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Critical care nurses call 5 routine practices into question

Sunday February 2, 2014
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The American Association of Critical-Care Nurses, as part of the Critical Care Societies Collaborative, has identified five routine critical care practices that should be questioned because they may not always be necessary and could be harmful.

The effort supports Choosing Wisely, an initiative of the ABIM Foundation intended to spur conversations between patients and healthcare providers on which tests and procedures truly are necessary.

AACN is the first nursing organization to collaborate on development of a Choosing Wisely list, according to a news release. CCSC is a multidisciplinary organization composed of AACN, American College of Chest Physicians, American Thoracic Society and Society of Critical Care Medicine.

The collaborative’s Choosing Wisely list includes five evidence-based recommendations that offer guidance to multidisciplinary teams of critical care professionals. The recommendations are:

• Don’t order diagnostic tests at regular intervals (such as every day), but rather in response to specific clinical questions.

• Don’t transfuse red blood cells in hemodynamically stable, non-bleeding critically ill patients with a hemoglobin concentration greater than 7 mg/dL.

• Don’t use parenteral nutrition in adequately nourished critically ill patients within the first seven days of a stay in an ICU.

• Don’t deeply sedate mechanically ventilated patients without a specific indication and without daily attempts to lighten sedation.

• Don’t continue life support for patients at high risk for death or severely impaired functional recovery without offering patients and their families the alternative of care focused entirely on comfort.

“A unique feature of this contribution to the Choosing Wisely initiative by the Critical Care Societies Collaborative is that the document represents the interdisciplinary collaboration of nursing and medical societies,” Ramón Lavandero, RN, MA, MSN, FAAN, AACN senior director and clinical associate professor, Yale University School of Nursing, New Haven, Conn., said in the news release. “This aligns with the standard for true collaboration in 'AACN Standards for Establishing and Sustaining Healthy Work Environments.'”

A CCSC task force with 10 members representing all four societies and the disciplines of internal medicine, surgery, anesthesiology, emergency medicine and critical care nursing developed the list over the past year after careful consideration of the latest evidence, expert opinions and research.

The CCSC recommendations join the growing library of more than 220 tests and procedures that have been identified as possibly unnecessary and potentially harmful and, therefore, may require further discussion between patients and physicians.

Since its launch in April 2012, ABIM’s Choosing Wisely campaign has partnered with dozens of national healthcare and consumer groups to develop evidence-based lists of tests and procedures that may be overused in their fields.

Choosing Wisely lists and downloadable PDF: www.choosingwisely.org


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