The Choosing Wisely® campaign has released new videos featuring leaders from across the healthcare spectrum talking about the challenges, opportunities and impact of the Choosing Wisely® campaign.
The Critical Care Societies Collaborative released a list of “Five Things Physicians and Patients Should Question” during the 43rd Critical Care Congress. The list identifies five targeted, evidence-based recommendations that can support physicians and patients in making wise choices about their care:
• 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 intensive care unit (ICU) patients with a hemoglobin concentration greater than 7 g/dL.
• Don’t use parenteral nutrition in adequately nourished critically ill patients within the first seven days of an ICU stay.
• 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 Quality and Safety Committee of the Society of Critical Care Medicine (SCCM) strongly endorses each of these measures and encourages each member of the Society to make a personal commitment to adhere to and advocate for the elimination of these wasteful practices,” noted Teresa Rincon, BSN, CCRN-E, FCCM.
The Choosing Wisely® top-five list was warmly received during the 43rd Critical Care Congress. Participants were interested in how individuals, ICUs, hospitals, and healthcare systems can foster the adoption of these practices. The SCCM Quality and Safety Committee encourages members of the critical care community to submit abstracts to the 44th Critical Care Congress related to efforts from the Choosing Wisely® Campaign.
Each practice on this list is supported by substantial evidence, including the recommendation for lighter levels of sedation.
Over the last 15 years, consistent ICU research has confirmed that lighter sedation improves outcomes (less delirium, shorter duration of mechanical ventilation, shorter ICU and hospital lengths of stay, and lower rates of tracheostomy). Lighter sedation means targeting Sedation-Agitation Scale scores of 3 to 4, or Richmond Agitation Sedation Scale scores of -2 to 0, for titration to the lightest effective level or for interruption of sedation (which may result in higher midazolam and fentanyl doses). Observational studies have shown that even in the first 48 hours of an ICU stay, less time in light sedation is associated with longer ICU and ventilator time and greater mortality.