Leaving Against Medical Advice

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Translational Research for Practice and Populations
Frances Hoffler
Western Governors University


January 30, 2015

Translational Research for Practice and Populations A. Identify a current nursing practice within your healthcare setting that requires change.

Emergency nurses must manage a variety of choices for patient departure from emergency departments. Typical choices of patient departure from emergency departments include admitted, transferred, discharged home, and discharge against medical advice (DAMA). Often, DAMA is further broken into subcategories for documentation purposes, such as left without triage, left without or before seeing the physician, left before treatment and left against medical advice. Discharged against medical advice can be defined as a situation in which a patient makes the choice to leave a hospital prior to official discharge from treatment by the attending physician (Kraut, et al., 2013). DAMA is also known as a form of self-discharge. An alternative term used by some is left against medical advice (LAMA).
Leaving a medical facility against a physician’s advice puts a patient at risk for untreated or incompletely treated medical issues, increases the need for subsequent readmission or visits to emergency departments and increases the risk of mortality. DAMA presents a dilemma not only to the attending physician but to the nursing staff caring for the patient. Ethically and legally, patients do have the right to agree to or retract consent for medical treatment; however the nursing management of DAMA is much more complicated and multi-faceted than the patient’s right to consent or dissent to treatment. Problems occur with the understanding of the different types of self-discharge from emergency departments, as well as how best to document such encounters and ultimately, how to improve upon current nursing
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