Critical Care Nursing Group Helps to Identify Potentially Harmful Practices

The American Association of Critical-Care Nurses (AACN), as part of the Critical Care Societies Collaborative, has helped to identify five routine critical care practices, which it says should be questioned because they may not always be necessary and could be harmful to patients. The recommendations are part of Choosing Wisely, an initiative of the ABIM Foundation that seeks to initiate conversations between patients and health care providers on tests and procedures.

The Collaborative is made up of four professional associations, which put together a 10-member interdisciplinary team representing critical care nursing, internal medicine, surgery, anesthesiology, and emergency medicine, to develop the Choosing Wisely list, Nurse.com reports.

The Collaborative 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 detailed breakdown of the five recommendations is available here.

Launched in April 2012, the Choosing Wisely campaign provides a listing of more than 220 tests and procedures that have been identified by national health care and consumer groups as being possibly unnecessary and potentially harmful. The lists were first published in Archives of Internal Medicine and are available at: http://www.choosingwisely.org/

In addition to AACN, CCSC includes: the American College of Chest Physicians, the American Thoracic Society and the Society of Critical Care Medicine.