Note for non cooperative patient

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Asking for Preferences

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For dialysis he is not ready to sit for 1 more hour

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Finding Sources

Here's a nursing/dialysis unit note you can use to document a patient who is uncooperative and unwilling to continue sitting for the remaining hour of a hemodialysis session. Fill in the bracketed fields as applicable.

DIALYSIS NURSING NOTE - PATIENT NON-COMPLIANCE / EARLY TERMINATION REQUEST

Date: [] Time: [] Patient Name/ID: [] Dialysis unit/bed: []

Session details: Patient started hemodialysis at [time], prescribed session duration [e.g., 4 hours]. At [time], approximately [X hours] into the session with [1 hour] remaining, patient became restless/agitated and verbalized unwillingness to continue sitting for the dialysis machine for the remaining duration.

Reason stated by patient: [e.g., fatigue, discomfort at access site, cramping, boredom/restlessness, anxiety, family/work commitment - specify]

Assessment at time of incident:

Vital signs: BP [/] mmHg, HR [] bpm, RR [], SpO2 []%, Temp []
Patient alert and oriented x [3], no acute distress noted / [describe if distressed]
Access site (AVF/graft/catheter) intact, no bleeding, no signs of infiltration
Ultrafiltration/fluid removed so far: [] L of prescribed [] L
No signs of hypotension, hypoglycemia, or cramping noted at present / [describe if present]

Nursing intervention:

Patient counseled regarding the risks of discontinuing dialysis before the prescribed time is completed, including inadequate solute/toxin clearance, incomplete fluid removal (risk of fluid overload, pulmonary edema, hypertension), and electrolyte imbalance (particularly hyperkalemia).
Attempted to reassure and address patient's stated concern ([comfort measures, repositioning, distraction, reassurance provided]).
Patient's caregiver/family member [present/contacted] and involved in counseling.

Physician/Nephrologist notified: Dr. [__________] at [time], informed of patient's refusal to continue treatment. Orders received: [continue with close monitoring / reduce ultrafiltration rate / terminate early and reschedule / other].

Outcome: ☐ Patient agreed to continue after counseling, session resumed at [time] and completed as prescribed. ☐ Patient continued to refuse; dialysis terminated early at [time] after completing [X] of [Y] hours. Post-dialysis vitals: BP [/], HR [__]. Patient stable at time of discharge from unit. ☐ Patient/family signed "Discontinuation of Treatment Against Medical Advice" form (attached/on file).

Plan:

Nephrologist to review labs (K+, urea reduction ratio) prior to next session and adjust prescription/schedule if indicated.
Next dialysis session scheduled for [date/time]; earlier missed time to be made up if possible.
Patient education reinforced on importance of completing full prescribed dialysis time to avoid complications of under-dialysis.
Social work/psychology referral considered if non-adherence is recurrent.

Documented by: [Nurse/Tech name, designation] Signature: [__________]

Clinically, this matters because cutting a hemodialysis session short reduces the Kt/V (dialysis adequacy) and can leave the patient fluid-overloaded and hyperkalemic - both flagged as risks in nephrology literature when dialysis time is shortened or delivery is inadequate. If this is a recurring behavior, it's worth documenting as a pattern and looping in the nephrologist and possibly a renal social worker to address the underlying cause (anxiety, access discomfort, dialysis fatigue, or psychosocial stressors) rather than just charting each incident in isolation.

Let me know if you want this adapted into your facility's specific EMR/note format, or if you'd like a shorter version for quick charting.

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