Patient leaving AMA

Basant · Mar 17, 2006

Nurses,

Don't be selfish, think for profession before yourself!

:kiss

~Anne~ · Mar 17, 2006

I usually try to talk to the patients , and find out why they want to leave AMA , and explain the risks of leaving etc etc etc. There are many patients who are just are scared or anxious because they have not really been told what the plan is . I had one pt that wanted to leave just because he said no one, ( meaning doctors , nurses, PA's) ... had not come in to see him and explain what is going on . He was just frustrated that nobody had given him much attention , once he was given some info he was fine. It depends on the patient though, and I have definatley had some pts that are just wasting our time, they are either drug seekers , or manipulaters , and dont really want to be helped.... and serioulsy, who has that kind of time to do psych evals when there are other very sick people in need of our nursing care . So in those cases i happily hand them the form and say Good Luck!

mom23RN · Mar 17, 2006

I was usually able to convince them to stay with the usual "you know your insurance may not cover this if you sign out AMA."

Other than that I worked in ER and those that usually signed out were beligerant, etc.... I took them the papers and said good ridance. :madface:

Undecided7 · Mar 17, 2006

Sometimes I fill out the AMA papers beforehand to have it ready- just in case (especially if they've been threatning to leave). I'll happily answer any questions within my scope but if someone doesn't want the treatment- it's not my job to "talk them into it". Assuming they are over 18 and oriented- I figure I'm a nurse, not a prison warden or professional psychologist. I don't always agree with a patient's decisions, but that's irrelevent. For instance, there was a mom in our hospital that delivered twins, then had a severe hemmorhage. The pt. and husband were Jehoves Witness (?) and they refused blood no matter what. Now the father can explain to his kids someday why he let their mom die when she could have been saved. To me the man (and women while she was awake and alive) was TOTALLY irrational, if not just plain stupid. :madface: That's my belief though. Sometimes, you just can't save everyone- especially the ones that don't want to be saved.

meownsmile, BSN, RN · Mar 17, 2006

Ive found there is usually a remedy for an AMA situation. True a lot of times it is because they cant smoke, they are upset with a staff member or the doctor, or they are just to ansy to stay in one place. I think with a little beside manner and honest communication these situations can usually be remedied. There are occasionally the cases that they just want to leave and there isnt anything you can do. I dont take papers with me when i go to the room at first because that implies to the patient that you arent planning on trying to solve their problem and you arent willing to hear what they want to vent. Sometimes that is all they want to do anyway.

TazziRN, RN · Mar 17, 2006

I always talk to the pt and try to get the doc to talk to the pt before he actually leaves, otherwise we cannot claim honestly that the pt was informed of the risks of leaving. It's called CYA. Taking the form in with you, already filled out, also gives the pt the impression that you don't really care if they stay or go (true in some cases, I'll admit!!). I then document what the pt said, what I said, and what the pt's reaction was to what I (or the doc) said.

I had an AMA the other day, a lady with known heart problems who had EKG changes. The cardio was going to arrange for a bedside echo but the woman was impatient....had been the whole time I had her. She finally took out her own IV, got dressed, and said "I'm going home." The doc and I tried to explain the very real dangers to her, including, "You could die."

She said, "So could you."

Doc: "Yes, we could, but if we die today it's probably going to be because of an accident that nobody saw coming, not because of our hearts."

I documented that conversation, including the pt's response of shrugging and leaving anyway.

KAW1962 · Mar 17, 2006

Some patients are determined to leave AMA no matter what you say. I had a patient elope a few months ago. I didn't have any idea he was even considering it. While I was on the phone with security, the patient called me from home to tell me why he had left! Of course he left with his IV intact and I urged him to go to the nearest ER to have it removed.

My facility has a policy in place when dealing with patients who leave AMA or elope. We have to notify the MD, security, the nursing supervisor, Risk Management, and write up an incident report. With all that, I'd much rather see what I can do to rectify any problems they may be having and try to persuade them to complete their treatment.

neneRN, BSN, RN · Mar 17, 2006

See lots of AMAs from the ER, and I would say 95% of the time its because of the wait. I have the same little speech for all of them, i.e., "we would like you to stay and be evaluated but I cannot force you to stay, that is your decision"--I also tell them they are welcome to come back if they change their minds.

Because the reason for leaving in the ER is generally the wait time, that's not something that can be fixed; esp when the person threatening to leave has a minor c/o that doesn't require an ER visit, and staff is running around working on codes/resp distress,etc. Sorry, I can't make you a priority.

I don't get dragged into the "trying to convince them to stay" game. It is often just attention seeking. Other times I think, why should I convince you to stay?; if you're not concerned enough about your own health, why is it my problem? I know I sound callous, but after seeing AMAs daily, I'm just over it.

Just yesterday, a man came through triage, and because he was having active chest pain, he was immediately walked back to our chest pain screening area (this is where all chest pain pts have an EKG, IV, and bedside labs done). The room had just emptied out, and the stretcher was being wiped down and re setup, that takes what, 3-5 minutes? No, he was livid, despite the fact that he had been through triage and back to the treatment area in less than 10 min, made a scene and stomped out. When you see this kind of behavior and know that there are little 80 year old pts who have been out waiting in the lobby for 6 hours, you just let them go.

mom2michael, MSN, RN, NP · Mar 17, 2006

We had a patient once that was brought in my EMS with chest pain, he was wheeled straight to his bed where for the next hour he proceeded to have a full cardiac work up from head to toe. For that entire hour someone was always in that room getting something done. He signed out AMA because he said #1 he had to wait too long and #2 no one did anything for him. We just stared at him in awe as we handed him his AMA papers.

KAW1962 · Mar 17, 2006

We had a patient once that was brought in my EMS with chest pain, he was wheeled straight to his bed where for the next hour he proceeded to have a full cardiac work up from head to toe. For that entire hour someone was always in that room getting something done. He signed out AMA because he said #1 he had to wait too long and #2 no one did anything for him. We just stared at him in awe as we handed him his AMA papers.

Curious to know if you've ever had anyone do that only to come back to the ER in full cardiac arrest?

tridil2000, MSN, RN · Mar 17, 2006

i don't think you can legally tell them that their insurance won't pay. it's a form of coercing and can be perceived as a threat.