So in my state, if a voluntary psychiatric patient wishes to "sign out" of treatment, they can sign a "72 hour notice" that they would like to withdrawal from treatment, but the form states they can be held up to 72 hours in the hospital for further observation. At your facility ,if a patient who has signed a 72 hour notice gets discharged, do you have them also sign a separate "AMA" paper that states they understand they are leaving AMA and that this and the risks of doing do have been explained to them? Basically, are signing a 72 hour notice and signing out AMA the same thing? Or can a patient sign a 72 hour notice to withdrawal from treatment, and then the psychiatrist says ok, you can be discharged and lets them go without it being considered AMA?
There is confusion on this at my facility....practice has been that if a patient signs a 72 hour notice, the MD will specify whether they want the patient to also sign an AMA form. Other times, patients sign a 72 hour intent to withdrawal from treatment form and are NOT required to sign a separate AMA form. I was always under the impression from working at a previous facility that if a patient signs a 72 hour notice and then gets discharged, the discharge would be considered against medical advise, but that doesnt seem to be the thought where I am working now...
In my state a voluntary patient can request to leave at any time. If the doctor decides they shouldn't leave but are not in danger and not dangerous, then they are discharged. If the doctor thinks they could benefit by staying and really shouldnt go, they sigh a request to leave AMA. The doctor then chooses if they can leave or not. If he says they cant leave, he starts the 72 hour hold legal, court-involved procedure.
Our certification hearings are also only scheduled one day a week so depending on when the involuntary patient is admitted they might not go to hearing for almost 5 days. Interesting to learn the different ways of doing things.
Yeah that is what I have been talking about. Maybe it is considered an automatic hold? I haven't heard it referred to any type of hold so it might just be a different terminology. They are not free to leave at any time they have to put in a 72h notice with intent to leave during which time they are seen by a provider. As noted above they absolutely do need to be informed of this prior to admission but there are times when I do not believe staff does an appropriate job of getting this point across to the patient.
Is that just for patients who have yet to be seen by the MD, or does that also apply to patients that have already had their admit done my the MD (or other LIP)?
Is that just for patients who have yet to be seen by the MD, or does that also apply to patients that have already had their admit done my the MD (or other LIP)?
Everyone either comes in as a voluntary or involuntary admission-perhaps the key word is admission not hold? Most are brought to the unit after being assessed by a social worker and ED physician but have not yet been seen by the psychiatrist or NP. They are seen per facility protocol within 24h of being admitted to the psych unit by a LIP.
to my knowledge, if they sign to withdrawl from treatment, make sure they understand that them signing AMA wouldn't be a regular discharge and the MD will not be giving them script. Most patients retract the form after knowing the will not have prescription.
Now, if a voluntary pt still persist about leaving (before MD discharge) and they do not seem to be a threat to self or others, they have 72 hours before the MD allows the discharge to happen, in my hospital, AMA and 4 hour notice is the same paper.
This. Mention that they don't go home with meds if they go AMA, and then suddenly things don't seem so bad to them.
My facility doesn't require 72 hours' notice of discharge--they can usually leave the same or the next day. If we feel a voluntary patient truly is not ready for discharge AND meets hold criteria, we'll just place the hold. AMAs do have to sign a form indicating that they are aware they are leaving AMA and that we're not liable. It's very rare for an AMA to get discharge meds.
Until about 3 years ago we had a 65 to 70 percent release rate of voluntary's who give the 72 hr notice and they did have to sign a 2nd ama form. Then we had a patient released on an ama within 24 hrs of the 72 hr notice who killed himself and his wife since then once a patient files the 72 hr notice almost 80 percent of the time i'd say closer to 85 percent we will file and get involunatry hold rights on the patient.
Until about 3 years ago we had a 65 to 70 percent release rate of voluntary's who give the 72 hr notice and they did have to sign a 2nd ama form. Then we had a patient released on an ama within 24 hrs of the 72 hr notice who killed himself and his wife since then once a patient files the 72 hr notice almost 80 percent of the time i'd say closer to 85 percent we will file and get involunatry hold rights on the patient.
What a sad story and I can get their concerns but I'd be very concerned that there is a violation of rights taking place because only thinking anecdotally of my patient population I would say maybe 10% at the very most are strongly urged to rescind their notice or end up being certified.
Jules A, MSN
8,864 Posts
Our certification hearings are also only scheduled one day a week so depending on when the involuntary patient is admitted they might not go to hearing for almost 5 days. Interesting to learn the different ways of doing things.