Choosing Wisely: Five common clinical practices to reconsider in critical care

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.

"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," said Ramón Lavandero, RN, MA, MSN, FAAN, AACN senior director and clinical associate professor, Yale University School of Nursing, New Haven, Conn. "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.

"The specialty societies partnering in the Choosing Wisely campaign have shown tremendous leadership by answering this professional call to action and working to ensure these critical conversations are happening in doctors' offices, communities, hospitals and health systems across the country," said Richard J. Baron, MD, president and CEO of the ABIM Foundation.

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 field.