Self-discharging patient Flashcards
The nurse in charge tells you that Miss Smith, a 28-year-old woman, who was admitted earlier today, wants to be discharged.
She was admitted with pyelonephritis and has been started on IV antibiotics.
She is telling the nursing staff she feels much better and needs to get home.
The nurse does not think Miss Smith should be allowed to leave as she still has several days left of treatment. He has asked you to come and speak with the patient.
. I could start by reading the notes and speaking with the nurse in charge. Ultimately I need to speak to the patient and find out why she wants to leave.
It may be that she feels much better with the first dose of antibiotics and it has not been explained fully to her that the antibiotics will be most effective if given over several days intravenously.
there may be legitimate reasons for why she wants to leave. For example, she may have young children. If so, who is looking after them? Is she concerned about work?
Prior to her leaving I will need to give her all of the facts about why we would advise she stays in hospital so that she is fully informed
I would ask her to return to the ambulatory care unit for review the following day. Although this might be difficult to arrange, I have a duty of care to the patient so I would do my best to facilitate this.
How do you assess capacity?
Understand the information relevant to the decision
Retain the information
Weigh up the information in the decision making process
Communicate the decision
The patient has capacity and wants to leave. Who else could help you with this situation?
contact my registrar to inform them of the situation and explain why I am concerned about the patient leaving. It may be that their greater experience in dealing with these kinds of situations may persuade the patient to stay.
I would also ask the patient if there were anyone she would like me to contact. Perhaps there is a family member who will be able to convince her to stay. However, I have to be careful that I do not break confidentiality and would only talk to the patient’s relatives if she gave me permission.
Do you still have a duty of care to the patient if she self-discharges?
. I would make sure that she understands what to look out for with regards to any signs of worsening infection
should seek medical help if she is deteriorating.
I can provide her with medication on discharge and make sure that she has follow-up arranged.
What would you communicate to her about the antibiotics?
patient understands the risks with not completing a full course of antibiotics. The likelihood of bacteria developing resistance to antibiotics increases if the full course is not given. If the patient were determined to leave then I would discuss the case with the microbiology team to see if there is an oral alternative.
