Documentation of Against Medical Advice Discharge for Patients with Thrombocytopenia
Essential Documentation Components
- The American College of Cardiology recommends that patients leaving against medical advice with thrombocytopenia should be informed that they are being excluded from denominator populations in quality measures due to their AMA status 3, 4
- The American College of Cardiology suggests documenting the specific risks of leaving with untreated/undertreated thrombocytopenia, including the risk of spontaneous bleeding, particularly with platelet count below a certain threshold 3
- The American College of Cardiology advises documenting the potential for intracranial hemorrhage or other life-threatening bleeding in patients with thrombocytopenia who leave against medical advice 1
- The American College of Cardiology recommends providing urgent follow-up appointment scheduling and prescriptions for patients with thrombocytopenia who leave against medical advice 5, 3
- The American College of Cardiology suggests documenting laboratory follow-up recommendations within a specific timeframe for patients with thrombocytopenia who leave against medical advice 2
Sample Documentation Template
| Category | Description |
|---|---|
| Assessment of Capacity | Patient demonstrates full decision-making capacity and understanding of the medical situation and risks involved with leaving AMA |
| Medical Condition | Current platelet count, trend, and severity of thrombocytopenia |
| Risks Discussed | Specific risks of leaving with untreated thrombocytopenia, including spontaneous bleeding and intracranial hemorrhage [1, 3] |
| Patient Understanding | Patient verbalized understanding of these risks but still wishes to leave AMA |
| Follow-up Plan | Urgent follow-up appointment scheduled, prescriptions provided, and instructions for medication use [5, 3, 1] |