Davita Lansing Home Training (Pd)

“PR-RESPECT & DIGNITY CFR(s): 494.70(a)(1) The patient has the right to- (1) Respect, dignity, and recognition of his or her individuality and personal needs, and sensitivity to his or her psychological needs and ability to cope with ESRD This Standard is not met as evidenced by: 15195 Based on interview and record review, 1 (#1) of 7 patients was not treated with respect and dignity by the home peritoneal dialysis nurse, resulting in the potential for less than optimal outcomes. Findings include: Medical record review revealed that patient #1 was a 79-year-old female with a diagnosis of end stage renal disease (ESRD) secondary to diabetes mellitus. The patient was admitted to the facility’s home peritoneal dialysis (PD) program on 10/26/22. The last clinic laboratory blood draws done were dated 8/9/23 and 10/4/23. The patient had orders for dialysis four times a day, then three times a day. The patient agreed to do peritoneal dialysis at least two times a day and she refused the cycler. The December 2022 patient flow sheets submitted revealed that she only did one treatment a day. Review of the facility Grievance Log revealed that the patient had multiple complaints/grievances in 2023, one of which was that the PD nurse swore in the presence of the patient on 7/21/23. The nurse immediately apologized, stepped out of the room, and the facility administrator (FA) nurse took over the meeting. The Medical Director was made aware of the incident. The patient was offered a different nurse but declined. On 4/5/24 at approximately 1400, phone interview with patient #1 revealed that the PD Nurse C “used the F bomb” (F**k) when arguing about what she was doing and not doing with her peritoneal dialysis. On 4/10/24 at approximately 0900, interview with the facility administrator (FA) verified that nurse C used the “F bomb” in the patient room and both the FA and social worker were in the room. The FA stated that the patient was getting very aggressive with Nurse C. The nurse apologized to the patient and stepped out of the room. The FA who was also a nurse continued the meeting and attended to the patient for a couple of months after the incident. The nurse was also verbally counseled. On 4/10/24 at 10:30, interview with Nurse C, verified that she used the “F**k word.” The nurse couldn’t remember exactly what she stated, but something to the effect of ’...you are telling me to “F**k the policies and procedures.’ Nurse C stated that she apologized and hasn’t used swear words with any other patient. Nurse C also stated that she became very frustrated because the patient refused to come in for lab draws, missed clinic days, and refused to do her treatments as prescribed. On 4/10/24 at 1100, interview with the Social Worker revealed that the patient was not complying with home peritoneal dialysis. She stated that the facility staff tried to support her but it was not safe for her to continue in the home program due to her non-compliance. The Social Worker also stated that the patient was depressed and refused transportation services for in-center program. On 4/10/24 at 1130, interview with the Medical Director revealed that he was the patient’s Nephrologist. He stated that the patient was very non-compliant. She had not done her prescribed peritoneal dialysis at home. She did not come to the clinic for assessments or lab draws. The Medical Director was made aware of the swear word incident right after it occurred, and stated frustration levels were high. Review of the facility policy and procedure titled “Patient Rights, #3-01-07A, dated revised 10/21” documented, “Your Rights as A Patient... #3. To be treated with (i) respect, dignity, and recognition of my individuality, choices, strengths, abilities, cultural values, religious beliefs and personal needs, to the extent possible during treatment; and (ii) sensitivity to my psychological needs and ability to cope with ESRD.””