ESRD Network 6 5 Diamond Patient Safety Program

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ESRD Network 65 Diamond Patient Safety Program

• Taking Time Out Working with
• Non-Compliant Patients
• Updated 2/5/09

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Objectives

• Identify the problem of non-compliance in the
  dialysis unit
• Specify the causes for non-compliance
• Identify interventions to address non-compliance

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What is Non-Compliance?

• Failure to conform - failure of a competent adult
  patient and/or staff member to adhere to the
  policies and procedures of the facility

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(No Transcript)
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Involuntary Discharge Survey

• Network 5 - 74 of discharges due to
  non-compliance nationally 49
• Federal regulations
• Ethical considerations

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Reasons for Non-Compliance

• Medical problems
• Technical problems
• Life task
• Transportation
• Patient decisions
• Women - skip more because of technical problems
• Men, younger, HTN - skip more because of life
  tasks
• African Americans skip more because of
  transportation problems

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Reasons for Non-Compliance

• Psychiatric conditions
• Hostility toward authority
• Depression and memory impairment
• Financial problems
• Impaired mobility
• Language/ethnic barriers

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Prevention of Non-Compliance

• Communication
• Active listening
• Istatements
• Non-judgmental
• Set limits
• Be consistent
• Offer positive choices
• Empower - let patients own the problem
• Taking care of yourself

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Prevention of Non-Compliance

• Staff education
• Appropriate use of staff
• Develop written policy and follow consistently
• Establish a committee to review difficult cases
• Ongoing CQI with use of QAPI
• Work to eliminate discomforts caused by dialysis

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Reactions to Non-Compliance

• Team
• CQI/QAPI
• Quantify the problem
• Identify a staff person whom patient trusts
• Determine if a clinical problem contributes to
  the behavior
• Assess whether or not patient understands the
  consequences of non-compliance
• Identify barriers

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Reactions to Non-Compliance

• Patient
• Involve patient and family
• Clear up any differences in expectations, review
  Rights and Responsibilities
• Directly ask patient the reason for
  non-compliance, Externalize the problem - focus
  on the behavior
• Identify any changes that have occurred in
  patients environment
• Clinical
• Psychological/psychiatric

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Reactions to Non-Compliance

• Identify Barriers
• Patients ability to understand
• Socially isolated
• Potential psychiatric diagnosis or substance
  abuse
• Financial problems
• Employment
• Inappropriate treatment modality
• Home care
• Self-care
• Withdrawal

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Reactions to Non-Compliance

• Other things to consider
• Offer peer counseling
• Send letter of concern
• Refer to an ethics committee
• Refer to Adult Protective Services
• Behavior agreement
• Mutual
• Consequences
• Realistic