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?
Specializes in Psychiatry, Community, Nurse Manager, hospice.
In my experience, it would be up to the physician to make a determination about whether it is appropriate to detain someone in order for an assessment of her/his capacity to choose to leave AMA to be done. The attending physician may be comfortable that the person has the capacity to make that decision, the physician may feel that the person lacks the capacity to make an informed decision about leaving and can therefore be detained against her/his will, or the physician may want the person detained long enough for a determination about capacity to be made.
In psych, yes. Because before patients come in, they are either signing themselves in as voluntary mental health patients or are committed as involuntary mental health patients.
So you already have a basis for questioning competency.
But in other settings, I don't think this same principle holds. You can't detain a patient before you've made a decision on competency, even just to sign an AMA form. Technically they don't have to sign the form to walk out the door. You would have to prove incompetency first.
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 always a bit skeptical, so I had a look.
A great example of a nursing myth. Ask around, and I bet most coworkers will be quite confidently wrong on this.
I've found too that a lot of staff are under the impression that insurance won't pay if pt leaves AMA. I used to do insurance billing. It comes down to if billing is submitted with appropriate coding, there won't even be a question of coverage. If something isn't clear or substantiated in the billing, the documentation to prove that treatment is medically necessary & appropriate is submitted. There isn't anything sent to insurance that says, "Oh, and by the way, pt left AMA."
You can't detain a patient before you've made a decision on competency, even just to sign an AMA form. Technically they don't have to sign the form to walk out the door. You would have to prove incompetency first.
Yes, you can. I work on the psychiatric consultation-liaison service of a large, well-known academic medical center, and we're the people who get called to make those determinations (when it's not easily apparent to the attending physician(s), or when the attendings just want to cover their butts). If someone wants to refuse treatment and leave AMA, it is up to the attending physician(s) to determine whether or not the individual, in the physician's considered professional opinion, has the mental capacity to make an informed decision to leave. The attending may a) be confident that the person has the capacity to choose to leave, and let the person leave, b) be confident that the individual lacks the capacity to make an informed choice, and, in that case, the individual can be detained against her/his well, or c) want further evaluation of the individual's capacity to make that choice, in which case the person can be detained in order for the attending physician to evaluate the person further or for a psychiatric evaluation to done.
No, people don't have to sign the AMA form if they don't want to. But it is perfectly legal to stop them from leaving in the setting of questions about their capacity to choose to leave, until those questions are resolved or a determination is made that the individual lacks the capacity to choose to leave (in which case, the individual can continue to be detained against her/his will). It happens all the time in hospitals all over the US.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Hi all.
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?
Why are they refusing? Talk to them and find out if possible. Do they have a family member at home who needs care? Are they concerned about the cost? Their insurance coverage runs out at the end of the month and today is the 31st? Social work may be able to help with these kinds of problems, but be sure to get the patient's physician in the loop. Are they refusing because they're approaching 72 hours without their drug of choice and they're starting to get twitchy? Evaluate them for signs and symptoms of impending withdrawal, then talk to the physician and explain the situation. The physician may order diazepam, lorazepam, an alcohol drip, a few cans of beer or the drug of choice for your facility. The physician should also explain to the patient and get them on board with the plan. (This is the most frequent reason I see patients with serious conditions suddenly want to go home. Although in certain localities, "harvesting my marijuana crop" is a close second.)
If, after you've evaluated the reason the patient wants to leave, assessed the patient, discussed the situation with the physician and involved the appropriate ancillary services they still want to go home, that's when you get out the AMA paperwork.
After the dust settles and the patient is gone, evaluate how things went and what you could do differently next time. And then think of whether this would be a good story to share on AN.
Yes, you can. I work on the psychiatric consultation-liaison service of a large, well-known academic medical center, and we're the people who get called to make those determinations (when it's not easily apparent to the attending physician(s), or when the attendings just want to cover their butts). If someone wants to refuse treatment and leave AMA, it is up to the attending physician(s) to determine whether or not the individual, in the physician's considered professional opinion, has the mental capacity to make an informed decision to leave. The attending may a) be confident that the person has the capacity to choose to leave, and let the person leave, b) be confident that the individual lacks the capacity to make an informed choice, and, in that case, the individual can be detained against her/his well, or c) want further evaluation of the individual's capacity to make that choice, in which case the person can be detained in order for the attending physician to evaluate the person further or for a psychiatric evaluation to done.
No, people don't have to sign the AMA form if they don't want to. But it is perfectly legal to stop them from leaving in the setting of questions about their capacity to choose to leave, until those questions are resolved or a determination is made that the individual lacks the capacity to choose to leave (in which case, the individual can continue to be detained against her/his will). It happens all the time in hospitals all over the US.
This tangent is a bit off the OP, but I am curious how this works.
Let's say that during my stay, I was considered competent. I signed consent, made decisions about my care, etc.
And, at some point, I decide to go home. I am told that I have to wait for a consult. I pull my IV, put on my own clothes, and walk toward the door while consult is being called. The nurses politely ask me to stay and just wait a few minutes until they can talk to the doc, or get the consult, or whatever the process is. I politely decline, and keep walking.
Does somebody physically stop me? I am determined to leave. Am I physically restrained? It seems that I have a legal right to leave, given that the hospital has not deemed me otherwise at that point. If nobody puts their hands on me, I am walking out. If somebody does put their hands on me, I will defend myself. Then what?
FolksBtrippin, BSN, RN
2,320 Posts
In psych, yes. Because before patients come in, they are either signing themselves in as voluntary mental health patients or are committed as involuntary mental health patients.
So you already have a basis for questioning competency.
But in other settings, I don't think this same principle holds. You can't detain a patient before you've made a decision on competency, even just to sign an AMA form. Technically they don't have to sign the form to walk out the door. You would have to prove incompetency first.