Patients Leaving Against Medical Advice (AMA)
Purpose: e.g., To describe process to be followed if patient decides to leave hospital
against medical advice (AMA) and to insure proper documentation of the event. Refer to
another policy if patient who lacks capacity attempts to leave AMA.
What is an AMA event (e.g., that it involves a competent patient (one with
capacity to consent, or non-consent), or a patient representative deciding to
leave, despite the fact that there is no discharge order from the physician).
Who will you train on this policy (e.g., nursing and medical staff, administrators)
Training to include strategies to respond to event.
Describe what staff should do if patient states that he/she intends to leave (e.g.,
immediately notify physician, ask patient to wait until doctor can speak with
patient; if patient does not want to wait to talk with physician, notify supervisor
and administration; give patient "informed refusal" info so patient understands
possible consequences of decision to leave.
If patient still wants to leave, what steps should be taken to increase patient safety
(arrange for transportation, medication, discharge instructions, what to do if
something goes wrong, encouragement to return if condition worsens, etc.).
Documentation: try to get patient to sign "AMA" form (e.g., CHA form 5-3) and
clearly document that he/she was informed of possible consequences and
encouraged to stay in hospital (call social services to discuss patient concerns if
desire to leave has to do with e.g., taking care of a pet); if patient won't sign form,
staff should sign it and indicate patient refusal to sign.
Describe what to do if discharge instructions and warnings cannot be given because
patient leaves too quickly.
Describe what to do if patient representative if making the decision where decision
will result in harm to patient (e.g., consider involving Elder Protective Services?)
Do you want an incident report even when there has been a "near miss."
Any follow-up with patient? (e.g. do you want staff to make follow-up phone call?)