Re: Informed refusal of ambulance transfer

[Guest guest]

Just out of curiosity why would it matter? Once refusal is signed and properly

informed they assume care for themselves (yes there are always loopholes to

legally) but once they refuse AMA who says they are really gonna go to the ED.

Not knocking you at all just curious, just sounds like one more piece of paper

to have to keep track of.

-Chris

Sorry for the spelling and punctuation this was typed on the tiny keyboard on my

iPhone

> We have had a few instances lately where our ED physicians have recommended

> transfer by ambulance and the patient/parent has refused and will go by POV

> instead. We have a refusal form for tests/treatment (this is not a leaving

AMA

> form but just refusing specific care items) but our CNO wants something

specific

> for these instances. Do you know of any hospitals with such a form/policy?

>

> I would imagine something such as:

> I refuse transfer to ________ hospital by ___ground ambulance _____Air

> ambulance. I will instead go by privately owned conveyance (my own car).

>

> I understand that my provider has prescribed EMS transfer for the following

> reasons: speed, patient monitoring, medications, oxygen, safety, bypassing the

> triage process at the receiving hospital, ___________.

> I understand and accept all potential risks and/or complications, including,

but

> not limited to: death, disability, pain, worsening of condition, shortness of

> breath, ________________.

> I understand and acknowledge that if I go by my own transport that I am

> accepting responsibility to carry and deliver the required paperwork to

complete

> the transfer. I understand that at the receiving facility I may be delayed in

> accomplishing triage and ultimate definitive care and this may be detrimental

to

> mine, or my loved one's care, comfort and final outcome.

>

> I understand and acknowledge that the staff of XYZ hospital have explained

this

> to me, feel that I have understood all items and have the mental capabilities

to

> understand all risks and complications, and have offered to answer any and all

> questions.

>

> I understand and acknowledge that if I change my mind I may tell staff right

> now! I also understand and acknowledge that if circumstances arise while

> driving to the receiving facility that I should immediately stop and call 911.

> If I do call 911, I may not be taken to the designated receiving hospital if

in

> the judgement of the responding agency it would be detrimental to the health

of

> me or my loved one to continue that transport.

>

> Thoughts? If anyone has such a form, I'd love to see it.

>

> Don

>

>

>

[Guest guest]

Sorry i think I initially mis-understood is this for an EMS provider or

hospital?

-Chris

Sorry for the spelling and punctuation this was typed on the tiny keyboard on my

iPhone

> We have had a few instances lately where our ED physicians have recommended

> transfer by ambulance and the patient/parent has refused and will go by POV

> instead. We have a refusal form for tests/treatment (this is not a leaving

AMA

> form but just refusing specific care items) but our CNO wants something

specific

> for these instances. Do you know of any hospitals with such a form/policy?

>

> I would imagine something such as:

> I refuse transfer to ________ hospital by ___ground ambulance _____Air

> ambulance. I will instead go by privately owned conveyance (my own car).

>

> I understand that my provider has prescribed EMS transfer for the following

> reasons: speed, patient monitoring, medications, oxygen, safety, bypassing the

> triage process at the receiving hospital, ___________.

> I understand and accept all potential risks and/or complications, including,

but

> not limited to: death, disability, pain, worsening of condition, shortness of

> breath, ________________.

> I understand and acknowledge that if I go by my own transport that I am

> accepting responsibility to carry and deliver the required paperwork to

complete

> the transfer. I understand that at the receiving facility I may be delayed in

> accomplishing triage and ultimate definitive care and this may be detrimental

to

> mine, or my loved one's care, comfort and final outcome.

>

> I understand and acknowledge that the staff of XYZ hospital have explained

this

> to me, feel that I have understood all items and have the mental capabilities

to

> understand all risks and complications, and have offered to answer any and all

> questions.

>

> I understand and acknowledge that if I change my mind I may tell staff right

> now! I also understand and acknowledge that if circumstances arise while

> driving to the receiving facility that I should immediately stop and call 911.

> If I do call 911, I may not be taken to the designated receiving hospital if

in

> the judgement of the responding agency it would be detrimental to the health

of

> me or my loved one to continue that transport.

>

> Thoughts? If anyone has such a form, I'd love to see it.

>

> Don

>

>

>

[Guest guest]

Would be for hospitals that are transferring and feel EMS is best way to go, but

patient refuses. I know most here are pre-hospital exclusively, but many also

work in hospitals too.

>

> > We have had a few instances lately where our ED physicians have recommended

> > transfer by ambulance and the patient/parent has refused and will go by POV

> > instead. We have a refusal form for tests/treatment (this is not a leaving

AMA

> > form but just refusing specific care items) but our CNO wants something

specific

> > for these instances. Do you know of any hospitals with such a form/policy?

> >

> > I would imagine something such as:

> > I refuse transfer to ________ hospital by ___ground ambulance _____Air

> > ambulance. I will instead go by privately owned conveyance (my own car).

> >

> > I understand that my provider has prescribed EMS transfer for the following

> > reasons: speed, patient monitoring, medications, oxygen, safety, bypassing

the

> > triage process at the receiving hospital, ___________.

> > I understand and accept all potential risks and/or complications, including,

but

> > not limited to: death, disability, pain, worsening of condition, shortness

of

> > breath, ________________.

> > I understand and acknowledge that if I go by my own transport that I am

> > accepting responsibility to carry and deliver the required paperwork to

complete

> > the transfer. I understand that at the receiving facility I may be delayed

in

> > accomplishing triage and ultimate definitive care and this may be

detrimental to

> > mine, or my loved one's care, comfort and final outcome.

> >

> > I understand and acknowledge that the staff of XYZ hospital have explained

this

> > to me, feel that I have understood all items and have the mental

capabilities to

> > understand all risks and complications, and have offered to answer any and

all

> > questions.

> >

> > I understand and acknowledge that if I change my mind I may tell staff right

> > now! I also understand and acknowledge that if circumstances arise while

> > driving to the receiving facility that I should immediately stop and call

911.

> > If I do call 911, I may not be taken to the designated receiving hospital if

in

> > the judgement of the responding agency it would be detrimental to the health

of

> > me or my loved one to continue that transport.

> >

> > Thoughts? If anyone has such a form, I'd love to see it.

> >

> > Don

> >

> >

> >

[Guest guest]

Good questions. A one sized fits all just isn't right. I have patients who

refuse a test or treatment, but not everything. In those cases, it is best to

do what you can and have them understand that the test or treatment is really

important by having a special informed refusal for that.

In my 20+ years, I have also found that often we treat AMAs as a do what I say

or get the hell out situation. Oh yes, and don't come back or call back. That

is WRONG! we must take the time to explain why everything is important (if it

is) and document they do understand that, have mental capacity to understand and

make the decision, and give them MANY chances to change their minds.

I do understand not wanting another form, in hospital or pre-hospital, but have

you looked at yours and your partners' documentation of these? I have looked at

lots, and we don't do them well, at all!

>

> > We have had a few instances lately where our ED physicians have recommended

> > transfer by ambulance and the patient/parent has refused and will go by POV

> > instead. We have a refusal form for tests/treatment (this is not a leaving

AMA

> > form but just refusing specific care items) but our CNO wants something

specific

> > for these instances. Do you know of any hospitals with such a form/policy?

> >

> > I would imagine something such as:

> > I refuse transfer to ________ hospital by ___ground ambulance _____Air

> > ambulance. I will instead go by privately owned conveyance (my own car).

> >

> > I understand that my provider has prescribed EMS transfer for the following

> > reasons: speed, patient monitoring, medications, oxygen, safety, bypassing

the

> > triage process at the receiving hospital, ___________.

> > I understand and accept all potential risks and/or complications, including,

but

> > not limited to: death, disability, pain, worsening of condition, shortness

of

> > breath, ________________.

> > I understand and acknowledge that if I go by my own transport that I am

> > accepting responsibility to carry and deliver the required paperwork to

complete

> > the transfer. I understand that at the receiving facility I may be delayed

in

> > accomplishing triage and ultimate definitive care and this may be

detrimental to

> > mine, or my loved one's care, comfort and final outcome.

> >

> > I understand and acknowledge that the staff of XYZ hospital have explained

this

> > to me, feel that I have understood all items and have the mental

capabilities to

> > understand all risks and complications, and have offered to answer any and

all

> > questions.

> >

> > I understand and acknowledge that if I change my mind I may tell staff right

> > now! I also understand and acknowledge that if circumstances arise while

> > driving to the receiving facility that I should immediately stop and call

911.

> > If I do call 911, I may not be taken to the designated receiving hospital if

in

> > the judgement of the responding agency it would be detrimental to the health

of

> > me or my loved one to continue that transport.

> >

> > Thoughts? If anyone has such a form, I'd love to see it.

> >

> > Don

> >

> >

> >

[Guest guest]

A valid refusal form must have the following ingredients:

Factual documentation that the patient possesses the present mental capacity to

understand the nature of his condition, the reasonably foreseeable consequences

of refusal, his understanding of those consequences, and that so knowing and

understanding, he makes a conscious decision to refuse.

Conclusions such as " patient is awake and alert and oriented " prove nothing

other than the writer's conclusions.

Recitations such as " the consequences of refusal were explained to the patient

and he understood them " are worthless since they are mere conclusions. The

information given must be specific and written clearly.

The patient's understanding is documented by having him repeat back to the

caregiver what he understands the possible consequences to be, and that he

willingly accepts them. This is best done by having the patient write his

understanding and decision in his own handwriting.

A checklist based upon Folstein's Mini-Mental Status Exam can be used to

demonstrate present mental capacity.

Also you must document any mentation altering drugs the patient has on board and

overcome any questions about ability to make decisions based on questions and

answers.

Some of the language used in consent forms for surgery can be borrowed for a

form like this.

But the secret is documenting facts that show anyone reading the refusal that

the patient had the requisite capacity and that all the elements are there.

GG

Re: Re: Informed refusal of ambulance transfer

Maybe when Gene Gandy checks his email, he'll be kind enough to repost his

suggestions on what's needed for refusal of care.

I believe that he's got something that might cover this already in the can.

ck

In a message dated 05/17/11 11:08:44 Central Daylight Time,

phillipsdo@... writes:

Good questions. A one sized fits all just isn't right. I have patients

who refuse a test or treatment, but not everything. In those cases, it is

best to do what you can and have them understand that the test or treatment

is really important by having a special informed refusal for that.

In my 20+ years, I have also found that often we treat AMAs as a do what I

say or get the hell out situation. Oh yes, and don't come back or call

back. That is WRONG! we must take the time to explain why everything is

important (if it is) and document they do understand that, have mental capacity

to understand and make the decision, and give them MANY chances to change

their minds.

I do understand not wanting another form, in hospital or pre-hospital, but

have you looked at yours and your partners' documentation of these? I have

looked at lots, and we don't do them well, at all!

>

> > We have had a few instances lately where our ED physicians have

recommended

> > transfer by ambulance and the patient/parent has refused and will go

by POV

> > instead. We have a refusal form for tests/treatment (this is not a

leaving AMA

> > form but just refusing specific care items) but our CNO wants

something specific

> > for these instances. Do you know of any hospitals with such a

form/policy?

> >

> > I would imagine something such as:

> > I refuse transfer to ________ hospital by ___ground ambulance _____Air

> > ambulance. I will instead go by privately owned conveyance (my own

car).

> >

> > I understand that my provider has prescribed EMS transfer for the

following

> > reasons: speed, patient monitoring, medications, oxygen, safety,

bypassing the

> > triage process at the receiving hospital, ___________.

> > I understand and accept all potential risks and/or complications,

including, but

> > not limited to: death, disability, pain, worsening of condition,

shortness of

> > breath, ________________.

> > I understand and acknowledge that if I go by my own transport that I

am

> > accepting responsibility to carry and deliver the required paperwork

to complete

> > the transfer. I understand that at the receiving facility I may be

delayed in

> > accomplishing triage and ultimate definitive care and this may be

detrimental to

> > mine, or my loved one's care, comfort and final outcome.

> >

> > I understand and acknowledge that the staff of XYZ hospital have

explained this

> > to me, feel that I have understood all items and have the mental

capabilities to

> > understand all risks and complications, and have offered to answer any

and all

> > questions.

> >

> > I understand and acknowledge that if I change my mind I may tell staff

right

> > now! I also understand and acknowledge that if circumstances arise

while

> > driving to the receiving facility that I should immediately stop and

call 911.

> > If I do call 911, I may not be taken to the designated receiving

hospital if in

> > the judgement of the responding agency it would be detrimental to the

health of

> > me or my loved one to continue that transport.

> >

> > Thoughts? If anyone has such a form, I'd love to see it.

> >

> > Don

> >

> >

> > [Non-text portions of this message have been removed]

> >

> >

> >

> > ------------------------------------

> >

> >