The American Association of Critical-Care Nurses (AACN) — as part of the Critical Care Societies Collaborative (CCSC) — has identified five routine critical care practices that should be questioned because they may not always be necessary and could, in fact, be harmful.
Its efforts support Choosing Wisely®, an initiative of the ABIM Foundation intended to spur conversations between patients and healthcare providers on what tests and procedures are really necessary. AACN is the first nursing organization to collaborate on development of a Choosing Wisely list.
CCSC is a multidisciplinary organization composed of AACN, American College of Chest Physicians, American Thoracic Society and Society of Critical Care Medicine.
Its 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 intensive care unit.
•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.
The list, including more detailed explanations and supporting references, can be found online at ChoosingWisely.org. A downloadable PDF, suitable for use in staff meetings and posting, is also available.
