Just wondering what everyone's workplace policies are regarding AMA discharges- I'm wondering mostly about acute inpatients but also ED or SNF or psych. My hospital does not provide any prescriptions when someone goes AMA-no antibiotics if confirmed infection, obviously no controlled drugs, no inhalers for asthma pts-nothing-period.
I'm thinking this is to try to convince the pt to stay. But I am more of a harm reduction believer and am wondering if this really is the right thing to do? After all a pts right to refuse has been established legally...but should that mean that they get no tx if they leave, even when there's a good chance the position abx or whatever would be successful? (Example- someone getting iv abx until full cultures and sensitivity come back despite the fact that resistance to all po abx is very unlikely in this case and you can always call with results or pt can return if they get worse. )
I absolutely understand that people take a risk leaving AMA. At the same time I have seen people held for ridiculous reasons for days. Regardless they have the right to understand the risk and leave. How do your facilities handle these discharges? Do you provide prescriptions, referrals etc or just wave goodbye? Am I totally crazy to think that if a pt is convinced to leave that we should at least consider providing prescriptions etc, or is the blanket "you get nothing" the best way to go?
I just say OK, notify the doctor, notify the charge and House Supervisor, get the paperwork signed and escort them out the door. Too many people threaten to leave as though it's supposed to matter significantly to me or get me to scramble to do things I'm not supposed to. My quick response of "OK, let me get the papers ready", seem to catch some of them by surprise.
Path One: I call the doctor and we talk with the patient to make sure its not something silly that we can't remedy. If we can't work it out you get discharged as an AMA patient with all the trimmings of any other discharge. I take out your IV and your bracelet and security escorts you out.
Path Two: The patient is truly ready to go and refuses to wait. I take out the patient's IV and security escorts them out. I write a nursing note about it, and call the doctor. It is what it is. Hospitals are not prisons.
In my unit, we don't give people prescriptions if they leave AMA because they are out of there before the doc sees them. If they are using the threat to leave AMA as manipulation, that doesn't work on me. I say, "Here's the form, please sign at the bottom."
I always notify the doc that the patient wants to leave AMA. Doesn't matter who's on call that night, they always say something along the lines of, "There's nothing I can do, make sure to tell them to come back to the ER if they need to."
I have decent people skills, so if my patients want to leave AMA, it's past the point of no return and they want to leave NOW. They never wait for prescriptions. Usually it's someone who wants to go home and get high because their previous drug use has worn off. I always give them education about their condition and when to call 911 or go back to the ER.
I agree with many others, I've never had a patient who left AMA who would have stuck around long enough for prescriptions. I'm not sure if we would give them or not, to be honest.
I once had a patient leave AMA with a chest tube. That was interesting. I think he ended up back in the ED a couple days later.
Specializes in Gerontology, Med surg, Home Health.
In most SNFs leaving AMA means you don't get anything....no meds, no 3 page referral, no follow upbooked...zip. Sometimes that's enough to convince someone to stay. Most times not. Personally, I think it's ridiculous to send them home with nothing. We all know they're going to end up back in the ER sooner or later. If they had their meds at least there would be a chance of them being able to be well enough to stay home. One thing....if someone signs out AMA, especially if it's because they want more pain meds than ordered, they are NOT welcome back.
I in NO way mean to sound condescending, but are you a new nurse? I only ask because I think some of us are jaded from seeing so much over our years of work and, personally, if someone's holding up a bed (an ICU bed in this case) just because he wants dilaudid, I'd rather see him go and make room for a trauma or an MI that will actually need/take my help. You can't help them all and if they're consenting adults, it's their choice. It's not like we are sending them home and for no reason.
xo
I am not offended but no i have been a nurse in several settings for 10 years so i do not consider myself new. Nor am i naive to the reasons MANY of these pts leave. However i have known a few who really did NEED to leave and the docs wanted them to stay to rule out something pretty unlikely or for observation. Actually, i had a family member in the hospital who was admitted on a saturday until they could rule out osteomyelitis under cellulitis by imaging...but they couldn't do the imaging until Tuesday. The doc told him that it was very unlikely to be osteo and he had to work. He went to the family doc, got po abx and was fine. The family doc set up outpatient imaging and there was nothing seriously wrong.
I do not have a problem with not giving narcs and obviously if someone is storming out over that it is a little different. And obviously if they need pressors or something then that's different.. I personally feel that it is just unfair to have this blanket policy that applies to everyone-if someone wants to go for whatever reason and has signed a liability waiver but also wants to finish their antibiotics and continue their new inhaler or whatever it kind of feels like throwing the baby out with the bathwater to give no treatment just because the pt refuses hospitalization.
Personally, I think it's ridiculous to send them home with nothing. We all know they're going to end up back in the ER sooner or later. If they had their meds at least there would be a chance of them being able to be well enough to stay home. One thing....if someone signs out AMA, especially if it's because they want more pain meds than ordered, they are NOT welcome back.
YES. This is what i mean. It feels like it would just be better for everyone to provide the best treatment for home and maybe or probably get better, than to give nothing and have them more than likely come back worse.
Thank you all for replying. I'm glad i asked because it sounds like different places do handle this differently.
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I only ask because I think some of us are jaded from seeing so much over our years of work and, personally, if someone's holding up a bed (an ICU bed in this case) just because he wants dilaudid, I'd rather see him go and make room for a trauma or an MI that will actually need/take my help. You can't help them all and if they're consenting adults, it's their choice. It's not like we are sending them home and for no reason. 
DeeAngel
830 Posts
I just say OK, notify the doctor, notify the charge and House Supervisor, get the paperwork signed and escort them out the door. Too many people threaten to leave as though it's supposed to matter significantly to me or get me to scramble to do things I'm not supposed to. My quick response of "OK, let me get the papers ready", seem to catch some of them by surprise.