Policy Re; AMA

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I have a resident that says he's signing out tomorrow (AMA). My question is, do we give him a discharge summary, or just his RX ? The last time a resident signed out AMA, all the departments filled out a discharge summary. My new DON said we only need to give him his Rx then call APS after he leaves. When I asked her why we wouldnt fill out the D/C Summary she said because if we do, then it looks like we are agreeing to the D/C. In my opinion, even though he's leaving AMA shouldnt we try to make it as safe as possible , which would include a summary Re; any follow up appointments, wt.bearing status recommended diet ect? I looked for the REGS reguarding AMA Discharges but was unable to fine one. How d other facilities handle AMA's, Any input would be greatly appreciated .

Thank You in advance for your jelp :)

Christine

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Specializes in Dialysis.

When we had residents leave AMA we didnt even give them scripts.... they we alert and oriented and were given the consequences of signing out AMA

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Specializes in Gerontology, Med surg, Home Health.

If someone signs out AMA, we give them nothing....no meds, no scripts, no services. They sign a form saying they understand. Then we put them on the "Do not EVER readmit" list.

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thank you for the replies. when the very first DON was there, thats exactly what she said... they get nothing. as time went on and our DON's changed, so did the "policy" (its in quotes because I cant find a policy on AMA anywhere !! :nono: OMG....) I brought this issue up in morning report again today and the DON is still saying we give them Rx, and D/C summary. The SW tried to explain to her, they should get nothing. No Rx, no D/C summary.. NOTHING. I looked on line at DOH , but cant seem to find anything. Does anyone know where I migght be able to find a regulation reguarding AMA , or is it just a facility decision ?

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Specializes in Gerontology, Med surg, Home Health.

I've never seen a regulation regarding AMA, but I can tell you I've worked in 9 different facilities and the policy was always the same. In order to get home care, there has to be a doctor's order

If you send meds home without an order, that is illegal. If the doctor doesn't approve of the discharge, there is NO order and therefore no home care. We do a discharge summary as part of the continuum of care, but with an AMA, the care stops at the door.

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Specializes in retired LTC.
I've never seen a regulation regarding AMA, but I can tell you I've worked in 9 different facilities and the policy was always the same. In order to get home care, there has to be a doctor's order

If you send meds home without an order, that is illegal. If the doctor doesn't approve of the discharge, there is NO order and therefore no home care. We do a discharge summary as part of the continuum of care, but with an AMA, the care stops at the door.

Your explanation seems to be the most logical I've seen.

In my past jobs, we've done as you; but in my explanations to the pt I like to include that I understand that insurances might balk at covering costs for the hospital stay. That the pt may then be responsible for the bill seems to have deterred the decision to leave at times.

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Yep...exactly as Capecod stated. I've had a few AMAs over the last year or so. They get nothing to leave with. I also inform them that any care, meds, treatments etc that they got won't be paid for while they were in the LTC.

Quite a few people came in thinking it woudl be different than what it was...doctors there 24/7, cafeteria food, wifi (we now have it) or the rooms were too hot/ cold/ small etc.

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Thanks for all the comments. I spoke w the DON about AMA , and how other facilities deal w/ it. She still insists , and ill quote, " When a resident wants to leave AMA, we still need to keep them as safe as possible. Which means EDUCATE, EDUCATE, EDUCATE! If the're not here on med a then give them there meds, do the referral to home care and call APS. If the home care agency doesn't pick up the case, at least we can say we tried to keep them as safe as possible despite education !" I appreciate all the comments and agree with all of you. :) Thank you again

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