Davita Greater Charleston Dialysis

“GOV-INVOL DISCHARGE PROCESS REQUIREMENTS CFR(s): 494.180(f)(4) The medical director ensures that no patient is discharged or transferred from the facility unless - (4) The facility has reassessed the patient and determined that the patient’s behavior is disruptive and abusive to the extent that the delivery of care to the patient or the ability of the facility to operate effectively is seriously impaired, in which case the medical director ensures that the patient’s interdisciplinary team- (i) Documents the reassessments, ongoing problems(s), and efforts made to resolve the problem(s), and enters this documentation into the patient’s medical record; (ii) Provides the patient and the local ESRD Network with a 30-day notice of the planned discharge; (iii) Obtains a written physician’s order that must be signed by both the medical director and the patient’s attending physician concurring with the patient’s discharge or transfer from the facility; (iv) Contacts another facility, attempts to place the patient there, and documents that effort; and (v) Notifies the State survey agency of the involuntary transfer or discharge. (5) In the case of immediate severe threats to the health and safety of others, the facility may utilize an abbreviated involuntary discharge procedure. This Standard is not met as evidenced by: 40269 Based on document reviews, medical record review, and staff interviews it was determined the facility failed to notify the ESRD Network and the state agency after a patient was involuntary discharged in one (1) out of one (1) involuntary discharged patient, patient #1. This failure has the potential to negatively impact all patients receiving care from the facility. Findings include: A policy was reviewed titled, “Patient Behavior Agreement, 30 days Discharge, Involuntary Discharge, or Involuntary Transfer,” last reviewed 10/2023. The policy states in part, “...Immediate Severe Threat: 17. If it is determined that a patient will be immediately discharged due to the nature of the threatening behavior (“immediate severe threat”), 30-day patient notice is not required. An immediate severe threat is considered to be a threat of physical harm. For example, if a patient has a gun or a knife or is making credible threats of physical harm, this would be considered an “immediate severe threat”, An angry verbal outburst or verbal abuse is not considered to be an immediate severe threat. 18. In instances of an immediate severe threat, facility teammates may utilize “abbreviated” involuntary discharge or transfer procedures. These abbreviated procedures may include taking immediate protective action such as calling “911” and asking police for assistance. In this scenario, there may not be time or opportunity for re-assessment, intervention, or contact with another facility for possible transfer. 19. After the emergency is addressed and teammates and other patients are safe, teammates must notify the Medical Director, patient ’ s physician, Risk Manager, ROD and DVP, State agency and ESRD Network of the involuntary discharge. Document this notification and the exact nature of the “immediate severe threat” in the patient ’ s electronic health record. The Risk Manager may recommend onsite security for a period of time after the discharge of the patient (mutually agreed upon by Operations and Risk Manager) .....” A medical record review was conducted for Patient #1. The patient began dialysis at this facility on 03/08/24 with a diagnosis of End Stage Renal Disease. The patient had a Tunneled Central Venous Catheter (CVC) access in the right chest. The patient was ordered a treatment duration of four (4) hours, three (3) days a week, Monday, Wednesday and Friday. On 05/03/24 at 2:33 p.m. a “Patient Note” by Emp #2 states, “patient continued to try to hit [Emp #1] while [Emp #1] was trying to take [Patient #1] off the machine. Pt refused to leave south charleston police department notified.” On 05/03/24 at 7:00 p.m. a “Late Entry Note” by Emp #1 states, “Written order for Immediate discharge signed by [Emp #4].” On 05/06/24 at 8:59 a.m., a “Patient Note” by Emp #1 states, “[Emp #4] notified patient via telephone of immediate discharge. Per [Emp #4], patient has requested admission to Dunbar clinic. Davita Guest services notified of patient need for placement.” The patient was sent a “FedEx Priority Overnight” envelope with signature receipt required on 05/03/24. The envelope included a letter describing the details of the discharge, information on how to file a complaint, and a dialysis center listing with names, addresses and phone numbers of other dialysis facilities. No further contact was made by Patient #1 with the facility. An interview was conducted with Emp #1 on 06/11/24 at 2:15 p.m. Regarding Patient #1, Emp #1 states in part, “... decided we should immediately discharge the patient. I called the medical director and explained what had happened and [Emp #4] agreed. After this happened, the next day I called the ESRD network a couple of times. I was dialing extension 2710 and leaving messages. Later I was told that the extension is actually 2705. I called two (2) to three (3) times a day for the whole week. No one ever called me back. I left messages. I told our regional director I couldn’t get a hold of the network. They assumed that someone would eventually call me back. After about a week I gave up. The network contacted me later on 5/29/24. I immediately complied with the request they had for me to fill out the involuntary discharge packet. We didn’t have a packet available, and I didn’t even know how to get one. They gave me the information and I immediately filled it out. I do not regularly have contact with the network, so that’s why I wasn’t sure what to do. Any data we need to send to them is submitted electronically and emails are usually auto-generated with no reply available. There’s no one in particular that I speak to. I do have the contact information now. I thought the network notified the state agency. I didn’t know that we had to do that. This was my first involuntary discharge from any facility I’ve worked at. We really don’t do that ...””