i recently worked a shift monday and walked in to a patient who wanted to sign out AMA, his INR was 4.5 and explained to him that i didnt think it was a good idea and to stay one more night, so we can check his levels in the morning. He didnt buy it...no i work on a tele unit.
he signed the AMA form i told him no coumadin and to see his md for repeat labs on wednesday per the physicans orders...all documented real well he left approx at 5 pm
anyway.....i find out from my supervisor that morning(tuesday) around 4 am (yes i worked a double) that he came into the ER after a fall in his bathroom, with a HIGE sub dural hematoma, was intubated and shipped to a different facility for emergent operation.
i look in the paper today (thursday) and saw he died later that day on wednesday
CAN WE TALK ABOUT ? LAWSUIT! I AM FREAKING OUT HERE....any advice anyone ever encounter this i have had people sign out ama before...but now a death related how good is this AMA form for legallity?
I think that he signed the papers, was Ox3. It's hospital, not prison. We can't hold patients against their will, even if it was in their best interest.
FWIW, we always list "death" on the possible outcomes of leaving AMA - even for minor injuries.
I'm sorry that you feel bad, but you are not responsible for this person once they leave your care - especially by their own choosing.
Call your union rep if you have one, check with risk management and make sure your malpractice insurance is up to date. There is no need for you to sacrifice yourself over this one.
Sorry, fail to see why you're "freaking out". You warned him of the consequences of his leaving AMA (remember what the letters stand for?). You documented (I'm making an assumption, hope to heck you did) that he wanted to leave anyway. End of story.
A grown adult who is of sound mind and not stating a suicidal intention is free to walk out of any hospital in America. A nurse is not a prison guard, and they are not incarcerated. If he does not wish to continue his medical treatment, your obligation is to tell him his options, why he should stay, and show him the door if he refuses.
Our forms list "death" as a possible outcome of the patient's decision to leave, and I UNDERLINE it.
He's the one at fault for his death; stupidity is HIS, not yours.
Poor guy, I am sure he knew all the risks with the teaching, he probably figured nothing would happen, who knew he would just happen to fall. Yes, it is very sad but he could also have stayed another day and walked out of the hospital to get hit by a car etc.
The AMA is just that "against medical advice", everyone has the right to refuse treatment and they sign they are aware of the risks. I agree however, it wouldn't hurt to notify Risk Management.
Why would you be sued if he was competent to make his own decisions and knew the risks associated with leaving?! We can't force people to stay in the hospital where sometimes they very well belong. Sometimes poor choices come with poor outcomes. You did nothing wrong.
Why would you be sued if he was competent to make his own decisions and knew the risks associated with leaving?!
Because people will sue for any and no reason.
Doesn't mean they will prevail, but the OP may have to defend herself.
One can only hope that this man's family will accept his responsibility for his own actions and death and not file suit, but it is wise to be prepared for the opposite.
Doesn't mean they will prevail, but the OP may have to defend herself.
One can only hope that this man's family will accept his responsibility for his own actions and death and not file suit, but it is wise to be prepared for the opposite.
True but in this case with good documentation done by the OP and a signed AMA form I would think they'd prevail. I too hope the family accepts his decision and realizes that with bad decisions sometimes come bad outcomes.
Sad thing is people often want it both ways. They want to be able to sign out AMA and then wanting to hold us accountable when something goes wrong. It's unfair and unjust. We even include death as one of the bad outcomes on our form so patients see how dire it can be.
I understand your feeling bad and worrying about a lawsuit, I would be too.
What were the circumstances of his original admission? What brought him to the hospital? Did you or another RN document that he was A&Ox3? Was there any ETOH on board? Disorientation & ETOH would be worrisome. Did the AMA form address the possible harm that could come to him being dischaged AMA?
I hope all works out and remember that most people do NOT sue.
Sorry, fail to see why you're "freaking out". You warned him of the consequences of his leaving AMA (remember what the letters stand for?). You documented (I'm making an assumption, hope to heck you did) that he wanted to leave anyway. End of story.
A grown adult who is of sound mind and not stating a suicidal intention is free to walk out of any hospital in America. A nurse is not a prison guard, and they are not incarcerated. If he does not wish to continue his medical treatment, your obligation is to tell him his options, why he should stay, and show him the door if he refuses.
Our forms list "death" as a possible outcome of the patient's decision to leave, and I UNDERLINE it.
He's the one at fault for his death; stupidity is HIS, not yours.
All of the above is true, but people have one similar lawsuits before. I too would be worried. I read on this website of a cardiac pt. who did not follow medical advise. His cardiologist had to pay 50% of the damages the family was seeking. The jury found the cardiologist 50% culpible despite the fact that the patient failed to get a stress test and left AMA several times. A good lawyer can go very far despite evidence.
Whether his INR was high or not, a bathroom fall can result in a head injury/subdural hematoma. You told him to hold coumadin and to follow up. The guy walked out with this info. Document well and you should be covered.
and he signed out AMA. why is it your fault? i understand your worrying, but then you must be able to share the burden of worry w/ his MD no? or is it simply b/c hospitals would pick the doc out the frying pan and leave the nurse to fry? why would it or should it all fall on the nurse's shoulders? he was competent!
what about frivolous lawsuits? what would they argue you are guilty of? advising a person of sound mind of the risks of his condition, which by the way, being on coumadin predisposes a pt. to increased risks of bleeding anyway. he signed an AMA form. will the family claim he didnt know what he was signing? then they need to prove that. is there a court order documenting his incompetence?
it makes me so angry the fear-mongering that goes on due to an overly litiguous society.
show me gross negligence that you contributed to. sounds like what you did is what any prudent nurse would do. isnt that the point?
Blee O'Myacin, BSN, RN
721 Posts
I think that he signed the papers, was Ox3. It's hospital, not prison. We can't hold patients against their will, even if it was in their best interest.
FWIW, we always list "death" on the possible outcomes of leaving AMA - even for minor injuries.
I'm sorry that you feel bad, but you are not responsible for this person once they leave your care - especially by their own choosing.
Call your union rep if you have one, check with risk management and make sure your malpractice insurance is up to date. There is no need for you to sacrifice yourself over this one.
Blee