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 Critical Care.
Show me the info that states this is not true. All the info I have states this can happen. I don't recommend saying I'm lying to a patient without literature to back it up.

It's an assertion that is often made so you're just repeating what seems to be common knowledge rather than a blatant lie, but here's a pretty comprehensive look at it:

Financial Responsibility of Hospitalized Pa... [J Gen Intern Med. 2012] - PubMed - NCBI

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

Thank you. As I said, it seems I was misinformed.

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Specializes in Critical Care.
Thank you. As I said, it seems I was misinformed.

Sorry, I posted before I noticed your new post. You're hardly the only one who's been misinformed by those we work with. As the study points out, about half of MD's believe insurance won't cover AMA discharges.

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Specializes in I/DD.
IF a person is sick enough to be hospitalized then they should not be allowed to leave the floor.

Not to single you out because I saw several posts like this, but I completely disagree. Can you imagine how stir crazy these people must get? We occasionally get a patient who comes in solely for anticoagulation. He has a genetic clotting disorder and a history of HIT. If his INR drops below 4 then they send him in for his argatroban gtt until he is therapeutic, all in the interest of saving his legs. He is totally independent, normally quite active, and fully capable to pushing his IV around. There is no medical reason for him to stay on the floor unless he is due for a blood draw.

Of course when it comes to tele it is a different story. There is the occasional tele patient where the doctor will write an order for them to come off tele for a specific period of time to leave the floor, but that is very rare. History of IV drug abuse? Forget it.

Now here I have a question. If I tell a patient they can go downstairs for a snack but that they are not allowed to leave the hospital premises and document this education, is the hospital liable? I'm not talking about going through the process of an AMA form. It seems to me that if you document that the patient was explicitly told that it is not safe for them to leave hospital grounds yet they are found passed out across the street, that this would fall under the same category of refusing a medication or a procedure. If I tell someone that this is what they should/shouldn't do, and this is why, they are big kids and can make their own decision. As long as I tell them every terrible thing that could happen to them if they ignore me and they express understanding, I feel that I have done my job. I may be guilty of some faulty logic because I had a long and awful shift today, but oh well :-/ I am also clearly not a lawyer.

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Ok, so I did some research outside of what the hospital gave me, and it seems true that insurance covers most AMA discharges. I learned something new, but I still bristle at stating I was lying to patients as this was what the hospital was teaching us. It seems administration was either seriously misinformed or lying, but I don't think staff was being malicious.

Just to be clear, I never said you were lying to the patient, I said the facility was - there is a difference.

Here's a link to another discussion on the subject:

https://www.google.com/url?q=http://www.kevinmd.com/blog/2012/03/leaving-medical-advice-stick-patients-bill.html&sa=U&ei=Eal2T8GvMtDptgfupNndDg&ved=0CAYQFjAB&client=internal-uds-cse&usg=AFQjCNG1SRgoOTFVzhFZSyWU16E903vmdg

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Specializes in ER, progressive care.

I spoke to my manager about this topic. She said having a patient sign an AMA form prior to go downstairs is not even considered legal. We cannot force a patient to sign an AMA form. The form we have them sign on admission states that if anything happens to them while they are off the floor (unless they go down for a test or something), we are not responsible. We can't have patients signing AMA forms.

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Specializes in CICU.

Makes me curious what my floor's actual policy is... However, I work tele/step-down and sometimes ICU. Soooo, if they are well enough to go outside they probably should be discharged.

Can't think of a time that I've had a patient ask, to be honest. Although, we have had security escort a few back when they were found wandering the hospital at odd hours. Occasionally, walkie-talkies might go to the family waiting room to visit - it is big, with nice couches, vending, coffee and a TV. We can still pickup the tele packs from there too.

Off topic, I guess, but the issue I have is with showers. We actually have showers in every room - that almost never get used. I only "allow" patients off tele to shower with a physician's order...

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Specializes in ICU.

I am surprised that patients are allowed to go to the cafeteria. My son was a patient at a large hospital, and he went down with me to the cafeteria. The cafe personnel "not so gently" told him he could not enter as he was a patient, and they did not allow active patients to enter the cafeteria. Apparently they considered the patients "sick" and would expose other's to germs, even tho he was not on isolation, nor was he in with anything contagious.

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Specializes in ER, progressive care.
Off topic, I guess, but the issue I have is with showers. We actually have showers in every room - that almost never get used. I only "allow" patients off tele to shower with a physician's order...

:lol2: I have an issue with that, too. I just use my judgement...if the patient is stable, I will let them shower. My floor has showers, but thankfully the ICU doesn't...and I say that because the non-intubated patients in the ICU are usually the ones who are ticking time bombs!

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Specializes in Critical Care.
I spoke to my manager about this topic. She said having a patient sign an AMA form prior to go downstairs is not even considered legal. We cannot force a patient to sign an AMA form. The form we have them sign on admission states that if anything happens to them while they are off the floor (unless they go down for a test or something), we are not responsible. We can't have patients signing AMA forms.

You can't force a patient to sign an AMA form when discharging themselves either, legally there's no difference between asking a patient to acknowledge AMA prior to discharge or going downstairs.

After an "incident" at my hospital we now have AMA forms for discharge and for refusing treatments or other orders. This was at the specific direction of lawyers and they should know what might and might not be legal.

Here's the definition of AMA from eHealth:

"To document that you have been given the option of obtaining a recommended treatment or test and have chosen not to, you may be asked to sign an Against Medical Advice (AMA) form to protect the health care provider from legal liability for not providing the disputed treatment. Refusing a test, treatment, or procedure does not necessarily mean that you are refusing all care. The next best treatment should always be offered to anyone who refuses the recommended care."

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Does anyone have a copy of their hospital policy they could share?

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