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?
He signed out AMA, you can't fix stupid. As long as all is documented you will be just fine. He fell in the bathroom and that was the cause of his injury, not his medical condition. Sure his blood being as thick as water and with about the same clotting factor didn't help but it didn't cause the injury.
Would you be just as worried if he was hit by a car and died?
I agree. Why we have to feel guilty as nurses for everything that happens to people? There are so many stupid, irresponsible people out there... There should be clear limits regarding those frivolous lawsuits.
Specializes in Community Health, Med-Surg, Home Health.
I see no legal danger either...as Roy stated, your responsibility ceased the MINUTE the ink was dry on the AMA. As long as you documented that you explained the risks, as well as his responses, then, hey...sorry to say, he sealed his own fate. Sorry it happened to him, though, ya know?
Did you contact the attending MD and get orders for this guy's AMA?
Did you have the patient sign the AMA form and provide him detailed discharge instructions about what could have and what he should do?
Was the patient in command of his faculties?
If you answered yes to all three of these things than take a deep breath and relax. You are in the clear.
People can make their own decisions. His decision, unfortunately, contributed to him dying a little sooner than necessary. Tragic, but it's his own darn fault. Not yours, the hospitals, the MDs or anyone elses.
Say a quick prayer for him and move on. Besides, people don't sue staff nurses. They sue facilities and anyone else with deep pockets cause they can pay.
I am so sorry you are feeling badly, but as stated over and over, it is not your fault. Would talking to a chaplain help you? Because of HIPAA, it would be better to get debriefed by someone in your hospital who prob. knows about the case by now. Hugs and prayers to you.
As pretty much all of the other posters have said, the patient can refuse treatment. Just make sure it is documented well.
I had a patient come in with an active MI, would not allow Retavase, or any clot busting meds. He had been going through a divorce, and made various statements like "I don't care if I die..." "I'd be better off dead". So here I am with an active MI, who would allow SL MTG, and Morphine, but nothing else. We call for a psyc eval, to cover our butts before he signed AMA paperwork. He was judged not to be suicidal. Doc and I explained the risks of leaving. That if he left, the next time we saw him would likely be in a body bag. He understood, signed the paperwork, and walked out.
The estrained wife found out, talked to him, convince hime to come back in, so about 2-3 hours later, he came back, he stated "I'm ready for those clot busting meds now" We explained that he passed the window of opportunity for that. We did put him on a heparin gtt - and noted his ST elevation was gone, the MI was over. He was admitted to ICU. I don't know how it ended up for him after that.
As another posted stated "you can't fix stupid". I know that's true, I tried.
So long as you followed your institutions AMA protocol, you've got nothing to worry about.
i want to thank all of you for your posts, a lot of my worry came from the fact that this has never happened before to me or any nurse i work with so i had no one to go to. i know you can fix stupid but i feel so bad for the family....he was such a good guy. i am mad at him FOR DOING THIS! I HATE when people sign AMA.....
anyway for an update....yes my manager was contacted by risk management, and assured them that we did everything possible for this man to stay, thank god my boss was there to witness it all....she told risk management to read the record and if there was any questions to call her.......my boss and i havent heard back...so i am assuming all the documentation was there!
i think i would have felt better to read my own notes after i found out this happened just for comfort value that everything was there....that is what i am mainly nervous about
also in talking with the family at his wake....they feel....that he must have had a sixth sense and known it was his time and wanted to die at home.....which is why he was so adamant about leaving....
Specializes in ICU of all kinds, CVICU, Cath Lab, ER..
First, you have no control over any one else's actions.....let go
Second, you can talk until you turn blue, if the patient is determined, and won't even listen (frequent reaction), LET GO!
Third, I offer to help them get home or contact a ride, whatever... this helps my sense of helplessness and means something (I think) to the patient.
By the way, what kind of orders does your doctor give an AMA...it's all about the orders (why the patient leaves)...doesn't make sense to me. Does he write: "patient may go AMA"??? Sorry, it just cracked me up when I read that!!!
Legally, as long as you informed him of the risks of his condition, I don't think you should be worried. All you can really do is make sure he is alert and oriented, not under the influence of narcotics or mind-altering meds at the time he signed the AMA, and to make sure that another person signed as a witness. We can't force people to make wise decisions. We can only attempt to lead them down that path and to help them be informed.
I once had a middle-aged female with an obviously fractured tib/fib (who was still attempting to bear weight on that leg!) sign out because she didn't have insurance. I spent as much time with her as I could to try to change her mind and to give her the possible and probable outcomes of her decisions. She would not listen. But you only have so much time. It would be great if we had more time to educate pts but it is not a reality in most healthcare settings.
First, you have no control over any one else's actions.....let go
Second, you can talk until you turn blue, if the patient is determined, and won't even listen (frequent reaction), LET GO!
Third, I offer to help them get home or contact a ride, whatever... this helps my sense of helplessness and means something (I think) to the patient.
By the way, what kind of orders does your doctor give an AMA...it's all about the orders (why the patient leaves)...doesn't make sense to me. Does he write: "patient may go AMA"??? Sorry, it just cracked me up when I read that!!!
no the physician isnt giving the order for discharge and the patient wants to leave the facilty for whatever reason he legally can sign a form that says he is leaving again medical advice.
MN BigJ
119 Posts
He signed out AMA, you can't fix stupid. As long as all is documented you will be just fine. He fell in the bathroom and that was the cause of his injury, not his medical condition. Sure his blood being as thick as water and with about the same clotting factor didn't help but it didn't cause the injury.
Would you be just as worried if he was hit by a car and died?