Dama

[acetabulum]

:nono:First of all,i would like to apologize for ranting here.It has been 4 days already but i can't just erase my disappointment with 1 of our Medical on Call.You see,i have called this Dr. to inform that 1 of our patients that time wants to go home without a discharge order yet.When I ask the pt.why he wants to go home,he just simply told me that he just wants to go.This pt.was admitted 2-3 days back due to slurring of speech and Lt.sided body weekness,he was scheduled to have procedures the next day.I inform this Doctor abt.it,hoping that he will tried to talk to the patient and atleast to convince the patient to stay since his treatment is still on going,although I was expecting already that the Dr.will most likely,will advice DAMA.As expected,after informing him the present status of the patient,he then told me that the patient will go as DAMA,I further ask him if he could come and explain abt. it to the patient(though i shouldn't be asking that).You know what this Dr.told me?He simply told me that he is busy and that he can't come,if I want I can call the P.R.O to explain it to the patient.I know that he's not kidding because I know this Doctor's reputation eversince,but i didn't expected that he will tell me that.I insisted that He is in the best position to explain everything to the patient.I was really disappointed of the system and the practices of some Doctors here,but I get more disappointed when this MOC has the guts to tell me that.I did the explaination to the patient,I presented the negative consequences of the action that he wants to happen,but then the patient told me that he will sign the DAMA so i get back to that Doctor.And you know what he had written on his notes when he came,he said that the nurse informed him that patient wants to go as DAMA and no nurse explains it to the patient,he even added that the nurse refused to explain to the patient.What kind of Doctor is this,he never even bother to encourage the patient to stay to finish the treatment or at least the investigation scheduled the next day for him(patient's right).He didnt even think twice of writing those notes as well.I inform the Nurse Supervisor that time,who adviced me to let this Dr.do the explaination to the pt.Then,I had a talk also with our Quality People about it.I just hope they will do something about it because that day,this Dr.talked to me badly when he came to let the patient sign the DAMA form...I don't want this Dr.to continuously treat the other nurses the way he did to me.:angryfire:angryfire:angryfire

[mom4josh]

Patients who leave AMA are usually ones who will do it regularly because they don't want to be there for whatever reason. I don't think there's anything else that you should have or could have done.

If I missed the point of your post, I apologize.

[FireStarterRN, BSN, RN]

I've never heard of a doctor running over to try to convince a patient not to leave AMA. He doesn't have time to cater to non-complaint patients in this way. Where I've worked we hand the AMA form to the patient, document our attempt to convince them otherwise, notify the doctor, and that's that.

[chevyv, BSN, RN]

I'm not yet a nurse, but have worked in hospitals many years. I've always seen nurses advise pt's who want to leave AMA about the risks they are taking. The only time I've seen a doc handle this was on the phych unit where police holds are in place. This was after nursing staff exhausted themselves. Is this usually a doc thing?

[mama_d, BSN, RN]

Where I work we notify the MD/DO if the patient is trying to leave, but it's up to the nurses to decide how hard to try to get them to stay. All you can do is document the teaching you did and that they signed (or refused to sign) the form. I've never once had a doc try to convince a patient to stay. Honestly, the ones who want to leave are usually the noncompliant ones who are just sucking up our resources while doing nothing at all to get better to go home...as far as I'm concerned, they might as well be at home doing nothing and freeing up the bed for someone who is going to actually use our resources to get better. I know that sounds cold and jaded, but there's only so much you can do for some people. The whole you can lead a horse to water thing.

[morte, LPN, LVN]

hmm since it is, leaving against MEDICAL advice, why isnt the doc the one doing the explaining......if the nursing is explaining it would be against NURSING advice........and this particular patient sounded neuro, and perhaps should have been coaxed to stay.....are we going to see another suit about a neuro/psych compromised patient being "allowed" to leave.....and sometimes patients, in particularly man, respond better to another man.....

[FireStarterRN, BSN, RN]

Many doctors are women these days, and many nurses are men.

[CoffeeRTC, BSN, RN]

Normally, if the pt wants to go AMA, the nurse hands them the form, they should read it...they sign it, then they leave. A lot of the docs don't have the time to come or can't drop what they are doing and get to the pt before they decide to leave AMA.

Did you chart in your notes that you discussed AMA with the pt? If so, that covers you.

[Ruby Vee, BSN]

i think she is saying that she's upset because the physician she called was rude to her and because he or she documented "nurse refused to" talk to patient about the consequences of leaving ama.

it's unfortunate that the physician was rude.

anyone who wants to go ama probably isn't going to stick around unless all they want is someone to cater to them and talk them out of it. and if someone wants to go ama, they're usually such a pain in the patoot that you really don't want them around anyway!

good luck.

[acetabulum]

By the way, im sorry if my grammar is very poor. I'm not a native ENGLISH speaker.

I forgot to mention that I am presently working in the UAE, and the scenario of the Medical practices here is quiet differrent from what you have in the US. Still, your comments are well appreciated.

[sirI, MSN, APRN, NP]

By the way, im sorry if my grammar is very poor. I'm not a native ENGLISH speaker.

I forgot to mention that I am presently working in the UAE, and the scenario of the Medical practices here is quiet differrent from what you have in the US. Still, your comments are well appreciated.

That is quite all right, acetabulum. No problem at all. We hope that the comments have helped you.

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