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Involuntary Discharge (IVD)

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Network 7, 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 7 at 813.383.1530, 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.

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: Alternative Strategies to Address Behaviors

This article discusses solutions providers can take to work more effectively with difficult and special needs patients while maintaining compliance with the ESRD Federal Regulations.

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Involuntary Discharge (IVD) Guidelines and Checklist

Use these guidelines and IVD checklist when considering IVD for one of your patients. The checklist must be completed and returned to the Network within two business days of an IVD being completed.

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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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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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Professionalism in the Dialysis Facility

This presentation, which is part of the 5-Diamond Patient Safety Program, helps providers to identify the characteristics and boundaries of proper professionalism, develop an understanding of how professionalism impacts conflict, and offers case scenarios of breaches in professionalism.

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Conflict Resolution Meeting Tip Sheet

This sheet provides helpful tips for resolving patient-provider conflict in the dialysis facility.

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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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