Tony’s Anatomy-#9: AAD, against advice discharge?

Patients come to a hospital in order to relieve their pain or cure their disease. But as patient right rises,  the more often patients refused to take the advice from medical staff(doctor, nurse…..). The term “AAD” means “Against advice discharge”.

It’s weid that people come here to seek helps from doctors and they refused the advice when diagnosis is made. This week, there’s a patient who was diagnosed as acute myocardial infarction (AMI) and admited to our ward. It’s really high risk of

deaths if not taking treatment emergently.In order to monitor the progress of AMI, it’s necessary to check cardiac enzyme and electrocardiograph(ECG,EKG) every 6 hours. After I finished the ECG and the nurse drawed the blood for cardiac enzyme tests at the midnight,

the patient’s wife ran out to the medical station and queried why we often interrupted the patient’s sleep and draw so much blood. She reported many unrelated medical storied to us and showed her angery.After repeat-and-repeat explantation, she turned back to the bedside. Then there’s a “click” sound poped out. She locked the door of the ward in order to prevent doctors and nurses to see the patient ANY MORE!  Fortunately, there’s a backup key of this ward. Unfortunately, we’ve to find a key to open his wife’s heart. To protect our medical staff from lawsuit, it’s common to discharge patiens when they decide to against advice.

 

In this story, I found we should take “AAD”as Anxiety, Agitation and Delirium  rather than against advice discharge. The family reported this woman(therir mom) didn’t have such weired response before and I was guessing it’s a delirium attack on this woman. Fortunately, there’re many

medications for delirium. Unfortunately, she is the family member and not the AMI patient who was admitted to our ward an lying on the bed now! Can we prescibe a medcation for her  ?? If we can’t control her temper and mood, the AMI patient may lose his life because she refused all of our treatement recommendation.

Well, I had to treat the couple , not only this old AMI man. It’s a tough on-duty night since I had to cope with the delirium and AMI simutaneously. When the sunlights shined into the ward from the window, this woman abruptly changed her attitute and responses ! She showed good manners to us and agreed any of our medications. What a delirium nihgt and the power of sunshine!

 

Tony