Discharging a patient AMA

[Tweety, BSN, RN]

Most of my coworkers when discharging a patient AMA just get them to sign the form and it's a "there's the door, don't let it hit you on the way out" kind of attitude.

I've always tried to give some semblence of d/c instructions, such as what to look out for, how to care for wounds, what kind of followup they need, when to come back to the ER, etc. similar to other discharges. Sometimes for the indigents I give them a few dressing supplies, etc.

Although my last AMA I gave him the MD's number, only to be told by the MD that when "when a patient goes AMA, I drop them and don't give them my number". I can understand that. Point well taken.

I'm not talking a major d/c like a person leaving normally, but I try to at least not send the patient blindly out on their own either.

What do you say? What do you do?

[sjt9721, BSN, RN]

I give 'discharge' instructions similar to what you described (if the patient is receptive).

[loridoo]

I try to give d/c instructions, but 9 times out of 10 they are in such a rush out the door that they don't listen to you at all. I say what I feel obligated to tell them, whether or not they listen is up to them.

[TazziRN, RN]

The doc has to explain the risks of leaving AMA to them, then I have them sign. At the same time I tell them what to watch out for and make sure they know they are welcome to come back. If they refuse to wait until the doc can talk to them, I document that in detail. The AMA form also has to be signed by the doc.

[gonzo1, ASN, RN]

Just recently had one of my ER docs remind me that it is very important to give these people discharge info since they are not following through to the end of treatment with us. Since then I try hard to make this happen, of course some patients won't listen to you. Document, document, document. Have had other nurses say don't give em nothin, but I am going with what my doc said.

Our computer discharge system won't let us print discharge info sheets for AMAs so I first do discharge as if leaving at end of treatment, then go back, cancel discharge and hit the AMA button. I find it rather disconcerting to do this as apparently the computer programmers think AMAs shouldn't get discharge info, but since being quided in how to circumvent the computer on this issue I do so.

[Daytonite, BSN, RN]

Tweety. . .I worked for a large city hospital where we had a large varied patient population. Patients, for any number of reasons went AMA, not because they were mad at the doctor or disagreed with him, but for many other reasons as well. The hospital policy, and seems to me, good, rational practice of any nurse to follow, is to handle them like any other patient being discharged. We have a duty to give each patient the same kind of discharge teaching and follow-up instructions as any other patient regardless of the circumstances or the haste of their leaving. And, that includes the telephone number of their doctor. It's the doctor's job to fire the patient, not ours, if that is what the doc wants to do. When each patient leaves through the doors I can be at ease that I did my best to make sure I sent them on their way with all the information and resources they need to continue their healing process and not a lot of attitude.

I used to work in a very prestigious hospital where we had many celebrity patients. They sometimes told the doctors when they were leaving. Technically, I guess, some of them went AMA. No one gave them any attitude about it. Guess having millions of dollars made the difference, ya think? Ahhhh, prejudice. Alive, well and thriving--everywhere.

[suzy253, RN]

Thanks for posting this Tweety. Continuing education for me.

[RunnerRN, BSN, RN]

I had some conflict about this last week. We have some docs that will sign a pt out AMA, but will go ahead and print out d/c orders, sometimes complete with meds! If someone is just needing to go before xray results are back (the classic "my kids get out of school in 10 minutes") then I'm okay with this. BUT we've AMA'd CP pts like this and adult syncopes/falls. It just seems like a liability to me. "Okay, here are your risks for leaving before xyz are done, but here's your Rx and some instructions."

I do, however, always try give some info to the patient no matter what. I had a pt practically running out the door one evening (gave no reason) and I just said "you just signed a paper saying that you could die from your condition. At least let me tell you what to watch out for so you can come back if xyz start to happen." Would you believe he was back the next day?

BUT if someone is totally unreasonable, I'll just give them the number to the other hospitals in town (kidding!)

[dragonflyRN]

Totally unreasonable? How acceptable is it when you encounter the wife in a patient's bed...and the patient is admitted with a heart condition? Tell the pt. and wife...not acceptable. Same goes for the family at the bedside pissing the pt. off....will the bp not rise? Hmmm...go f***ing figure.

Let's go AMA because your wife can't do ya in the hospital bed. Let's go to the hospital and piss gramps off. I think in both cases there was no intent to do harm...

[dragonflyRN]

Not many doc's will let a patient go AMA. And from my experience, they get nothing if they go AMA. That's enough to keep them till the doc comes in.

[Tweety, BSN, RN]

Thanks. It's always good to get input from other nurses! :)

One reason I ask is that the charge nurse came out of report and AMA'd a patient. The nurse who was caring for the patient came out of the room and didn't even know her patient was discharged. I had AMA'd a patient earlier in the day and took a different approach.

[Tweety, BSN, RN]

Not many doc's will let a patient go AMA. And from my experience, they get nothing if they go AMA. That's enough to keep them till the doc comes in.

I've heard people tell patients "you're insurance company will not pay if you go AMA".

I seem to remember many years ago to never say this to a patient, but I can't understand the rationale.

Anyone?