when pts leave AMA do you..........

[l.rae]

We seem to have conflicting views with the some of the MD's regarding our AMA policy. The way I understand it, once a pt has seen a MD and decides to leave AMA, there is no further treatment for this patient...no more meds, no RX to take home. When the pt signs the AMA paper, doesn't this nullify the permission to treat and end the status as a patient?..one of the MD's had a pt sign out AMA the other day because they refused a LP but continued to state "worst h/a ever"....The MD however. wanted the pt to have another dose of demerol and wrote RX's for this pt. I said to MD, why not just document pt refused px instead of AMA if you want to continue to treat?....she said she was not comfortable with this due to pt's statements, so I say I can't medicate her again and she shouldn't get RX to take with her....ended up having several nurses disagree, and unable to locate written policy. I maintain that once the AMA status is validated, our contract with the pt for medical/nursing care is void and therefore any further treatment or advice after that places the nurse or MD in a precarious predicament....as they are no longer considered a pt. What kind of policies do you have. Does anyone else ever face this situation and what do you do?.........thanks.............LR

[RainbowSkye]

Well, I don't know our official policy, but I have had doctors tell me that just because someone refuses a treatment or admission to the hospital doesn't mean that we don't offer them some other treatment and follow-up instructions/advice. Seems wise to me.

[l.rae]

Rainbow, are you equating refusing a proceedure or admission to AMA?....refusing these doesn't necesarrily mean the pt has to go AMA, Seems to me there should be a refusal of proceedure and an AMA form. If the DR wants to go on treating then they should do refusal of proceedure....when the pt's refusal makes the DR feel too uncomfortable to continue any other direction of medical treatment so that the DR designates the pt AMA...then why continue to treat...seems it would place the DR/nurse at risk....l don't mean not to give them follow up advice, like, "call a squad if cp comes back"...but l am talking about the specific theraputic instructions.....but several of the nurses said same as you,..l was not comfortable giving demerol after AMA was designated....thanks for your input...........LR

[canoehead, BSN, RN]

I agree that refsing a procedure does not equate with refusing care. I would have given pain medication, but would refuse to give a med that would make the underlying condition worse. I would also teach the pt and document that the pain med will just hide the symptoms, the HA is still there, and so is the illness, and that they could be getting progressively worse even though they feel better.

[Scooby365]

The fact that the patient is releasing us from liability because they are refusing either a procedure or admission should not mean that we don't do everything else in our power to treat the patient.

[JE1RN]

I SOMETIMES WAVE GOODBYE

[CMERN]

When our doctors have a patient as mentioned above well...they document pt refused Tx or procedure...the patient can then be continually monitored or recieve other options in treatment...IF..a patient signs OUT AMA...he/she is out....Bye see ya.....Had one just the other night...came for chest pain after EKG...refused all other tx (blood work etc.) Said she wasnt staying for the Cardiologist to come consult and said ahe wnated to go home....Fine ...Made her sign AMA..did Dc vitals...Explained risk... dr. documented for her to seek care from a cardiologist..documented his wishes too..all on the ama sheet ..and made her a copy...and said GOOD BYE...(tried to cover all butts) call it creative AMA but....no way I would have went back in and given her any meds to GO!!!

[CMERN]

For the H/A...pt....I would have told Doctor it aint an AMA...Its a refused procedure "document it". ... non-compliant even...I would tell DR. if ya want ME to medicate then the pt is going to stay and be monitored..IF YOU want to medicate..then write a script/ or give it your self.....If pt is leaving by choice at any point against your plan of care THEY ARE AMA>>> BYE okok ok im thru yappin:)

[l.rae]

Originally posted by CMERN

For the H/A...pt....I would have told Doctor it aint an AMA...Its a refused procedure "document it". ... non-compliant even...I would tell DR. if ya want ME to medicate then the pt is going to stay and be monitored..IF YOU want to medicate..then write a script/ or give it your self.....If pt is leaving by choice at any point against your plan of care THEY ARE AMA>>> BYE okok ok im thru yappin:)

that's pretty much what went down.....doc looked at me like l had 2 heads......oh well....LR

[RNFROG3, BSN, RN]

I. rae-- you are right on the money if AMA peperwork is signed pt. is outta there. If they refusse a procedure simply all the MD has to do id document they don't want the procedure. If they are uncomfortable treating them after that then the Md needs to document and either DC or treat another way. In no way is a refusal for a procedure or special tx equivlant to signing out AMA

[ERQueen]

Sometimes a physician will get a patient to sign AMA and then give them scripts anyway in our ER. I think this is for their liability. The AMA form states that the pt is leaving the hospital against the advice of a physician, and releases that physician and the hospital from liability if a bad outcome results from the pt not staying. That statement does not terminate further care if the MD still wants to help the pt out with symptomatic relief.

[mark_LD_RN]

refusing a tx is not leaving ama. IF a pt refues a tx care is still provided in other ways,but if patient leaves ama it effective ends alll tx as well as RX.