I've only come across this incident once, last week as a nursing student. I had a patient who had a wound that was stitched. 2 different doctors worked with the patient. one said told the patient that they need to stay for further treatment and the other said the wound looks fine and they can go home.
eventually we had them sign papers so they could leave. the patient was stabled, wound healed really nice too.
my question is, what if a patient is being hospitalized for like a stroke, heart attack, something serious like that, and they refuse any further treatment after being hospitalized for days?
some may refuse because of financial issues. I would think maybe getting social work involved, PT, OT, dietician, etc. but isn't the cost for home health care MORE than being hospitalized? because its by the hour, who's visiting, how often they're visiting, etc?
as an advocate, that is what I would do, get social work involved, PT, OT if they're going to have issues getting around and financial issues. but I don't know much about that stuff (what to do if patients refuse further treatment and just want to go home). I'm not going to convince them, but educate them as much as possible and if they still refuse, they could sign papers and idk what else from there?
You literally have no legal power to detain a person who is hell bent on leaving. If you've paged the almighty attending but they aren't calling you back, the pt is well within their right to just leave. Do you really not feel qualified to assess mentation and gait?
Or, in another scenario, there's a doc right there. He says the pt isn't capacitated, you think they are. Doc says hold him down and give him versed. Are you going to defer to the physician?
I've read on other similar posts that if a patient signs an AMA form insurance won't cover their hospital bill. Not 100% sure if it's true? Health insurance is such a crazy upside down and backwards mess!
I was under the impression that this was something of a myth, although I can't say for certain.
I would think maybe getting social work involved, PT, OT, dietician, etc. but isn't the cost for home health care MORE than being hospitalized? because its by the hour, who's visiting, how often they're visiting, etc?
In general, the push these days is to treat a patient in as close to the home setting as possible. As in, don't hospitalize them if they can be treated outpatient or with home health.
As far as cost, think of all the overhead required for a hospital. Home health may actually be most cost-effective, although the financial effect on the patient will still be determined by insurance coverage/non-coverage of different types of care.
I've read on other similar posts that if a patient signs an AMA form insurance won't cover their hospital bill. Not 100% sure if it's true? Health insurance is such a crazy upside down and backwards mess!
This is at least 500% false.
That said, contrary to what the posters have said, there are some instances in which you can, without question, 100% prevent the patient from leaving. However, the patient you describe in your scenario does not meet any requirements that would allow this to happen (based on what you've said).
You have to get to the bottom of why the patient is wanting to leave and address their fears and/or concerns. You have to be an advocate for your patient and if they really do want to go home they have the right to do so. You as the nurse contact the physician and medical support staff to help with the discharge of the patient. Some patients I know are scared due to financial reasons or other things happening at their home. What is difficult is when those types of patients need to stay in the hospital to recover but they really are stressed all the time and want to leave against medical advice. Then they can go home after you have educated them on the discharge plan of care.
The whole AMA is a situation I've been wondering about lately.
I'm a student nurse and we had a pt trying to leave AMA. She was very agitated. I don't know anything about her medical situation since she was not my patient, but I know they didn't want her to leave. It was an hour long ordeal with security involved. She got a bit physical during this time. Lots of screaming and swearing too. Her physician was present. Next thing I knew, she was sedated and in 4-point restraints.
The situation seemed a bit borderline to me. It has me wondering under what circumstances this would be okay. Should the people involved in this case be worried about a lawsuit?
The whole AMA is a situation I've been wondering about lately.
I'm a student nurse and we had a pt trying to leave AMA. She was very agitated. I don't know anything about her medical situation since she was not my patient, but I know they didn't want her to leave. It was an hour long ordeal with security involved. She got a bit physical during this time. Lots of screaming and swearing too. Her physician was present. Next thing I knew, she was sedated and in 4-point restraints.
The situation seemed a bit borderline to me. It has me wondering under what circumstances this would be okay. Should the people involved in this case be worried about a lawsuit?
It really depends if she was certified or not. If she had been deemed mentally incompetent, then yes, we have the power to restrain them and prevent them from leaving and would be considered liable if they left and something happened to them. In BC, I believe they can be held for 24 hrs with one physicians signature certifying them. However, to keep them longer, a second physicians signature is required.
Without more details of the patient history, it's almost impossible to say if they were legally covered in sedating and restraining the patient.
I've had patients kept when they wanted to leave before. There's a legal process to it, but it happens. We called the attending down, they got psych involved, and then papers were signed by the physician and sent to the courts.
So it happens. When a patient wants to leave AMA, I call the physcian and they explain the ramifications of leaving AMA. 90% of the time, they stay.
You notify the doctor, notify your charge and in my old hospital the house as well, document everything and tell them to call their ride. Some patients act like I'm supposed to care if they decide to leave, nope, so long.
If the patient wants to go, you don't have to help them. Yes, remove the medical equipment, but you don't need to assist them with dressing, call them a cab, or get them a wheelchair. It's not medically indicated for them to leave, you don't have to be an accessory to their decision.
A coherent patient will phone a friend, or do it themselves. An incapacitated patient will cuss and swear, and generally bring the house down. That buys time, and evidence of their incapacity, and the doc has more of a chance to get to the bedside. You might be able to negotiate another dose of medication, or get more time to talk about their resources and the consequences of their decision if you slow them down a bit.
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elkpark
14,633 Posts
That is true once it has been determined that the individual is capable of making a "cogent" decision to leave.