What to do with noncompliant patients???

[traumaRUs, MSN, APRN]

okay guys - you are a wealth of knowledge and i'm here to get some more - lol. we have about 10 of our patients who no call, no show on a regular basis. the company is a large for-profit center that obviously gets paid a lump sum for each pt from medicare. however, i have talked till i'm blue in the face to these patients about the importance of dialysis. i have also approached it from the idea that stopping dialysis is possible too. what kinds of things have your units done to get more patients to come to dialysis? this is a large 130 pts, 32 chair unit in the inner city with a population of indigents including homeless, drug addicts, mentally ill and those that meet the poverty guidelines.

i also have a smaller unit of 15 chairs which has the upscale, compliant population and i only have one person that is frequently no call, no show.

thanks for any hints.

[DeLana_RN, BSN, RN]

Typically, noncompliant patients are not interested in stopping dialysis. The reasons for their noncompliance are simply the many problems in their life - addiction, poverty, etc. They will certainly not be impressed to hear that the center loses $ each time they skip (as I know it does) and I'm sure you wouldn't tell them that anyway.

Perhaps some kind of incentive - I wouldn't want to call it bribe - might help? As for what that could be, I'm at a loss right now... maybe a drawing for a cash prize if you miss less than x% of your tx's. But that would be a bribe... Maybe the clinic social worker could help you with the this, or even the dietician - they often play games with the patients (bingo)and give them small prizes, so they will know what's appropriate.

Best of luck,

DeLana :)

[gwenith, BSN, RN]

Let them have a piece of chocolate during dialysis - If I remember from my days in dialysis chocolate is a no no because of the high K - so maybe??

[traumaRUs, MSN, APRN]

Thanks guys. We have (in the past) provided monetary incentives but that didn't work well (per the staff). We are now in the punitive mode: if you miss too much, then you get the Tue/Thu/Sat second shift. That way our NH patients can still have the Mon/Wed/Fri second shift, our patients who work full-time can have Mon/Wed/Frid third shift and then the rest of our retirees and disabled folks can have the fill-in spots.

[DeLana_RN, BSN, RN]

That sounds like a great incentive! Miss x tx's, lose your spot. I think this would work (and how can they argue with that?)

DeLana :)

[Migrant_Renal_RN]

Document, document, document. We too move all non-com pts to 3rd shift MWF, I have been considering TRS second shift, but my teammates are against this......

[traumaRUs, MSN, APRN]

Thanks everyone.