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Involuntary Discharge

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Network 17, on behalf of the Centers for Medicare & Medicaid Services (CMS), wants to make sure that all patients have access to dialysis care in an outpatient setting. No facility takes lightly the involuntary discharge of a patient. Challenging patient situations are often the result of unresolved issues involving both the patient and staff, where each has an expected responsibility.

In the unlikely event that your facility is faced with making a decision about involuntarily discharging a patient, you must abide by the parameters set forth in the Conditions for Coverage. You should also call Network 17 at 415.897.2400, regarding the issuance of a 30-day notice or immediate involuntary discharge.  All your efforts need to be documented in the patient’s medical record.

The Safety is No Joking Matter poster highlights the importance of safety in your facility and that comments and actions are taken seriously. The poster is available in both English and Spanish.

English letter size (8.5 x11)
English tabloid size (11 x 17)
Spanish letter size (8.5 x11)
Spanish tabloid size (11 x 17) 


Addressing Abusive Behaviors in the Dialysis Center

This document looks at some of the specific underlying causes of conflict that could possibly lead to abusive behaviors and methods for overcoming them.

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Can You Ever Be Discharged from Dialysis?

This document designed for use with patients outlines the situations in which a patient can be involuntarily discharged from his or her dialysis facility.

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Can You Ever Be Discharged from Dialysis? (Spanish)

This document designed for use with patients outlines the situations in which a patient can be involuntarily discharged from his or her dialysis facility.

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Involuntary Discharge Process and Checklist

This document provides an overview of the guidelines for involuntary discharges (IVDs) and a checklist to ensure proper documentation of an IVD to the Network.

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Conflict Resolution Tip Sheet

This Conflict Resolution Tip Sheet  provides useful suggestions for dealing with conflict rather than avoiding it.

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Managing Patients' Challenges at Dialysis

This presentation by  Kristin Kuntz, Ph.D., Assistant Clinical Professor of Psychiatry at Ohio State University, provides an overview of the psychological challenges of dialysis and identifies interventions to support patients’ mental health. 

 

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Decreasing Dialysis Patient-Provider Conflict Toolkit

The goal of the Decreasing Dialysis Patient-Provider Conflict (DPC) initiative is to provide the dialysis community with resources to manage and decrease conflict. The DPC Toolkit provides resources to help staff involved in the daily operations of the dialysis clinic to better understand, respond to, and decrease conflict.

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Universal Behavioral Precautions: Techniques of Verbal De-escalation

This PowerPoint presentation:

  • Helps facilities to recognize situations that impact potential verbal and physical abuse by a patient or visitor toward staff.
  • Provides tools to help facilities de-escalate potentially volatile situations.

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Dialysis Facility Compare

Find and compare Medicare-certified dialysis facilities and get information about chronic kidney disease, dialysis and transplants.

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Behavioral Agreements - Things to Consider

This document outlines what a behavioral agreement is and items to consider when utilizing them in the dialysis facility.

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When Patients Don't Come to Dialysis

This document outlines some of the reasons a patient may miss their dialysis treatments, and suggested interventions to help combat these barriers.

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IVDs: V-Tags and Interpretive Guidance

This document is an excerpt from the CMS ESRD Surveyor Training Interpretive Guidance (version 1.1) that highlights information regarding involuntary discharge.

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Information and Recommendations for Challenging Dialysis Placements

This document provides information and recommendations related to placing dialysis patients who do not have an assigned dialysis facility.

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Working Together to Address Challenging patient Behaviors and Prevent Involuntary Discharge

This presentation:

  • Reviews the End Stage Renal Disease (ESRD) Conditions for Coverage pertaining to involuntary discharge (IVD).
  • Increases awareness of risk factors that place patients at risk for IVD.
  • Identifies resources and approaches to manage challenging situations.

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