نام فایل : ترخيص با رضايت شخصي

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ترخيص با رضايت شخصي
Discharge Against Medical Advice (AMA)
بسم الله الرحمن الرحيم
گروه اساتيد حاكميت خدمات باليني
دفتر مديريت بيمارستاني و تعالي خدمات باليني
وزارت بهداشت و درمان و آموزش پزشكي
Case 1
A homeless man with schizophrenia was admitted with abdominal pain believed to be due to a volvulus. He was allowed to leave AMA in the middle of the night, only to be found a few hours later collapsed on the sidewalk within one block of the hospital. All efforts to resuscitate him were unsuccessful.

Case 2
A 50-year-old man with a history of alcohol abuse and alcohol-induced dementia was admitted to the medical service with mild alcohol withdrawal. He was also found to have a proximal humeral fracture, and the orthopedic consult recommended surgical repair. The patient was treated with benzodiazepines for his alcohol withdrawal and remained medically stable. After hearing the risks and benefits of surgery from the physicians, the patient refused.
In light of the patient’s chronic dementia and acute delirium due to alcohol withdrawal, formal mental status testing was performed, which indicated that the patient lacked the capacity to make medical decisions. A psychiatry consultation supported this determination.
On hospital day 4, at approximately midnight, the patient stated to his nurse that he wished to leave the hospital. Neither the floor nurse nor the charge nurse was aware the patient had been found to lack decision-making capacity. They contacted the nightfloat covering resident and informed her that the patient wished to leave. The resident glanced at the chart, asked the patient a few questions, and allowed him to leave against medical advice (AMA).
The primary medical team was informed the following morning about the discharge. They had no contact information for the patient, and he could not be located. What happened to him is unknown.?
DEFINITION:
Against Medical Advice, or AMA, sometimes known as DAMA, (Discharge Against Medical Advice), is a term used with a patient who checks himself out of a hospital against the advice of his doctor.
Discharge against medical advice (AMA), in which a patient chooses to leave the hospital before the treating physician recommends discharge, continues to be a common and vexing problem.
تعريف:
انتخاب بيمار براي خروج از بيمارستان قبل از اينكه پزشك معالج بيمار را مرخص اعلام كند
بيان مسئله:
مشكلي براي بسياري از پزشكاني كه بيماران بستري را درمان مي كنند
افزايش خطر مشكل طبي به كفايت درمان نشده و احتمال بستري مجدد
تعارض اخلاقي آشكار براي پزشكان :
احترام به حق بيمار در انتخاب درمان و درمانگر يا اصل Autonomy
اين اصل كه بهترين كار را بايد براي بيمار انجام داد
مديريت دشوارتر از اولويت بندي صرف اخلاقي است
مسائل مطرح در مديريت:
رابطه پزشك و بيمار
رضايت نامه آگاهانه
موضوعات روانپزشكي زمينه اي
....