If a competent adult wishes to leave against medical advice, what is your next step?

The appropriate next step when a competent adult wishes to leave against medical advice is to provide information about the risks involved. This is crucial because it ensures that the patient is fully informed about the potential consequences of their decision. As a healthcare provider, it is important to communicate the possible medical risks they might face by leaving, such as worsening of their condition, lack of follow-up care, or complications that could arise without treatment.

This step is important for both ethical and legal reasons. Ethically, it respects the patient's autonomy while also ensuring they are making an informed decision. Legally, documenting that the patient was informed of the risks can protect the healthcare provider and the facility in case the patient experiences adverse outcomes after leaving.

While documenting the refusal is an important action to take, it should come after ensuring that the patient understands what they may be risking. Contacting the base may also be necessary in certain circumstances, but the imperative at the moment of the patient's request is to provide that crucial information. Restricting movement is not appropriate since the patient has the right to refuse care as long as they are competent to make that decision.