Opinions wanted
Joined: 28 Apr 2003
Posts: 2
Posted: Thu Nov 20, 2003 6:54 am Post subject: OUR TAX DOLLARS AT WORK/NEW DISMISSAL POLICY
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This is a random ESRD Network definitions of "dismissal".and Staff Behaviors. THIS IS THE ANSWER TO ALL PATIENT DISMISSALS<
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>Introduction: The purpose of these materials is to provide dialysis staff with definitions<
>and descriptions of typical non-conforming ehaviors, and group them into<
>at-risk categories. If utilized correctly, staf can apply the interventions<
>or make the response that is appropriate to the situation. Equally<
>importantly, they can avoid over-responding or wrongful termination of<
>medical services.<
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>At Risk Categories<
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>1. Behaviors, physical or non-physical, acts or omissions by a patient that result in placing the patient?s own health, safety and well being at risk. (This is generally referred to as nonconforming medical behavior).<
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>Examples: Signing out against medical advice, refusing assistance in ambulation or use of a wheelchair, refusal to have vital signs taken per facility protocols, refusal of saline for hypotension, shortening or not appearing for treatment as prescribed, interfering with the dialysis prescription or its delivery, failure to follow diet or medication orders.<
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>2. Behaviors, actions or inactions by patients or staff that are perceived to put the safe and efficient operations of the facility at risk.<
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>Examples: Disruptive, attention seeking, or acting out behaviors, and/or failure to conform with or adhere to facility policies and procedures.<
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>3. Behaviors, actions or inactions by patients or staff that are perceived to place health, safety or well being of others at risk. Others includes patients, staff, families, and other persons on the facility premises.<
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>Examples: Abuse, physical/verbal assault, battery, dangerous acts, intimidation, threats, sexual harassment, disorderly conduct.<
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>Definitions and Descriptions<
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>Abuse: A patient or staff member who intentionally uses physical or non-physical actions or gestures as tools to intimidate, punish, frighten or manipulate others.<
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>Examples: Using obscene gesture, using fist or body in a threatening manner.<
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>Abuse, Verbal: A patient or staff member who intentionally uses language to intimidate frighten, or cause discomfort or emotional distress.<
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>Examples: Name-calling, shouting, use of obscenities, and use of disparaging remarks.<
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>Assault: A patient or staff member who uses or threatens force with the intent to harm or intimidate, that produces in someone the perception of imminent harm.<
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>Patient Examples: Misusing medical equipment with the intent to harm, the use of blood or bodily fluids as a weapon,
andishing other objects as weapons.<
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>Note: This term should not be confused with battery, which is unwanted physical contact with another.<
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>Staff Example: Insertion of needles against patient?s will, performing a procedure without patient?s consent.<
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>Attention-Seeking Behavior: (Also known as acting-out behavior.) A patient or staff member who uses negative behaviors or uses the expression of negative emotions to get attention. These behaviors are frequently manifested through overt or latent behaviors rather than words. <
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>Patient Examples: Showing up late and/or early for and demanding dialysis, demeaning remarks about the staff or clinic to other patients, refusal to let staff take vital signs.<
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>Staff Examples: Failure to comply with English only policies, ignoring alarms or requests, inappropriate language.<
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>Dangerous Acts: Behavior or acts by a patient or staff member, able or likely to cause physical injury or pain.<
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>Patient Examples: Bringing weapons into a dialysis facility, patient with an infectious disease uses bodily fluids to threaten others.<
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>Staff Examples: Being under the influence of any substance, which impairs judgment or performance, assigning ill-trained or ill-prepared staff to perform tasks, which performed improperly, could cause injury or illness to patient, using poorly maintained or functioning equipment.<
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>Disorderly Conduct: Repetitive and persistent patterns of behaviors by staff or patients in which the rights and safety of others are violated.<
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>Patient and/or Staff Examples: Verbal abuse, acting out, disruptions, intimidation, aggression, threats and sexual harassment.<
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>Disruptive: A patient or staff member whose behavior interferes with the orderly conduct of dialysis clinic activities.<
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>Patient Examples: Causing excessive noise; interfering with or manipulating dialysis machines; unauthorized entry into restricted areas; altercation, destruction or removal of medical records.<
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>Staff Examples: Verbal or physical altercations with other staff, patients or patient?s family.<
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>Failure to Conform: (Replaces the phrase noncompliant behavior.) Failure of a competent adult patient and/or staff member to adhere to the policies and procedures of the facility.<
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>Patient Examples: Interference with treatment of other patients, not cooperating with reimbursement requirements, unreasonable refusal to be treated by a particular staff member.<
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>Staff Examples: Unreasonable refusal to care for a particular patient, refusal to enforce policies and procedures, unauthorized manipulation or change to a prescribed treatment or physician?s order.<
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>Intimidation: A patient or staff member who uses verbal, physical or psychological methods or power to instill fear, obtain submission, obtain something of importance, or to prevent another from doing or not doing something.<
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>Patient Examples: Knowingly making unfounded allegations of racial discrimination, medical negligence, and violations of state and federal regulations; threatening a lawsuit or contacting regulatory agencies; retaliation to staff or other patients; using physical presence, size or body language to instill fear.<
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>Staff Examples: Threatening retaliation against patients who file grievances or complaints or assert their rights.<
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>Sexual Harassment: Verbal or physical harassment by a patient or staff member of a sexual nature.<
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>Patient and/or Staff Examples: Inappropriate touching, lewd remarks, masturbation, sexual jokes<
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>Threats: Behaviors or actions used by patients or staff that communicate intent to inflict harm or the fear of harm on others.<
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>Patient and/or Staff Examples: Verbal statements, physical actions or gestures that convey intent to commit harm, references to possession of or access to weapons with the intent to intimidate.<
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>This is what your behavior is rated from.What happens to the staff member? The ESRD Network has no say over staff members behavior. <
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laba
Joined: 10 Nov 2003
Posts: 2
Posted: Thu Nov 20, 2003 8:04 am Post subject: say what
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I WOULD LOVE TO SEE THIS POSTED IN A CANCER FACILITY! THEIR AUDIENCES ARE NOT CAPTIVE AND HAVE CHOICES!<
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>SOUNDS GOOD ON PAPER, AS IT ALL DOES,BUT IT IS THE SAME OLD SAME OLD.<
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>iF ITS NOT CARRIED OUT IT IS MEANINGLESS .ONCE AGAIN THE FACILITY DETERMINES THE DEFINITION OF NON-COMPLIANCE! <
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>THIS IS THE CRAZIEST THAT I HAVE HEARD YET! BUT WHAT HAS BEEN RATIONAL WITH THE ESRD NETWORKS! NOW THEY ARE GOING TO GO AFTER STAFF,THAT SUCKS!<
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> MAYBE THE NETWORK WILL BE MORE SUPPORTED OF DISMISSED STAFF, THAN THEIR TRACK RECORD WITH THE PATIENTS.<
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>ONCE AGAIN IT IS THE PATIENTS FAULT WITH NO SAFETY NET!
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What
Joined: 13 Feb 2003
Posts: 11
Posted: Thu Nov 20, 2003 8:06 am Post subject: I DID NOT HELP WITH
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the spelling of their article of behavioral issues....smile!<
>Arlene
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OOPS
Joined: 20 Nov 2003
Posts: 1
Posted: Thu Nov 20, 2003 8:09 am Post subject: did it again
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I did not help with the spelling in the posted article. Smile again!
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leadsag
Joined: 31 Oct 2002
Posts: 263
Posted: Thu Nov 20, 2003 8:56 am Post subject: Re: did it again
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The one I like the best is....<
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>Intimidation: Patient Examples: ... threatening a lawsuit or contacting regulatory agencies; ....<
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>Staff Examples: Threatening retaliation against patients who file grievances or complaints or assert their rights.<
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>SOmething is wrong in the unit but if we contact regulatory agencies that is intimidation!!!!<
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>The staff at my unit would be in violation of this anytime you mention anything to them!!!<
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Disgusted
Joined: 26 Jan 2003
Posts: 45
Posted: Thu Nov 20, 2003 10:11 am Post subject: Leadsag's post
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When I read that one it blew my mind also. This is to try and keep the patient that has a complaint quiet so that the other patient's will not be aware they have any right's when they have a complaint.
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Educated myself
Joined: 20 Nov 2003
Posts: 1
Posted: Thu Nov 20, 2003 12:22 pm Post subject: This would make me look like a nut!
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> refusal of saline for hypotension.. interfering with the dialysis prescription or its delivery.. <<
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>My doctor doesn't give me the correct tx Rx. For ex., he sets my dry weight and then thinks it's set in stone. The techs are trained to
ing me back to my assigned dry weight no matter how much weight I've gained or lost. Well that never works and throws the whole tx off. <
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>They treat me like I'm a disrupter, because I don't do what most of the other patients do - just blindly follow the doctor. Then they want to dump saline in me. <
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>There are many other things I've learned about the tx that my staff doesn't do correctly or know how to do at all. So, naturally I speak up and say what I would like done. <
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>So, then they battle for taking part in my tx. According to the paragraph quoted, I would be considered non conforming, because I want my tx. done professionally and with my input as the patient. <
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>I read in the AAKP magazine that the patient should be the quarterback of the healthcare team (doctor is the coach). But according to the Network's definition, I'm non-conforming. <
>In this document, the Network has correctly named many abuses, but they don't seem to realistically understand what actually goes on in the units and why so many things are not as they seem. The main harrassment comes from crooked unit policies and inadequately educated staff. Patients react, rightly so, to the inequity and dismissive attiudes of their rights! <
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FRN
Joined: 24 Feb 2003
Posts: 25
Posted: Thu Nov 20, 2003 2:50 pm Post subject: Now Arlene......
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Honey I can tell it wasn't you who wrote that! I know your writing anywhere so if you need someone to vouch for you, I will. <
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>As to the ESRD going after "staf" (staff), they couldn't help the patients before with their complaints or problems and as Arlene and I well know, they have their own problems with their own staff behaving and responding in inappropriate ways. They have no jurisdiction over any staff working in dialysis units so who do they think they are to try to go after staff? It's the companies who dictate and set the standards for staff behavior, not the ESRD Networks! Though I must admit that at times I thought that many "staf" out there had learned their behaviors from the ESRD "staf". Hum...!<
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>Grasping at straws? Wonder why they are acting so scared? It's a bit late to try to turn their record around! D">
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Fri Nov 21, 2003 3:00 am Post subject: Big problems
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I have more than a few problems with this! After reading over the criteria realize at one time I could have fit in the "mold".<
>I have pkd, which staff wasn't really all too familiar with. When I started dialsysis they insisted on taking fluid off and insisted it was in my best interest and medically necessary; it wasn't! I was gaining weight, didn't need any fluid removed, and in addition have a peculiar quirk for a dialysis pt. in that during tx. I can't hold onto fluids. They would tell me not to worry, if we take off too much we can give you back saline. It doesn't work with me. They repeatedly hooked me up to the Critline telling me even it showed I needed fluid removal. Eventually I put a halt to things. If I hadn't gone against their professional judgements I'd probably be dead right now. A person can only lose so much fluid! So, because as a pt. I listened to my non professional gut feelings about my care I would've been labled a "non compliant" pt.and could've been given the boot. Lin.
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Opinion
Joined: 17 Jan 2003
Posts: 13
Posted: Fri Nov 21, 2003 5:42 am Post subject: BY WHOMS DEFINITION
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The danger here is that the Federal govt has been allowing the dialysis industry to do as they please for over 30 years. Nothing ever questioned and able to perform at a minimum level. Yes at a minimum level with still no standards of care. The governement was alerted in 1998,and it still baffle me that how much information does one
ing the emperor?<
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>No safety net was ever given to the patients and with full knowledge of the industry failures, our Senator did not do anything to protect you the patients. This is the same old stuff that was in the 2000 GAO report? Not one thing was put into place after the 2 year OIG inspection. Now once again we are at election time and the great Grassley is once again spitting in the microphone outraged.<
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>We never expected different from the Senate, as they have been aware of the dumpings and lack of rights in these clinics. That was
ushed over and buried. We have already gone over to the house side and will have safety nets put up.<
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>It appears that the ESRD Networks havent learned. They are still going to dismiss patients at will for non compliance, when the government knows that this is a death sentence. By whoms definition is non compliance? What about the lack of education that one receives in these clinics? I believe that if a patient is advised and educated, they have a choice and with the cutting of treatments, they have done so with full knowledge. They are adults and live with their own actions. I feel that the clinics job is education and to provide life support. But to decide that they will not care for a patient and dismiss them with no neutral enity, is criminal and against the law. Unlike any other health service, this is paid by the majority of tax dollars for service. The government allows them to give minimum service only and the patients have fallen through the cracks because minimum service isnt achieved in the first place. <
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>Until the ESRD Networks are gone, they give out stars and report cards to the clinics that voluntarily send in their sqewed information in the first place. After all they only validate 5% of all information. That is where the danger lies to have the industry policing themselves and allowing the patients to be dismissed and not to help. It appears that the industry tells the government what it will and wont do. I think it is about time that the government makes them accountable. Now they think that they will go after staff? They couldnt even take care of the patients.
