Akinbodewa Ayodeji Akinwumi, Adejumo Oludamilola Adebola, Adejumo Oluseyi Ademola, Adebayo Funmilola Yinka, Akinbodewa Gladys Oghenevo, Alli Emmanuel Oladimeji, Benson Mercy Aanuoluwapo
Department of Medicine, Kidney Care Centre, University of Medical Sciences, Ondo, Nigeria.
Legal Services Unit, Kidney Care Centre, University of Medical Sciences, Ondo, Nigeria.
Niger Postgrad Med J. 2016 Jul-Sep;23(3):141-5. doi: 10.4103/1117-1936.190346.
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.
违反医疗建议出院（DAMA）对医护人员意味着严重的伦理法律后果。多项研究描述了其发生率和模式，但在发展中国家，几乎没有研究评估医护人员在实施违反医疗建议出院时对标准的遵守情况。
本研究的目的是评估翁多州一家公立二级医院的医护人员在实施违反医疗建议出院时对标准协议的遵守情况。
在一项描述性回顾性研究中，我们检查了2014年4月至2015年9月期间获得违反医疗建议出院的住院患者的病历和DAMA表格，以了解其设计、签署情况和完整性。数据采用SPSS 17版进行分析。
在7465名住院患者中，共有235名患者（男女比例为1.03:1）获得了违反医疗建议出院。他们的平均年龄为40.5±19.3岁（范围为17 - 110岁）。医院违反医疗建议出院的总体发生率为3.2%。DAMA表格设计不当、存在缺陷且无法防范诉讼。违反医疗建议出院的处理不当情况很严重（66.7%）。DAMA表格中唯一的签署人是护士（8.5%）和患者亲属（100%）。表格中没有医生的签字。
医护人员对标准的违反医疗建议出院协议的遵守情况很差。开展伦理法律事务更新课程、采用出院计划团队、升级DAMA表格并强调全球最佳实践将减少或消除诉讼风险。
