Against Medical Advice

[rachmac03]

At my facility there is a nurse that has been given a hard time regarding the AMA forms, and I was hoping to help her out with an answer to the following question. Whose legal responsiblity is it to fill out the risks/benfits portion of the AMA form, the nurse or the physician? In school we have been taught that it is ultimately the physician's responsiblity to explain the risks and benefits and fill out that portion. PLEASE HELP!!!

P.S. in the P&P manual of this facility it does not specify who should fill out this portion.

[Whispera, MSN, RN]

Where I've worked (2 different hospitals) the doctor would order the AMA, and state a reason and the nurse would fill it out, and explain it to the patient. The doctors weren't likely to come back in to do the details and the patient was usually in a hurry to leave.

[argos]

It is always the physicians responsibility to explain ama. If the pt does not want to wait then there should be a place for 2 rn's to sign verifying that the pt left ama without signing or eloped. Also be sure to document that the md was informed that the pt wants to leave ama but the md did not explain risks prior to pt leaving. Also state that pt did not wish to wait for md to explain risks of ama. You can't force the md to do the paperwork or the pt to sign but you can document what occured in your documentation.

[leslie :-D]

i have never, ever felt it to be within my scope in explaining/DIAGNOSING what may happen to a pt who wants to leave.

only the md truly knows what may happen.

and so, i always write, "refer to md notes".

no way in hell, is the onus going to be put on me.

nor do i care to invite any legal repercussions down the road.

nope, no way.

this is totally the doc.

and risk mgmt agrees where i work.

leslie

[Virgo_RN, BSN, RN]

Our AMA form is quite simple. It doesn't have a place to write in the risks/benefits, it just states that the person is leaving the hospital against the advice of their physician, and the patient signs it. As the nurse, I call the physician to let them know the patient wants to leave, and the physician can either come in to talk to them or not. Usually people leave over not being allowed to smoke.

[js408]

Last year, my wife was in the hospital in labor and delivery and around 2am decided she wanted to go home (she was sick but not in labor). There were no OBGYN doctors in the hospital at the time. She asked repeatedly when she could leave but the charge nurse refused to let her leave. Eventually I went outside and called the oncall OBGYN on my cell phone and asked why we aren't allowed to leave. The doctor told me that she told the nurse to discharge us hours ago and has no idea why we were still there. The doctor then called the charge nurse and told her to discharge us and the charge nurse refused and said that we would have to sign AMA if we wanted to leave because she wasn't convinced it was safe for her to go! Have you ever heard of such a thing?

It is always the physicians responsibility to explain ama. If the pt does not want to wait then there should be a place for 2 rn's to sign verifying that the pt left ama without signing or eloped. Also be sure to document that the md was informed that the pt wants to leave ama but the md did not explain risks prior to pt leaving. Also state that pt did not wish to wait for md to explain risks of ama. You can't force the md to do the paperwork or the pt to sign but you can document what occured in your documentation.

[canoehead, BSN, RN]

I notify the doc that the patient wants to leave, and if they make it to the room before elopement then the MD fills out the AMA and has the patient sign.

If the doc doesn't make it to the room I review the risks I see from a nursing point of view, and have the patient sign. I always include injury and death as possible consequences. After going to a conference a few years ago I also tell the patient they can come back at any time if they wish, or if they get worse, and I document that I told them that.

[canoehead, BSN, RN]

js408

If I was that nurse I would be going up the chain of command if I disagreed with the treating physician, and I would notify you that I had concerns that I was trying to get addressed before you actually left. If you chose to leave before that process was over I wouldn't pull out the AMA form, but I would document that I asked you to stay until another doc could assess the situation, and whatever teaching I had done about her condition, especially the reasons to return, or signs of trouble. Maybe the nurse was just hoping you'd stick around until morning rounds? Anyway, it's a delicate situation because we're not supposed to question the docs judgement in front of the patient.

Sometimes I'd like the doc to actually see the patient and the strip before discharge, so that may have been what she was hoping for. She probably had your best interests in mind.

[Whispera, MSN, RN]

I always worry about patients who want to leave AMA even after they know their insurance won't pay for their visit if they leave AMA....

[kellykelly]

What virgo said.

[mudd68]

Since the patient is leaving "against medical advice", not "against nursing advice", the MD should explain the risks. Sometimes, as stated above, the pt just leaves (elopes). In this case the nurse can document the pt eloped.

[Batman24]

We have a standardized form so we don't have to explain anything as it's all there in black and white. Sometimes the doctor will come in and speak to them but that's the exception not the rule. It does state that leaving could result in death. Those that leave usually do so over something like wanting us to get them a a Big Mac or to have a ciggy in their room while on oxygen. lol