What do you do when a patient refuses treatment and wants to go home?

Nurses General Nursing

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Hi all.

I've only come across this incident once, last week as a nursing student. I had a patient who had a wound that was stitched. 2 different doctors worked with the patient. one said told the patient that they need to stay for further treatment and the other said the wound looks fine and they can go home.

eventually we had them sign papers so they could leave. the patient was stabled, wound healed really nice too.

my question is, what if a patient is being hospitalized for like a stroke, heart attack, something serious like that, and they refuse any further treatment after being hospitalized for days?

some may refuse because of financial issues. I would think maybe getting social work involved, PT, OT, dietician, etc. but isn't the cost for home health care MORE than being hospitalized? because its by the hour, who's visiting, how often they're visiting, etc?

as an advocate, that is what I would do, get social work involved, PT, OT if they're going to have issues getting around and financial issues. but I don't know much about that stuff (what to do if patients refuse further treatment and just want to go home). I'm not going to convince them, but educate them as much as possible and if they still refuse, they could sign papers and idk what else from there?

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Yes they can go home. Everyone competent has a right to refuse care. Forcing one against their whish will land in jail for false imprisonment, assault and battery. You will destroy your financial future after losing that multi million dollar lawsuit

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Yes they can go home. Everyone competent has a right to refuse care. Forcing one against their whish will land in jail for false imprisonment, assault and battery. You will destroy your financial future after losing that multi million dollar lawsuit

I am already aware of that. thank you

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Specializes in Critical Care; Cardiac; Professional Development.

You can assess why they want to leave. I read a story of a gentleman who felt he needed to go very badly, to the point of being belligerent. When they finally assessed his reasoning, it was because he had a special needs, bed bound daughter at home who was without care. He was desperate to get back to her. Therefore social work was brought in, the daughter was brought to the hospital and he settled down and accepted care. You will see this kind of panic with pets or elderly parents at home or a debilitated spouse. It can't always be easily solved unfortunately.

With other reasons that cannot be fixed, you inform them they are able to leave AMA (Against Medical Advice). You can inform them that doing so will likely result in none of the claims associated with the ER visit and/or hospitalization being paid by Medicare/insurance. If it is finances making them want to go, this usually results in them staying.

You can bring in social work if you have a clear assessment of the situation and there is something they can help with. Some patients feel this way no matter what...it isn't about the reason, it is about independence or personal philosophy or a million things they may not be able to articulate. In those cases it is their right and you help them get home. You may explore, if they are patient enough, with their physicians whether there are options other than hospitalization.

If they still want to go you bring them the AMA papers to sign, inform their physicians, remove IV and tele just like any other discharge and allow them to leave.

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One of the first things to do is notify the attending physician/provider. Everywhere I've ever worked over the decades, allowing someone to leave AMA would not be a decision that would be made unilaterally by an RN. The physician has a right/duty to make a determination (or perhaps already has an opinion) about whether the individual has the mental capacity to make an informed decision to refuse treatment and/or leave. Or the physician may want to request a psychiatric evaluation to determine capacity.

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One of the first things to do is notify the attending physician/provider. Everywhere I've ever worked over the decades, allowing someone to leave AMA would not be a decision that would be made unilaterally by an RN. The physician has a right/duty to make a determination (or perhaps already has an opinion) about whether the individual has the mental capacity to make an informed decision to refuse treatment and/or leave. Or the physician may want to request a psychiatric evaluation to determine capacity.

Shaky ground here.

The RN may not unilaterally decide, but the patient sure can.

Unless the patient has already been deemed not competent, there is no choice but to allow them to leave.

Sure, you can say "You must stay", but then if they up and leave, about all you can do is say "Bye bye".

Here is a weird one- If a patient becomes apneic after a lethal dose of narcotics, We give narcan. They wake up and decide to go home. We explain that the drugs that stopped them from breathing will still be in their system, when the narcan wears off. They can say, "Well, I am not going to die. I am heading home to do just a bit more heroin." And, they are free to go. Despite the obvious lethality of their actions, they are free to go.

On the other hand, somebody takes 15 tylenol, then posts it on the World Wide Web so an ambulance will show up lights and sirens and there will be much drama. Despite the non-lehtality of the action, they will be held against their will.

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I've read on other similar posts that if a patient signs an AMA form insurance won't cover their hospital bill. Not 100% sure if it's true? Health insurance is such a crazy upside down and backwards mess!

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Unless the patient has already been deemed not competent, there is no choice but to allow them to leave.

In my experience, it would be up to the physician to make a determination about whether it is appropriate to detain someone in order for an assessment of her/his capacity to choose to leave AMA to be done. The attending physician may be comfortable that the person has the capacity to make that decision, the physician may feel that the person lacks the capacity to make an informed decision about leaving and can therefore be detained against her/his will, or the physician may want the person detained long enough for a determination about capacity to be made.

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In the ER, I have patient's leave AMA all the time. It really depends on the reason.

1) Some leave because they want to go to a different hospital, but the ambulance brought them to Local Community ER, and now they're stable enough to get a ride to BIG NAME HOSPITAL

2) They are not from the area and don't want to stay. I had a woman who came in for a medication refill, was found to be in the 70s on pulse ox, without oxygen, being admitted for hypoxia. Signed AMA and as she left was back in the 70s on room air/pulse ox. But she was competent and left AMA.

3) They don't want treatment. I had an 82 year old who came in from a SNF who had refused dialysis for a week, refused all work up and associated treatment in the ER, and just wanted to go back to SNF because he was ready to die. Not suicidal but just tired of the dialysis and everything else. Mental health deemed him competent and he was able to go back to his SNF to die.

ETC. A lot leave AMA because they're tired of the wait in the ER and just want to leave, even without a dx.

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In my experience, it would be up to the physician to make a determination about whether it is appropriate to detain someone in order for an assessment of her/his capacity to choose to leave AMA to be done. The attending physician may be comfortable that the person has the capacity to make that decision, the physician may feel that the person lacks the capacity to make an informed decision about leaving and can therefore be detained against her/his will, or the physician may want the person detained long enough for a determination about capacity to be made.

And, that would be the case if the physician is right there, and security is available to stop the patient. Otherwise, there is nothing keeping the patient there while the doc gets paged.

You can tell them whatever you want, and they can still get up and leave.

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Specializes in MCH,NICU,NNsy,Educ,Village Nursing.

OP---please use proper capitalization in your words, especially the first words of each sentence. I hope you don't chart that way. It is difficult to follow you with no caps. It may seem unimportant, but it is. That being said.....

If someone is adamant about going AMA, there isn't much you can do, for reasons stated by previous posters. A clear explanation of consequences of them doing so is often all you can do. That is one of the sometimes difficult challenges of nursing....leaving people to make their own decisions, even when we know it may to be their detriment.

You stated in one of your responses that you are aware of the risk of being accused of false imprisonment, etc., if the patient is forced to stay. What other things do you think could help "turn it around" for the patient and help them make a better choice than leaving AMA?

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allowing someone to leave AMA would not be a decision that would be made unilaterally by an RN.

Nor is it unilaterally a physician decision. A doc can't force you to detain a pt who is making a cogent decision to leave.

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