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Q&A: When a resident discharges against medical advice, should we send the medications that were ordered for him in the nursing home?

Q: When a resident discharges against medical advice, do we send the medications that were ordered in the nursing home for him/her? If so, does it matter if he/ she was receiving skilled or intermediate care? I have two thoughts… The first is that we do not have an order to send the resident home with medications because we do not have an order to discharge. The second is that the medications are already paid for. If the resident was receiving skilled care then the nursing home paid for them, but if the resident was receiving intermediate care, then the resident paid for them.

I know that way back in the day, we sent nothing home with the resident. However, residents’ rights have changed since then. 

A: ​This is a complex analysis that must be individualized for each resident.  Some of the considerations:

1.  Are there any specific state requirements related to AMA discharge and medications?  Each state has differing sets of requirements.
2.  What are the specific facility/company policies regarding AMA discharges?
3.  Are there medications that are vital to the resident’s immediate health and safety?  If this resident is discharged without these medications will harm likely occur?
4.  I have never advised to release narcotics because of the safety factor etc. and street value of same.

There have been instances in which some medications were released by facilities during an AMA process.  My experience is that many of the individuals leave without medications.  I believe that there are no hard and fast rules when serious harm may occur with the resident without medications.  However, it also depends upon the ability of that former resident to go the ER or reach out to the attending physician when the former resident leaves your facility.

Contacting Adult Protective Services or the equivalent in your state that the resident left AMA can also be an opportunity to alert authorities that this individual might be in danger based upon their AMA decision.  If there are specific questions, I would advise you to reach out to your legal counsel or to other trusted advisors.  Hope this helps.  Janet

Janet Feldkamp, BSN,JD,LNHA,CHC,RN

Interested in reading more FAQs? Visit the AADNS Network where you can review questions and answers on pressing topics from peers and experts in long-term care nursing leadership.

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