When a patient signs out AMA...

[Lev]

Every so often, I have a patient who signs out AMA for the dumbest reason when they really really should stay in the hospital.

Example: We just shot your thighs with epi about 30 minutes ago for the anaphylactic reaction you're having and you want to leave??

Another example: Came in with shortness of breath. Oh your troponin is bumped...you could be having a heart attack or have a blood clot in your lungs and you want to leave??

Both true examples.

These people make me so mad.

For your typical ER patient who doesn't really need to be in the ER, is yelling at everyone and demanding things, sure sign your AMA form and get out of my face. Bye!

However, when they actually have a legit reason to be observed in the ER/stay in the hospital overnight, the nurse in me kicks in and I don't care about how nasty and demanding they've been. I just want them to be helped. And they just don't care. And that is why I get mad.

And you know what happens then? Whatever professional attitude I've had with them til that point just disappears. I told patient #1 she was being "stupid." Because she was. The doc was like "we just saved her life and she wants to leave?" I get short with them and my annoyance shows. This is after a conversation about how they can die and we won't be responsible. I know this isn't professional and I want to change this behavior.

So what do I do?

[Mia415]

We all struggle with the frustration of those who cannot be helped sometimes. Lots of good advice here. I would add, instead of asking whats wrong with this person, instead ask what has happened to this person? What is happening in their life right now to create this thought process or world view. Not always, but sometimes its just a gentle question can give you good insight, such as "Id like to better understand why you feel this way Mr. ____. Can you tell me what specifically makes you uncomfortable about the doctors treatment recommendations? Maybe I can address some of your concerns or answer some questions?"

Do they fully understand what is happening and what might happen? Have they had a really negative experience with hospitals or doctors? Are they worried about getting home to pick up their kids? Do they have to get to work or risk being fired from work? Can you identify some other social or emotional, or mental health factor that may contribute to their illogical actions? I just try to convey that I am concerned about their health and wellbeing, and try to assess their understanding of their condition, and do my best to explain how the treatment works in their body, or why they need to be observed, and consequences of declining care, and risk reduction advice. Then ultimately, you just gotta accept that thats all you can do! I can tell you my particular pet peeve that I struggle with is working with domestic violence victims who refuse to leave the relationship and stay with the abuser. grrrr! anyways hope that helps! p.s. I'm not an ER nurse - I know often you may not have time for these conversations with the patient! I am in public health and I am fortunate to have long conversations with people, inlcuding their attitudes towards health practices and treatment plans. everyone has a reason for the choices they make about their health. just try to figure out their perspective - even if you disagree with it, maybe you can meet them where they are at and compromise on a treatment plan. good luck! i think its great you are asking this question.

[hppygr8ful, ASN, RN, EMT-I]

Our AMA Forms read Your condition is not stable at times and leaving the facility now places you at risk for negative outs (Insert list here) up to and including death. By signing this form you and all your family members agree that the Hospital and all staff members involved in your treatment will not be held liable for any outcome that may occur.

Hppy

[sissiesmama, ASN, RN]

I'd always heard this too about the insurance might not pay if the patient left AMA.

Had to find out myself in July of this year. I have a history of an ASD repair, a CVA and an MI - had a syncopal episode at church one Sunday. Was going to be admitted for prob 3 days of tests - made the decision to leave AMA because my Dad was in ICU in south Louisiana - about a 5 hour drive from our city.

That would be the last chance to see him again - hubby and I made it there about 12 hours before we lost him.

Anne, RNC

Thankfully, insurance did pay, we were expecting a HUGE bill!