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when patients go off the floor...

Posted

Specializes in ER, progressive care. Has 7 years experience.

...To go outside for a "walk," do you have them sign an AMA form?

I've never thought about it until yesterday when I received report on a patient who likes to go downstairs a lot with a family member for a walk. The dayshift RN had the patient sign an AMA form just in case and told me that you're supposed to do that, but I'm not sure if that is an actual policy that we have.

Pepper The Cat, BSN, RN

Specializes in Gerontology. Has 35 years experience.

Our pts go off the floor all the time. Out to the coffee shop with their family. Outside in nice weather for some fresh air. In fact, we encourage it as it gets them out of bed even if they are in a wheelchair. I have never heard of calling the AMA , that is for people that leave and don't come back.

turnforthenurse, MSN, NP

Specializes in ER, progressive care. Has 7 years experience.

Our pts go off the floor all the time. Out to the coffee shop with their family. Outside in nice weather for some fresh air. In fact, we encourage it as it gets them out of bed even if they are in a wheelchair. I have never heard of calling the AMA , that is for people that leave and don't come back.

That is my thought, too...I have patients leave all of the time. This was just the first time I have ever heard of a nurse making a patient sign an AMA just to go off the floor for a little bit.

KelRN215, BSN, RN

Specializes in Pedi. Has 10 years experience.

My patients go off the floor all the time. All I do is inform the family that they must remain on hospital grounds. I have never once had someone sign an AMA form for that... they aren't leaving against medical advice, they're stable enough to go off the floor for a while.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

AMA forms are for anything the patient wants to do that goes against recommendations; exceeding a fluid restriction, going off tele to go outside, etc.

loriangel14, RN

Specializes in Acute Care, Rehab, Palliative.

We have a clipboard where our patients or the family member signs them out.Quite often we have patients leave the hospital propety.They have to have a doctors order staing they can go out and they sign a release of responsibility in case something happens while they are out.AMA forms are for if they are doing something the MD has advised against.

Dazglue, ADN, BSN, MSN, RN

Has 8 years experience.

I guess you should refer to your policy. On our gyno/postpartum floor the patients are required to sign an AMA form when they walk off the floor so the hospital is not responsible if anything were to happen while downstairs. However, on the floor I work on now, they don't have to sign anything because we love for family members to wheel them downstairs or go outside on the patio for some fresh air. It can be depressing sitting in a hospital room all day. I am not sure how many other floors require the AMA form at our hospital.

turnforthenurse, MSN, NP

Specializes in ER, progressive care. Has 7 years experience.

I guess you should refer to your policy. On our gyno/postpartum floor the patients are required to sign an AMA form when they walk off the floor so the hospital is not responsible if anything were to happen while downstairs. However, on the floor I work on now, they don't have to sign anything because we love for family members to wheel them downstairs or go outside on the patio for some fresh air. It can be depressing sitting in a hospital room all day. I am not sure how many other floors require the AMA form at our hospital.

The only policy I can find is leaving AMA...for a patient actually leaving prior to discharge. I do not see anything regarding signing an AMA form to go outside. I work on a tele floor so when patients leave they get disconnected. I remember during a staff meeting several months ago, they mentioned that we cannot hold a patient hostage in their room. If they want to go downstairs, they are allowed to, providing that they are stable. Our manager at the time just stated to disconnect the patient from the monitor and explain to them that while they are downstairs we cannot properly monitor them, and then document that in the nurses notes ("patient requesting to go downstairs; explained risks of being off the monitor, patient verbalized understanding" etc). Nothing about an AMA form. But that was also several months ago. :confused:

noyesno, MSN, APRN, NP

Specializes in Family Medicine. Has 11 years experience.

Our patients aren't allowed to leave the floor. Most of them are hooked up to PCA's or loaded up on pain medication.

We had an interesting patient escape the floor/hospital for a few hours. He had a bullet lodged near his aorta and had a chest tube. He was scheduled to have surgery in the morning. Apparently, he went walking around town, chest tube and all. I guess this all occurred because he wanted to have a cigarette.

Glad I wasn't his nurse.

DookieMeisterRN

Specializes in Cardiac, PCU, Surg/Onc, LTC, Peds.

The only reason our pts want to go off the floor is to smoke. They try and get sneaky by saying "I need to get some fresh air", " I want to go down to the gift shop", "I want to go down to visit with my family down in the cafeteria while they eat dinner". No, no and no. If you're that well you need to go home. The sneaky ones I fib and say they can't leave the unit because of their cardiac monitor, it's against hospital policy.

I had one pt whose room was right next to the elevator. She stumbled outside with her PCA, tripped, tipped over the whole IV pole all before she had even lit up. Security found her and hauled her back upstairs. That night she was crying over her skinned knees.

Boo stinking' Hoo.

The stable, honest, long timers I let off the unit with responsible family.The others can sign an AMA form.

applewhitern, BSN, RN

Specializes in ICU. Has 30 years experience.

Our patients (guests? clients?) have to sign themselves out. Plus, they are told that if anything happens to them while outside, they must go back thru the ER instead of back to whatever department they were in. For instance, if they should get SOB or have chest pain, they must go directly to the ER. We are a non-smoking facility, so they can't go out to smoke, anyway.

DookieMeisterRN

Specializes in Cardiac, PCU, Surg/Onc, LTC, Peds.

Our patients aren't allowed to leave the floor. Most of them are hooked up to PCA's or loaded up on pain medication. We had an interesting patient escape the floor/hospital for a few hours. He had a bullet lodged near his aorta and had a chest tube. He was scheduled to have surgery in the morning. Apparently, he went walking around town, chest tube and all. I guess this all occurred because he wanted to have a cigarette. Glad I wasn't his nurse.
Haha nice. There was a pt on out floor who had gotten a pass signed by the MD to leave the hospital. Don't know WHAT reason for leaving he told the MD. He left wearing baggy clothes and came back with 2 brown grocery bags of expensive steaks he had to keep in our refrigerator. Hmmm....

turnforthenurse, MSN, NP

Specializes in ER, progressive care. Has 7 years experience.

Our patients aren't allowed to leave the floor. Most of them are hooked up to PCA's or loaded up on pain medication.

We had an interesting patient escape the floor/hospital for a few hours. He had a bullet lodged near his aorta and had a chest tube. He was scheduled to have surgery in the morning. Apparently, he went walking around town, chest tube and all. I guess this all occurred because he wanted to have a cigarette.

Glad I wasn't his nurse.

:eek: That would freak me out!

I remember I was going into the elevator to go up to my floor (just coming into work) and here comes a patient heading out the door with his PCA pump...I don't know who's bright idea it was to let him leave the floor with that!! :no:

The only reason our pts want to go off the floor is to smoke. They try and get sneaky by saying "I need to get some fresh air", " I want to go down to the gift shop", "I want to go down to visit with my family down in the cafeteria while they eat dinner".

Although mostly true, not all patients want to go downstairs and smoke. Although we discourage smoking, our manager reminded us that the patient has rights and can leave the floor if they wish.

DookieMeisterRN

Specializes in Cardiac, PCU, Surg/Onc, LTC, Peds.

Our patients (guests? clients?) have to sign themselves out. Plus, they are told that if anything happens to them while outside, they must go back thru the ER instead of back to whatever department they were in. For instance, if they should get SOB or have chest pain, they must go directly to the ER. We are a non-smoking facility, so they can't go out to smoke, anyway.
That's an awesome idea! Unfortunately hard to enforce here since everyone just walks out to the sidewalk in front of the hospital to smoke.I'm a former smoker (I quit when it changed to a non-smoking campus 3 yrs ago) but find it extremely tacky to see hospital employees smoking in front of the hospital on the sidewalk.

sapphire18

Specializes in ICU.

Before I started working ICU, we simply had to get a dr's order if a pt wanted to go off the unit without staff. That way, it's up to them, not you. If the dr decided they weren't stable enough and they insisted on going anyway, they had to leave AMA. They would usually end up in the ER later that night or the next day.

ScarryBear,RN

Specializes in Oncology. Has 2 years experience.

This all sounds crazy to me! At our facility the pts can't leave the floor at all unless it is for testing taken via escort. Even the ones who are not a fall risk, and in my hospital that is only about 10% of the population. Our fall risk policy is so unbelievably strict that if you are even a slight fall risk, you get a yellow "fall risk" band, yellow socks and a bed alarm. No getting up to use the bathroom by yourself unless you call us. If you're not a fall risk pts need an order to walk the unit. Then administration wonders why we have so many complications. We are too short staffed to ambulate everyone like they should. (only 1 aid to 20 pts and 3 nurses with no charge) I work on a med-surg/oncology floor. I have been there for two years and this is my first nursing job. I just thought this was the norm, I guess I was wrong.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

Policy, Policy, Policy......it depends on the facility and the usual standards of practice. Some areas, of course, you can't leave .....like a locked psych unit...... but I have worked at facilities that have dunkin donuts or starbucks that patients and families may take out to the court yard (restrictions permitting) but this facility also had pet visiting hours. The patients had to sign out an alert disc (like at the restaurants) and return when beeped.

I really miss that place.....sigh.

loriangel14, RN

Specializes in Acute Care, Rehab, Palliative.

Our patients aren't allowed to leave the floor. Most of them are hooked up to PCA's or loaded up on pain medication. We had an interesting patient escape the floor/hospital for a few hours. He had a bullet lodged near his aorta and had a chest tube. He was scheduled to have surgery in the morning. Apparently, he went walking around town, chest tube and all. I guess this all occurred because he wanted to have a cigarette. Glad I wasn't his nurse.[/quoteWe have PCAs that come in a portable pouch so the patient can ambulate or go out in a wheelchair easily.