If you have a patient who wants to leave AMA, how do you usually handle it?
I'm a nursing student who's been working as an extern at a big hospital in Philadelphia for a little over a year now. I've seen two patients sign themselves out AMA so far- they were both young (mid to late 20s) Chron's patients and they were both pretty stable- but they got totally different reactions. The first time the patient's nurse and the charge nurse were really upset and tried everything to talk them out of it, and the second time (with different nurses) they both acted like it was the patient's choice and nothing to freak out about.
I think they're all really good nurses, so I'm not asking who was wrong and who was right- I'm just curious as to how most nurses deal with this situation.
Specializes in Infectious Disease, Neuro, Research.
A question
What if someone will not sign the AMA paperwork ?
What happens if someone is not in there right mind ? I was in the er once and went from a sweet person to a screeming b@@ch yelling to get the he'll out of there when my sugar dropped . As I was waiting for for my close to be found I was given D50 and was fine and sweet again but I could have died if I left .
Then you simply document the refusal (preferrably with a witness/co-signer).
As a type I, who has ministered to other DMs: If you are grossly/generally combative, I will wait 'til your happy a** passes out, then tag you with D50.
Usually, I have been able to pop a Coke from the fridge, and get people to slurp it down while I, "get your papers together." Opening with something like, "I'm a diabetic too, would you like a drink? I'm worried your BS may be low, and you can sip it down while I print off some forms, in just a second..."
Then you simply document the refusal (preferrably with a witness/co-signer).
As a type I, who has ministered to other DMs: If you are grossly/generally combative, I will wait 'til your happy a** passes out, then tag you with D50.
Usually, I have been able to pop a Coke from the fridge, and get people to slurp it down while I, "get your papers together." Opening with something like, "I'm a diabetic too, would you like a drink? I'm worried your BS may be low, and you can sip it down while I print off some forms, in just a second..."
Then you simply document the refusal (preferrably with a witness/co-signer).
As a type I, who has ministered to other DMs: If you are grossly/generally combative, I will wait 'til your happy a** passes out, then tag you with D50.
Usually, I have been able to pop a Coke from the fridge, and get people to slurp it down while I, "get your papers together." Opening with something like, "I'm a diabetic too, would you like a drink? I'm worried your BS may be low, and you can sip it down while I print off some forms, in just a second..."
You're giving me evil ideas Rob....like spiking the Coke with D50....:)
Specializes in Infectious Disease, Neuro, Research.
You're giving me evil ideas Rob....like spiking the Coke with D50....:)
You could, but, word of warning, usually when we're in the happy dance/combative drunk phase, we're already starting to experience some gastric stasis, so the sugar load on the tummy might cause spontaneous violent emesis.
One other note, if anyone here doesn't like artifical sweeteners, that's how many long-term DMs perceive the taste of sugar. I can choke down a cup of coffe with sugar, or a regular Coke, but I don't much care for it. The sweeter something is (via sucrose), the less appetizing it is (YMMV).
I know, everybody at work runs when we have one because unfortunately, I'm a vomit magnet...."Oh, God, Nerd's in ER5, somebody just go ahead and go get her another set of scrubs out of supply...."
Alert and oriented? yes? sign the paper... bye bye! OK, Assuming the patient knows the risks of leaving, I never, ever, ever, beg any patient to stay and be treated if they understand the risks of leaving. My time is better spent on those that want help, education and care. Sign and go, I'll help you pack.
obviously the confused, demented and drunks do not apply to this scenario, so don't go there.
:lol2:
Rob72, ASN, RN
685 Posts
Then you simply document the refusal (preferrably with a witness/co-signer).
As a type I, who has ministered to other DMs: If you are grossly/generally combative, I will wait 'til your happy a** passes out, then tag you with D50.
Usually, I have been able to pop a Coke from the fridge, and get people to slurp it down while I, "get your papers together." Opening with something like, "I'm a diabetic too, would you like a drink? I'm worried your BS may be low, and you can sip it down while I print off some forms, in just a second..."