when patients go off the floor...

Published

...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.

Specializes in ER, progressive care.
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.

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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.
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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.

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Specializes in Oncology.

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.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

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.

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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.
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Specializes in NICU, PICU, PACU.

If our stable patients want to go to the little snack place, library etc they get a visitor pass sticker that states when they left. To come back on the floor, they have to have the sticker on (they can only be gone 30 minutes, only exception are moms coming to the NICU to care for their babies, they can have unlimited time, but the nurses do check to make sure they are still with us after 30 minutes). If they want to go out to smoke, they are told they have to sign an AMA form and they can't come back, they have to go thru ER. If they leave and we don't know it, we call a missing person thing and after 15-20 minutes we pack their belongings, say they are AWOL and they have to go thru ER to be readmitted.

When it is nice out, the patients that do not have IV's or hospital equipment attatched to them can go outside, but only with a family member, once again, the stickers come into play and they have 30 minutes.

This has cut down on those...where is my patient???

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Specializes in General Internal Medicine, ICU.

At my facility, we only get patients to sign an AMA form is if they're going out on a pass approved by their attending physician....or if they decided to sign themselves out.

If we had patients sign the AMA form everytime they went out for a smoke break or a walk to the cafeteria, my days would be filled with nothing BUT making the more independent patients sign themselves out everytime they fancied a smoke break or some snacks from the cafeteria!

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Specializes in OB, Med/Surg, Ortho, ICU.

Our patients sign a no-smoking acknowledgement on admit. It states that should the patient be found outside smoking they shall be discharged against medical advice and insurance will likely not cover their stay. I've only seen one person do so anyway, but the nurse did not enforce it.

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Specializes in ER, progressive care.
Our patients sign a no-smoking acknowledgement on admit. It states that should the patient be found outside smoking they shall be discharged against medical advice and insurance will likely not cover their stay. I've only seen one person do so anyway, but the nurse did not enforce it.

This is what we should have...instead patients receive a smoking cessation packet (with information on quitting, etc) that they have to sign on admission, even if they do not smoke.

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Just a point of clarification. You can't legally force a patient to sign an AMA form....or anything else for that matter. Sure you can try to talk them into it, but if they refuse there's really nothing you can do but document it. And except in very limited and specific circumstances, you can not legally prevent them from getting up and going for a walk if they choose to do so. About the only way to handle this is to have policies in place as some have described, and even then you have to be careful not to over do it. Policies that are overly restrictive or punitive could get you on the wrong side of CMS, among others.

Patients are not prisoners. They have the absolute right to make any and all decisions redarding their treatment if they so choose, including the right to refuse any specific test, treatment or procedure without prejudice to any other needed care. This would include not being allowed to get out of bed or go for a walk if they are able to do so. You can and should attempt to educate them, but if they choose not to listen, there's not a whole lot you can do.

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Specializes in OB, Med/Surg, Ortho, ICU.

We don't make them sign an AMA form if refused, but we can still discharge them that way and document the proposed plan of care they are refusing. I don't necessarily agree with our non-smoking policy because it is very rigid. Some patients may not get the treatment they need because they are too attached to cigarrettes. We do offer nicotine patches, etc. Many choose not to use them. Under our state law, there is no smoking allowed in any business or public building. They way it is written is how the hospital is able to have this policy.

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