Late patients

Specialties Urology

Published

Our dialysis unit has been struggling to find a way to deal with a few of our patients who are chronically late. We run 2 shifts, so if they are late for first shift, the patient who follows them has to wait, and if they are late for second shift, the closing staff has to stay late. Sometimes these patients are half to an hour late. Our director doesn't want to cut their time, so that isn't an option (it would probably seem to be a reward to some of them!) Does anyone have any suggestions on dealing with this?

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Specializes in PACU, pre/postoperative, ortho.

Have you talked to the pt about how being late sets everything else off?

Have you tried calling at 15 minutes late? After a few phone calls, maybe they'll get a clue & realize being late is unacceptable. From working in an office, we had some regulars that were never there on time. Often we would schedule accordingly, say 1:00 to the pt knowing full well it would be 1:30 before they showed & could slip another person in that spot if needed (of course in this case you couldn't just slip another dialysis pt in). And if they showed on time for once, then they could wait on you. If it was for another type of appt, I'd be telling them they have to be rescheduled but for dialysis? Yeah that puts you in a tough spot.

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Specializes in Med surge, ob,pediatrics,GYN,dialysis,ER.

Consistancy with cutting or not cutting time is important as well. Geography of the clinic is important too. Our clinic culture over time is one that the patients know we are the only hemodialysis unit within 380 miles, so we have to deal with it...we had them sign contracts/promise to be on time, however it doesn't last for long. My suggestion? Be consistent and everyone at the facility be on the same page: if your going to cut it for one, cut it for everyone...when there labs look horrible and out of goal, good documentation with attempts to reeducate are very important from a moral and legal standpoint:)

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At IU, patients are treated as adults, not as infants or babies. You might want to try to treat them as people, instead of cattle. Over 90 percent of dialysis personnel stated that they could not live as they demand as others live, does that not tell you something?

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The labs look horrible, because not enough dialysis is being given, setting patients up to fail. How do you expect someone to function with only 12 hours per week of dialysis, is not enough. The body is not made to work according the current dialysis regime.... Remove 48 hours of fluid and eating in 4 hours, you have to be joking. This is a standard of care you would not accept for yourself or your families..... If you were giving enough dialysis, you would not have these terrible lab results. I know, it is always the patient's fault, I know. The very bare minimum should be Nocturnal, 4 days per week..... In addition, dialysis should be a bridge to a transplant, not an endless revenue stream.

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The labs look horrible because not enough dialysis is being given, setting patients up to fail. How do you expect someone to function with only 12 hours per week of dialysis, is not enough. The body is not made to work according the current dialysis regime.... Remove 48 hours of fluid and eating in 4 hours, you have to be joking. This is a standard of care you would not accept for yourself or your families..... If you were giving enough dialysis, you would not have these terrible lab results. I know, it is always the patient's fault, I know. The very bare minimum should be Nocturnal, 4 days per week..... In addition, dialysis should be a bridge to a transplant, not an endless revenue stream.[/quote']

What exactly does this have to do with trying to get patients to treat those around them with courtesy and respect? I do not get to choose how much dialysis my patients get, so why do you try to hold the nurses responsible? You should be going after Medicare, not the nurses.

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Specializes in Nephrology, Dialysis, Plasmapheresis.
At IU patients are treated as adults, not as infants or babies. You might want to try to treat them as people, instead of cattle. Over 90 percent of dialysis personnel stated that they could not live as they demand as others live, does that not tell you something?[/quote']

We cannot change the rules, just as you can't. I don't blame people for living their lives as best they can, even if they sometimes have a potato, a piece of chocolate, or cut their treatment short bc they just can't take it today. Please understand that most of us nurses are doing the best we can considering the conditions and time constraints. It's true that it's not fair to the second shift patient who is delayed 45 minutes of their previous time bc the first person is always late. We are talking chronic lateness. If you have been made to feel like you are being treated as a child or ignorant, I am sorry, but we are not all the same. I cannot help that during the monthly meetings, I am asked why so and so was 15 minutes late getting on the machine. Or why I had 30 minutes of overtime and that is not acceptable. Just like many jobs in today's world, we are doing the best we can with limited resources. The person on the receiving end suffers and the middleman gets blamed. We are the middleman and are trying our best to make this awful situation tolerable and maybe even have a few smiles.

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Specializes in Med surge, ob,pediatrics,GYN,dialysis,ER.

Amen.

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Most Nursing individuals are highly intelligent and when my RN mom went to Nursing school, it was extremely difficult. Therefore, I would think that most Nursing individuals would know and realize that the standard dialysis treatments are not enough for the average dialysis patient to be successful. No, I do not condone any dialysis individual being 30 minutes late consistently for a treatment. If I were a patient rep, I would be on their case before you lecture them. :) I do love Nursing people very dearly and I think Nurses are very intelligent. No, if the individual in question is 15-30 minutes late for a treatment, it is the fault of the patient, if it is on a consistent basis, not the Nursing staff. Yes, I have worked in the real world and I know clearly about the obsession with overtime. No, I really do not blame the Nursing staff, I blame idiots who have set standards with no basis in reality. I think patient reps are a great idea, because they are credible where you cannot be credible. Yes, I know what it is like to feel awful, yet, that does not entitle you to make life difficult for your fellow patients or the nursing staff. I know and realize that all nurses are not the same, they are clearly not. However, you have to realize that not everyone on dialysis is the same, we are individuals as well.

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Specializes in ICU.

We cut hours. Anywhere else in our hospital, if you are late for your appointment, you lose your appointment.

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You need to be able to cut times when patients are Non-Compliant with their scheduled appt. times. It's in the best interest of the clinic as a whole. Your manger needs to discuss this issue at length with your Medical Director. If he continues to refuse perhaps he would agree to a patient contract that gives 3 strikes before a patient gets moved to second shift- at least that way second shift patients won't be punished for first shift patients decision to be late.

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Specializes in Dialysis.

My medical director puts them on a behavioral contracts. If they do not meet the standards laid out in the contract my Medical Director terminates them from his practice. No MD to cover the patient leads the dialysis unit to having to involuntary discharge the patient. This only happen once in my unit after numerous intervention by CCHTs, RNS, SW, MDs did not work. I hated that it came to this, but we all have responsibilities as adults and there are consequences for not meeting one's responsibility. It was amazing that after this happen all the over late/no show patient started coming to treatment. It goes to show when most of us are held accountable we meet the responsibilities that are handed to us.

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