Involuntary discharge of a patient receiving hemodialysis.

摘要

Involuntary discharge of a patient on hemodialysis is a "lose-lose" situation. The patient is always put in a life-threatening situation, and the team that discharged the patient has to admit failure to resolve the conflict. After 26 years of practicing in nephrology, I finally met my match and gave a patient his "marching papers." After multiple discussions with the patient, action plans, filed complaint forms, care plan meetings, quality improvement (QI) initiatives, and corporate documentation, we were not making progress with the behavior at hand, and direct patient care staff were angry. We requested the medical director's intervention (who the patient had fired) and held two conferences with the licensed master social worker (LMSW), implemented a behavior contract, and even had one conference call monitored by our End Stage Renal Disease (ESRD) Network without success. This patient had left two other clinics and been discharged from a nursing home as a result of his behavior.