5 Critical Care Practices Come Under Scrutiny
The five recommendations are part of the Choosing Wisely campaign that encourages patient-provider dialogue about choosing necessary care. They 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.
Deborah Becker, PhD, ACNP, BC, CCNS, one of the members of the CCSC task force that developed the recommendations, says rethinking these practices will help to reduce costs, especially repetitive costs for procedures that are only being done "because we're covering our butts."
In addition, the recommendations can also be a catalyst for a change in provider mentality, says Becker, who is a Practice Associate Professor of Nursing at the University of Pennsylvania School of Nursing; assistant dean for Innovations in Simulation; and the Adult Gerontology Acute Care program director.
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