>If the facility elects to immediately terminate services to a patient, the facility should follow all of the guidelines detailed in FINAL STEPS - THE TERMINATION PROCESS. However, the patient should be notified that the termination is immediate, so no last date of treatment is specified.<
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>ACKNOWLEDGEMENTS: The Renal Network, Inc. gratefully acknowledges assistance from other networks in developing these guidelines, specifically:<
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>1.) Working with Noncompliant and Abusive Patients, Mid-Atlantic Renal Coalition-ESRD Network 5.<
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>2.) Access To Care Position Statement, Southeastern Kidney Council-ESRD Network 6.<
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>3.) A Facility Guide to Termination of Dialysis Services, TransPacific Renal Network-ESRD Network 17.<
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>These resources are available through The Renal Network, Inc.<
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>SAMPLE: NOTICE OF TERMINATION<
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>DIALYIS FACILITY LETTERHEAD<
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>Date:<
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>Patient Name<
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>You are hereby notified that you are being terminated as a dialysis patient at FACILITY NAME. The undersigned physician and FACILITY NAME will no longer provide medical diagnosis, treatment, evaluation, or dialysis services due to your abusive, disrupting or threatening behavior or actions.<
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>The following behavior was exhibited by you:<
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>(LIST DATES AND SPECIFIC BEHAVIOR WHICH OCCURRED ON EACH DATE)<
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>CIRCLE ONE:<
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>You are being terminated immediately because you have endangered the safety of staff or other patients or have threatened physical harm or violence. You must find another physician and dialysis treatment facility immediately. Your failure to do so could endanger your own health. <
>You will be terminated within sixty (60) days from today?s date. You should begin looking for another physician and treatment facility to provide your dialysis care. <
>________________________________________________________<
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>Physician Signature<
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>Physician Name (Printed)<
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>Facility Name <
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>Facility Address <
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>SAMPLE: LETTER OF TERMINATION<
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>Dear PATIENT NAME:<
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>The purpose of this letter is to terminate the physician-patient relationship between us and to inform you that you will no longer be able to receive hemodialysis services at the DIALYSIS FACILITY NAME, effective DATE OF LAST TREATMENT.<
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>This letter is the last step of a process which began on DATE. Over the past SPECIFY TIME PERIOD IN QUESTION you have repeatedly LIST NEGATIVE BEHAVIORS & ACTIONS. I have met with you on at least HOW MANY occasions to discuss the consequences of your behavior. As your physician, it is not possible for me to assume responsibility for your care under such circumstances.<
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>Other patients feel their own safety is at risk. Our social worker has met with you and your family on several occasions to try to come to some agreement as to the conditions under which you would continue to receive treatment and the DIALYSIS FACILITY NAME. A psychiatric or psychological consultation was also recommended, but you refused.<
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>Therefore, I feel I have no choice but to withdraw as your physician, and recommend that you seek medical management elsewhere. I am attaching to this letter a list of nephrologists in the area, and a list of dialysis clinics were you might seek treatment. Our SOCIAL WORKER/HEAD NURSE/OTHER STAFF MEMBER will assist you.<
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>You should understand that when I withdraw from this relationship, the DIALYSIS FACILITY NAME will no longer be legally able to provide dialysis services to you.<
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>I cannot stress enough the importance of your making energetic attempts to find another physician and facility. Your records will be transferred promptly.<
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>Sincerely,<
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>PHYSICIAN SIGNATURE<
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>FACILITY ADMINISTRATOR SIGNATURE<
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>MODEL<
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>AGREEMENT OF EXPECTATIONS/TREATMENT AGREEMENT<
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>PATIENT NAME agrees and understands the following aspects of his/her dialysis treatment at DIALYSIS FACILITY NAME.<
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>1.) Your physician will review your dialysis progress each month. He or she will be available for appointments for other medical problems. If not, staff will explain why he/she is unavailable, and tell you when you can expect to see the physician. If you choose to see your physician in his/her office, it is your responsibility to arrange the appointment.<
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>2.) A dietitian will be available to you every month. If you need to see a dietitian, you may schedule an appointment or talk by telephone.<
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>3.) A social worker will be available to you and your family monthly. If you or your family need your social worker, you may schedule an appointment or consult by telephone.<
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>4.) Facility staff will teach you about your disease and treatment, tests, equipment, medical risks involved with non-compliance with physician orders, risks of infections, and other treatment options.<
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>5.) Facility staff will tell you about changes in your treatment before they are implemented and tell you the reason for the change. You will be informed of your medical condition and response to treatment, as indicated.<
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>6.) Facility staff will provide competent, high quality health care. Staff will treat you with respect and dignity. Staff will not threaten or abuse you with language or actions.<
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>7.) Facility staff will tell you of any procedural changes when you arrive for treatment. Facility staff will provide you with an explanation whenever a change in a procedure is made. You will be informed of possible treatment options and allowed to participate in the decision as to the type of treatment selected for you.<
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>8.) Your facility staff will inform you of the benefits and risks of transplantation. You will be informed of your suitability for a kidney transplant. If you are an interested candidate, you will be further evaluated at the transplant center of your choice.<
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>9.) Your medical records will be treated as confidential and private. Except as required by law and obligations imposed by governmental regulation, permission must be given to you prior to release of your medical information. In the presence of a professional staff, you have access to review or request interpretation of your medical record.<
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>10.) Your dialysis treatment team will create a dialysis care plan for you and update it every 12 months. You will be notified when your care plan is being reviewed. You and/or your family will be offered an opportunity to attend the meeting. This plan will be reviewed with you annually.<
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>11.) You have the right to refuse treatment to the extent permitted by law, and to be fully informed of the consequences of this action. In addition, you will be asked to sign an informed consent or a refusal of treatment forms prior to administration or withdrawal of treatment.<
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>12.) You will be provided with an interpreter or advocate as indicated for language, visual or hearing problems.<
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>13.) Facility staff will not discriminated against you based on age, sex, race, or medical disease.<
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>14.) You will receive regular statements from the business office. You are encouraged to telephone or make appointments with representatives of the business office to answer any questions you may have about dialysis related charges.<
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>15.) You can ask questions or file a grievance without fear of retaliation from facility staff.<
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>16.) You may be offered the opportunity to participate in experimental research, however, your participation should be strictly on a volunteer basis.<
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>For In-Center Hemodialysis Patients<
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>17.) The dialysis facility staff will assign your days and time for treatment, LIST TREATMENTS DAYS AND TIME. On occasion, an unforeseeable event might prevent a machine from being available at the time of your appointment. In which case, you will be given an explanation. A hemodialysis machine will be made available to you as soon as possible.<
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>18.) The NAME OF DIALYSIS FACILITY employs reuse of dialyzers. You will be informed of the reuse process used at the facility and asked to sign an informed consent.<
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>19.) You agree to arrive on time for dialysis treatments and all appointments scheduled with dialysis staff, such as social worker or dietitian, business office, etc. If, on occasion, unforeseeable events prevent you from arriving at your scheduled time for treatment, (or scheduled appointment) you should give a two hour notice to your facility. Your dialysis time or schedule may be changed because of tardiness to avoid interfering with other patients' schedules.<
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>20.) You agree to treat all members of the health care team and other patients with respect and dignity and to refrain from threatening others with your language or actions.<
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>21.) You agree to take responsibility for your illness by following your physician's orders, taking medications as prescribed, and complying with the renal diet.<
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>22.) You agree to ask questions about any part of your illness or treatment that you do not clearly understand.<
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>23.) You agree to participate in the annual review of your treatment with facility staff.<
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> The Renal Network - 911 E. 86th Street, Suite 202, Indianapolis IN 46240<
>For more information call 317-257-8265 (phone) or 317-257-8291 (fax) or <
>Email to: info@nw9.esrd.net and info@nw10.esrd.net <
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>This website adheres to the CMS Privacy Policy for all
owsers <
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Finding Information
Joined: 19 Jul 2003
Posts: 1
Posted: Sat Jul 19, 2003 5:03 am Post subject: Even more on Dumping
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Here is even more information:<
> <
> Restore Menus ESRD Network 9/10 Privacy Policy <
>Home -> Network Policies -> Recommendations for Termination of Dialysis Services <
> <
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> Recommendations for Termination of Dialysis Services <
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>THE RENAL NETWORK, INC.? <
>Legal Review Complete 2/99<
>MRB Approved 2/10/99<
>Board of Trustees Approved 3/23/99<
>Recommendations<
>For Termination of Dialysis Services <
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>INTRODUCTION: Terminating services to a chronic dialysis patient is a serious step which should not be undertaken lightly, and only when all other steps have failed. There are legal, medical, and ethical considerations to be explored.<
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>Dialysis professionals, along with others in health care, are responsible for taking care of all patients in their charge, some of whom may be unusual, difficult, unpleasant, or even dangerous. By the same token, facility managers and medical directors have a responsibility to protect their staff and patients, and assure their safety.<
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>Dialysis staff should be trained to deal with difficult patients, and how to defuse potentially explosive situations. Training should be available to staff members by experts in the field.<
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>Psychiatrists, psychologists, mediators, law enforcement, legal counsel, and clinical social workers are just some of the resources that might be utilized. Dialysis staff must act in a consistent manner and support each other to carry out the decisions taken. Problem patients can exploit or manipulate inconsistent behaviors.<
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>BEHAVIORAL CONTRACTS: Prior to the decision to terminate services, steps should be taken to counsel the patient on his or her unacceptable behavior. Behavioral contracts can be used to define problems and state expected solutions, for both the patient and the facility staff. The behavioral contract should be a written document containing the following:<
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> A clear definition of the problem behavior and why it is unacceptable.<
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> The expectation for improvement of the patient's behavior.<
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> Responsibilities of the dialysis staff to the patient.<
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> Timelines for improvement.<
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> Actions which will be taken if the timelines are not met.<
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> A statement that the patient's continued negative behavior will cause the dialysis facility to begin termination of treatment process against him or her, and at what time this process will begin.<
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>When setting out timelines, a minimum of 30 days should be allowed for the behavior to improve, separate from any notice of termination of services.<
