Evaluation of administration of discharge against medical advice: Ethico-legal considerations.

Abstract

Discharge against medical advice (DAMA) portends serious ethico-legal consequences for healthcare givers. Several studies have described its prevalence and pattern but hardly any to evaluate adherence to standards by medical staff while administering DAMA in developing countries. The objective of this study is to evaluate adherence of medical staff to standard protocols during the administration of DAMA in a public secondary hospital in Ondo State. In a descriptive, retrospective study we examined case files and DAMA forms of in-patients who obtained DAMA between April 2014 and September 2015 for design, signatories and completeness. Data were analysed by means of SPSS version 17. A total of 235 patients (male:female, 1.03:1) who obtained DAMA out of 7465 in-patients were studied. Their mean age was 40.5 ± 19.3 years (range, 17-110 years). The overall hospital DAMA prevalence was 3.2%. DAMA forms were inadequately designed, deficient and not protective against litigation. Improper processing of DAMA was high (66.7%). The only signatories in the DAMA forms were the nurses (8.5%) and patients' relatives (100%). There was no physician entry in the forms. Adherence to standard DAMA protocol by medical staff was poor. Update courses on ethico-legal matters, adopting a discharge planning team, upgrading of DAMA forms and stressing global best practices will reduce or eliminate risk of litigations.