New clinic issues. What can I do in this situation?

[*kana*]

Hello,
Just switched clinics and having some issues with the nurse and not sure if I am just being over sensitive about the forcefulness.

We moved back in December and amongst the move, I lost my December flow sheet.  Well, today I was told that that was 1 strike against me and I had 2 more strikes and then I would be out.  Out meaning I would be forced off of PD and on Hemo for non compliance.   
Mind you, all my levels(protein, K, Phos, KT/V, fluids) are within normal range.  I have never missed my treatments, appointments etc.
She also got all pissy with me because I don't record my temperatures everyday and told me if I missed them that would also be a strike against me.  I've been on PD for 2.3 years and never was I made to record these, so I'm getting used doing them and have missed a few here and there. 
I understand why they need the flow sheets etc, but threatening me like a child and scaring me by threatening Hemo is beyond what I call appropriate.

My other petty issue........ 

My other clinic had blood draws the first Tues of the month and clinic days the last Tuesday of the month.  This clinic just calls me up and tells me to come in next week at 1pm for blood and then they give me a clinic date on my blood draw day.  I have no idea what day of the week it will fall so can't plan anything for that week. 

This month they scheduled Clinic the day after Easter and I am going home to be with my family.  I also have a vascular appointment that I made 3 mths ago in my home town.  Do I drive 4hrs to go to clinic/Nephrologist for the 2 min he spends with me or do I just skip clinic and get another strike against me?  I tried calling his private office to see if I could get in the office(not clinic) another day, but not sure if that will work out or not.  I'm going to call my regional dialysis nurse and see what she has to say.

Do most clinics have a set day every month for lab draws and clinic? 


Any advice as to what I should do? 
     

[Jie]

The nurse probably is a nut. I had never measured my temperatures. It is waste of time to do it since if one has fever, she or he will feel it and if no feeling it, one should not measure it. For the flow sheet, I mean daily recording sheet. To deal with such a nurse, just make up another one to hand it to her, so that the first strike is removed.   

[*kana*]

Thanks!

Seriously, can they really force me to go on Hemo for something like this?

I honestly lost Decembers sheet..........however............

I admit that I was fantastic about getting up, taking my BP, jumping on the scale and then recording it.  After about 2 years of PD I have become a bit more laid back about it and record most (95%) days, but not all.  Does anyone else cheat a little on those sheets or am I a big loser?  I know when my weight is up, I know when my diastolic bp is too low etc.  It is never high anymore and if it were high, I am super sensitive to a slightly elevated number. 

I am looking into getting a new clinic because this just isn't working out for me.  I can't hate my nurse and I am starting to.   

[M3Riddler]

Thanks!

Seriously, can they really force me to go on Hemo for something like this?

I honestly lost Decembers sheet..........however............

I admit that I was fantastic about getting up, taking my BP, jumping on the scale and then recording it.  After about 2 years of PD I have become a bit more laid back about it and record most (95%) days, but not all.  Does anyone else cheat a little on those sheets or am I a big loser?  I know when my weight is up, I know when my diastolic bp is too low etc.  It is never high anymore and if it were high, I am super sensitive to a slightly elevated number. 

I am looking into getting a new clinic because this just isn't working out for me.  I can't hate my nurse and I am starting to.   

Kana,

Dont worry about a think.. Especially coming from a nurse.. They cannot force you on another modality of dialysis. Especially for mis placing flow sheets. It happens all the time.  There is no strike system in place with dialysis.   A nurse ccannot kick you off of dialysis. And they would not kick you off to another modality, the very least they could do is ask you to go to another clinic.  If it doesnt come out of the nephrologists or administrators mouth, then do not take it seriously.
The nurse is probably saying this just to put some fear into you, so you do not misplace the flowsheets. But some things are just out of our control when we have a lot going on....  Know your rights.....Next time she says you have a strike, ask to see the policy that says there are 3 strikes...

///M3R

[greg10]

Correct me if I am wrong, but flow sheet is how the nurse or FA does the Medicare billing - which is a big deal because that is primarily how the facility gets paid.  Doing PD, you seem to have only one sheet per month, while doing home HD, generally a full flow sheet is done every session, with 22 or more sessions per month, with generally 40 to 50 entries in each session sheet covering BP, blood flow, access and dialysate flow measurements every half hour, drug infusions, access conditions and patient vitals, including temperature before and after dialysis.

Do try to make a copy of the flow sheet, either just take a picture of it with your digital camera/phone or use a scanner so that you have an extra copy.

As to temperature readings, do try to take it seriously because that is often how you determine an onset of infection which is unfortunately all too common with PD and HD.  Body temperature readings can be done quickly using some of newer infra red scanning thermometers, many available for $30 to $50:

http://www.amazon.com/Kidz-Med-11900-VeraTemp-Non-Contact-Thermometer/dp/B003YUFG8Y
http://www.amazon.com/Exergen-Temporal-Scanner-Infrared-Thermometer/dp/B0015TIZGQ

[Meinuk]

The best thing that you can do is have an open and honest communication with your nurse.  If you feel that she is being threatening to your treatment, and that you are not communicating well with her, follow your units grievance procedure.  DO NOT let them brand you as non-compliant.

Now, about flow sheets, and why they are important.  Not only are they used for billing, they are a part of your medical record (which is a LEGAL Document).  Your medical records can and may be audited by the State Survey Agency when they inspect your unit.  Your training nurse could be cited and potentially lose her job if her records are sloppy or incomplete.  Part of the kickback of the lobby to make dialysis units safer is that those caring for us need to tow the line.  (this is in OUR best interest) even though it can be annoying, it needs to be done.

This is an outline of a basic Dialysis Unit Inspection (State Inspection):
http://www.ipro.org/index/cms-filesystem-action/esrd/OutlineESRDSurveyProcess.pdf

Here is a brief idea of what the State is looking at when they inspect a unit:
http://www.ipro.org/index/cms-filesystem-action/esrd/1-mat-17.pdf

Oh, and as I modified this to fix a typo, I saw JBeany's post just below.  mmm fudge... I've had some of that while I was on dialysis   

[jbeany]

You're soooo not the only one to fudge results on a hand in sheet - nope! 

I've always been a bit lax about recording my blood sugar. It mattered more, of course, when I was still on insulin, before the pancreas transplant, but still, if I was checking and taking action to adjust it as needed, what difference did it make if I wrote it down? I take it every day, so if it's high for more than a reading or two, I'm all over it, and start writing it down every time to track the trends and figure out what changed.  I don't need a doc to tell me when it was too high or too low over the last month, I was there when I checked it.  What am I going to do with that information now?  Keep track of what days I went out to eat and had too many carbs? 

As long as I've checked and it's normal, though, then, no, I don't care if I write it down.   The only thing the doc ever cared about was my A1c anyhow, which was usually under 6.  I had one doc who would get all upset and insist I write it all down for a month, but when I took it in to her, she barely even glanced at, so why was I wasting my time?  For the space of time I was stuck with her, I'd just thumb back once in a while when I had time while I was writing one in, and fill in the blanks with a random number. 

To me, it doesn't make any more sense than writing down the temperature outside every day.  If I checked it and wore the appropriate jacket, why do I need to know what it was 3 months from now?

If you need records to give the nurse that bad, I could have sent you a boxes full of them when I dumped my grandmother's hoard.  My gram wrote hers down with every meal, and what she was planning to eat.  For years.   

[Rerun]

I'd make up shit.  97.6F is a good temp.  OMG.... NO she can't force you to do anything.  Next time tell her that you will just quit dialysis all together if she pushes you too far.  AND you will tell everyone why you have decided to quit.  She will back way off.  Not that you will quit.  Tell you doctor the next time you see him about this nurse's idol threats.

You go through enough you don't need this crap!       

[*kana*]

Thank you for the replies!

I have decided that she has gotten to strike three with ME......so I am taking my prized insurance money somewhere else, but first I need to report her behavior in two tactful ways.  I am going to call the clinic manager and ask for the written 3 strike policy that I am being threatened with.  I am going to talk with the doctor about this nurse.  They did give me an appointment at the office so I can go home to be with my family. 

I hardly ever get upset about things, but for some reason this has just gotten to me and made me feel like a bad person.  It actually made me weepy all day and that is just crazy because I NEVER cry.        

Thanks again for the support! 

[*kana*]

Correct me if I am wrong, but flow sheet is how the nurse or FA does the Medicare billing

Does it matter that I dont have Medicare?

[jbeany]

Well, maybe not, but when the nurse starts whining that she has to have have it for the billing, you can snap that answer right back at her!

[greg10]

Correct me if I am wrong, but flow sheet is how the nurse or FA does the Medicare billing

Does it matter that I dont have Medicare?

As you know, sooner or later in the US, Medicare becomes the primary and the insurance company becomes the secondary.  You can only switch clinics so many times and hopefully it is for better reasons than not keeping a proper flow sheet.  Making up flow sheet data only works so long until you get sick and you try to find out what really went wrong - sometimes the data does tell you something about the state of your health.

[cookie2008]

My flow sheets go into my medical binder, when I go in for my monthly checkup the doctor looks over them.  I am on nxstage home hemo.

[Jie]

At least for private insurance, the flow sheet is not needed for billing from my clinic. I have not turned in my last flow sheet, yet my clinic has gotten the money from my insurance. I usually turned in every three months, and it did not affect the billing at all. My nurse told me that the reason they need them is Medicare may audit them from time to time, so they need to have them in the record.

[*kana*]

Thank you for more info and support. 

I woke up this morning and realized what was really upsetting me about this whole thing.

I need to retain control of my life and she is violating that part of me.  As we all know, going on dialysis and being dependant on some stranger takes a lot of that away.   I would be switching clinics based on the fact that this nurses job is to help keep me alive.  I don't like her one bit, so I can't place her on that level therfore it would be detrimental to my own health because I wont go to her if I need help.  I had that feeling when I first met her, but tried to like her and just let our personality issues go.
   

 

[Lillupie]

Not trying to sound stupid here but will someone please, please explain to me what a flow sheet is. Is it the sheet that You record your bp and weight? Im on PD, and I really hate to admit it, but i have not done that sheet in years, and neither has many people in my clinic. Usually once I do get up, I end up in such a hurry to take care of something I usually forget it. so, i have been wayyy laxed on it. But my labs have been perfect. When I travel I dont carry a scale with me, so I wont take my weight when I leave town.
 I know my doctor has asked for them a few times. I hate to admit this too. But i have been on dialysis for soo long now, for like 4 years and I am sooo tired of it that Im just so used to skipping the recordings I dont think I can go back to doing those on a daily basis. They cant make us do those, and when I did make a point to do the blood pressure in the morning and weight id forget to bring them in.

If I were you Kana, id look to going to another clinic. Some of them are more relaxed then others. That would be the last day someone would tell me that I might have to go to hemo. I utterly refuse to go to hemo. Physcially I have been fine without the recordings of temp, blood pressures, and weight on a daily basis. i mean I get their reasoning. If my labs were bad, I was constantly retaining water, getting dyhdrated constatly, had an extreme decrease in appeptite (sp), then they probably would say something to me. The truth of the matter is, you could do it and lie about it, WHICH is NOT a good idea, not suggesting anyone lie, someone who despises being forced to fill that our every single day after doing it for years, yeah I could see someone lying just to shut the nurses up about it. and to keep from being forced to go on hemo.

I utterly, utterly, refuse to go on hemo. No offense to those on hemo. Been there done that.
And no thank you

Lisa
p.s. let me know what happens.

[*kana*]

Thank you all for your replies!

Lisa,
Yes, the flow sheets are where you record your bp, wieght, temp etc.  I just got a new machine and can use the IQstick.  Didn't work on my last machine.
THANK YOU so much for admitting all of that.  I totally understand and agree with you on labs, weight etc being great so why
be forced to write all that crap.  I know how I feel and when things get out of whack, which rarely happens. 

Just a hint......don't ever go to the clinic in Dundee.  lol
We are in Ypsi now and I am thinking about going to the clinic in Livonia. 
You are at UofM, right?