- Yes
- No
Who is responsible for checking them?*
What pain scoring system is used?*
What is the emergency call out system?*
Is there a resuscitation team for the hospital?*
- Yes
- No
What is the escalation process for patients deteriorating condition once the surgical team has left?*
Is there a surgical on call team to support us?*
- Yes
- No
How do we organise a bed if a patient requires hospital admission overnight?*
Which of the following are available?*
- Select All
- Warming devices
- Thermometers
- Capnography
- SCD and Flowtron boots
- Portable suction
What types of airway adjuncts are available*
- T-bags
- Mapleson
What is the process for managing dirt and soiled linen?*
What is the process for managing clinical waste?*
What analgesia is available for the wards?*
Will the trust provide porters to transfer patients from the recovery area to the ward?*
- Yes
- No
What will the handover process be between the 18WS Co-ordinator and the hospital staff?*
Who will have the CD Keys? T*
- Trust Link Nurse
- 18WS Co-ordinator
Is every room equipped with Slit-Lamps and a Snellen Chart?*
- Yes
- No
- Other
How many Tonometers are available?*
How many I Care or Tonopens are available?*
How many Ishirahara books are available?*
How many indirect ophthalmoscopes are available?*
How many Pachymeteres are available?*
How many OCT machines are available (are they linked)?*
How many V. fields are available (are they linked)?*
How many auto-refractors are available?*
How many focimeters are available?*
Are manual and electronic BP machines available in the clinic?*
- Yes
- No
- Other
What system does the trust use to document patients notes or to generate discharge letters?*
Does the trust require 18WS consultants to sign the discharge letter when sending to the GP especially for dictated notes?*
- Yes
- No
- Other
Will the 18WS team be carrying out intravitreal injections for AMD?*
- Yes
- No
- Other
Will 18WS team be carrying out FFA?*
- Yes
- No
- Other
Will 18WS team be carrying out minor surgeries on the clinic day?*
- Yes
- No
- Other
What type of Argon and Yag laser machines does the trust you have?*
- Yes
- No
- Other
Are intravitreal drugs available onsite?*
- Yes
- No
- Other
Will all the topical drops be available over the weekend?*
- Yes
- No
- Other
Are patients pre-assessed?*
- Yes
- No
How far in advance is this done?*
Confirm that all new patients for cataract surgery have face to face pre-assessment*
- Confirm
How many patients will be booked for the pre-assessment cataract clinic?*
Are auto-refractor and focimeters available in the pre-assessment clinic?*
- Yes
- No
What type of biometry machine will be available?*
What type of A scan will be available?*
Are manual and electronic BP machines available in the pre-assessment clinic? BM machines?*
- Yes
- No
Where will the pre-assessment nurse be working from?*
When would you like pre-assessment to commence?*
Please provide a copy of all pre-assessment documentation*
- Confirm
What drops do Trusts give pre and post-operatively?*
Can the Trust confirm that Mydrane will be used during COVID period?*
- Confirm
Is there a prep room available in the theatre?*
- Yes
- No
What type of Phaco machine is available in the operating theatre?*
What type of operating microscope is available?*
What type of IOL is available?*
What IOL power is available in the Trust IOL bank?*
Is a 3-piece IOL available?*
- Yes
- No
Are vitrectomy and sub-tenon sets available?*
- Yes
- No
What consumables are available?*
Are Aprokam and Gentamicin available in theatres?*
- Yes
- No
How many weeks post-op do patients come back for follow up?*
Who is the contact person if patients have post op complications?*
What consumables are available?*
Will the generic x-ray local rules be provided in advance of attendance?*
- Yes
- No
How would the trust like 18WS’s recorded reading/acceptance of the rules?*
Are room specific rules displayed in all rooms using radiation?*
- Yes
- No
What make and model of x-ray equipment will staff be expected to use?*
Are equipment doses Audited and doses within National Diagnostic Reference Levels?*
- Yes
- No
Is all equipment maintained and QA completed regularly in line with IRMER guidance?*
- Yes
- No
Does the trust have all required PPE for staff undertaking procedures involving ionising radiation, including Lead Coats, Eye Protection and lead shielding?*
- Yes
- No
Which radiology information system (RIS) and picture archiving computer system (PACS) does the trust use?*
Will staff be provided access to radiology information system (RIS) and picture archiving computer system (PACS)?*
- Yes
- No
How will staff record patient dose and examination information post procedure?*
Who will act as ‘practitioner’ should staff have queries regarding requests or patients who have unexpected findings and who may require further imaging?*
What is the Trust’s policy for injection of iodinated contrast? Please provide for review before attendance*
Does the trust have a process for patients who experience a contrast reaction or become unwell during a radiological procedure? Please provide for review before attendance*
- Yes
- No
Does the trust have a process for patients who experience an extravasation? Please provide for review before attendance*
- Yes
- No
Does the Trust have a process for recording doses to Comforters and Carers? Please provide for review before attendance.*
- Yes
- No
Equipment available for use by 18WS*
- Select All
- Endovenous Packs
- Oscher Hooks
- Radio Frequecy or Lazer
- 60+ catheters
- 2 Infusion pumps
- Skin Glue
Dressings (non-sterile) available for use by 18WS*
- Select All
- Class 2 stockings
- Big Jelonel (2 of each per leg)
- Softban (2 of each per leg)
- Crepe (2 of each per leg)
- Coban (2 of each per leg)
Section 12: Vanguard - Mobile Units
Is this contract a Mobile Unit*
- Yes
- No
Will the Trust provide CD drugs on a daily basis for 18WS staff?*
- Yes
- No
Will a Link Nurse be available remotely to ask questions if required?*
- Yes
- No
What’s the make, model of equipment in the unit?*
What’s the process for stocking and restocking prior to launch?*
What’s the induction and training plan prior to launch?*
Does the unit have a waiting area for patients?*
- Yes
- No
What is the process for patients?*
Any other comments?

Site Visit Report

Risk Assessment

Section 1: General Information

Section 2: COVID-19 Management

Section 3: Quality Planning

Section 4: Governance / Patient Safety / Incidents & Complaints

Section 5: IT Administration

Section 6: Ongoing Communication

Financial (to be extracted for 18WS Finance and excluded from distributed report)

The Patient Pathway

If not please discuss with Link Nurse - arrangement in events of emergency situations including resus, fire etc.

Section 8: Booking

If yes, please book these patients into AM slots

Section 9> Admission

Section 10: Recovery/Discharge

Section 11: Decontamination

Section 11: Specific Requirements

Section 12: Vanguard - Mobile Units

18 Week Support

London

Birmingham

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