Choosing Wisely in Critical Care

A National Survey of Critical Care Nurses

Clareen A. Wiencek, PhD, RN, ACNP; Ruth Kleinpell, PhD, RN, AG-ACNP; Marc Moss, MD; Curtis N. Sessler, MD

Disclosures

Am J Crit Care. 2019;28(6):434-440. 

In This Article

Abstract and Introduction

Abstract

Background: To promote the use of appropriate testing, and decrease unnecessary treatments, the ABIM Foundation established the Choosing Wisely campaign in 2012. Initially targeting physicians, the campaign has evolved to encourage all providers to promote high-value care; however, information related to critical care nursing is limited.

Objectives: To assess nurses' reports of the use of Choosing Wisely recommendations in critical care settings.

Methods: Responses from nurses were examined as part of a critical care survey of members of 4 societies in order to assess awareness and use of the Choosing Wisely recommendations.

Results: Of the 1651 acute and critical care nurses who were members of the American Association of Critical-Care Nurses and responded to the survey, 632 (38.3%) reported being familiar with the Choosing Wisely campaign. Of these respondents, 200 identified as advanced practice nurses. A total of 620 reported implementing the 5 Critical Care Society Collaborative recommendations, including reducing diagnostic testing (n = 311 [50.2%]), reducing the number of red blood cell transfusions (n = 530 [85.5%]), not using parenteral nutrition in adequately nourished patients (n = 293 [47.3%]), not using deep sedation in patients receiving mechanical ventilation (n = 499 [80.5%]), and offering comfort care for patients at high risk for death (n = 416 [67.1%]). Staff education, specific protocols, electronic medical record alerts, and order sets all raised nurses' awareness of the recommendations.

Conclusions: Acute and critical care nurses are directly involved with measures to reduce unnecessary testing and treatments. Greater awareness and championing of the Choosing Wisely recommendations by acute and critical care nurses can help to promote high-value care for acute and critically ill patients.

Introduction

Extensive diagnostic testing and procedures are often a part of the medical management of critically ill patients in acute care and intensive care unit (ICU) settings. Laboratory and radiologic testing are commonly performed daily in acute care and ICU settings for diagnosing conditions and for monitoring and assessing critically ill patients. Nurses often collect laboratory specimens for testing and prepare patients for diagnostic imaging. These measures directly affect nurses' workloads. A recent systematic review of the literature on the effectiveness of interventions to improve the quality of patient care highlighted the importance of reducing unnecessary testing in order to promote high-value care.[1]

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