AMA safety

[CNSnurse]

Hi everyone,

I recently had a situation that made me feel a little uneasy and I am wondering what other nurses think about patient leaving AMA safely. Patient was signing out AMA due to lack of insurance and was going to the local county hospital immediately from our hospital (worrys about bills they cant pay). The issue I had was that this patient was almost 6'5" 450lbs and ambulated (barely) with a front wheel walker. I searched all over our unit for a bariatric wheelchair to push them to the valet where their ride was waiting. I could NOT locate one fast enough, and the patient was already unsteadily walking down the halls with the walker. When I called for assistance from my charge nurse and other staff, they ALL told me its hospital policy that "we don't help patients who sign out AMA".

WHAT?! I just imagined this patient falling down, hitting their head, getting a subdural hematoma and dying.

Even management told me that since they signed the AMA form, it releases us from all liability. I feel like it is still nursing responsibility to make sure they patient leaves the facility safely, even if they are leaving AMA. If they person is independent and ambulatory, sure..... they can walk out, but what do you do if they can barely walk? any ideas or opinions would be greatly appreciated :)

[FL_Nurse92]

Well, regardless of the situation, you can't hold a patient unless they are baker acted or their mentation is altered. Unfortunately in your case the patient wanted care, but at a hospital he/she could afford. It sucks because as a nurse, you want the best for your patient whether they are staying or leaving but at the end of the day it is correct that if something were to happen to the patient, nor you or the hospital would be liable. In this case, I would have at least tried to walk down with the patient it time permitted and permission was given to do so.

[AJJKRN]

As a PP stated, I (or another staff member) would have walked the pt out to their vehicle regardless of what management said.

I would not have put myself in harms way if the pt were to have fallen (a call to 911 if they've made it out into the parking lot -as is our hospital protocol for downed visitors) or had trouble getting onto their vehicle though.

It seems to me that even though a facility says they don't have any legal obligation to help the pt once they leave AMA, as nurses (and as humans), I would ask myself...what would a prudent nurse do in this situation?

Especially if I were the nurse that was taking care of the pt when they signed out...I think a court of law wouldn't give two flips if something happened to the pt on their way out and a nurse just turned a blind eye.

Buts that's JMHO.

[hppygr8ful, ASN, RN, EMT-I]

As a PP stated, I (or another staff member) would have walked the pt out to their vehicle regardless of what management said.

I would not have put myself in harms way if the pt were to have fallen (a call to 911 if they've made it out into the parking lot -as is our hospital protocol for downed visitors) or had trouble getting onto their vehicle though.

It seems to me that even though a facility says they don't have any legal obligation to help the pt once they leave AMA, as nurses (and as humans), I would ask myself...what would a prudent nurse do in this situation?

Especially if I were the nurse that was taking care of the pt when they signed out...I think a court of law wouldn't give two flips if something happened to the pt on their way out and a nurse just turned a blind eye.

Buts that's JMHO.

The legal standard for in the situation to avoid civil or criminal litigation is to ask your self if you are acting in the manner of a reasonably prudent person with the same level of training under the same or similar circumstances. If you can answer yes to this question you are probably legally and civilly covered.

Hppy

[martymoose, BSN, RN]

We usually get assistance for them somehow. we dont just throw them out, although if they are heading out independently, we usually dont go with them at that point.

[Boog'sCRRN246, RN]

I think your hospital may be grossly misinterpreting what an AMA discharge should be. Even though the patient is discharging AMA, you still want a SAFE discharge. Just letting them sign a paper and be on their way is setting everyone up for failure and repercussions. This is a link to an article on the AHRQ website (it's a bit older than I'd like, but still relevant information): Discharge Against Medical Advice | AHRQ Patient Safety Network. The section titled "Reducing Errors and Adverse Outcomes Associated With Discharges AMA" is particularly interesting.