The American Academy of Nursing (AAN) recently announced that it has joined the ABIM Choosing Wisely campaign with a list that focuses specifically on nursing interventions or practices that are not supported by evidence. The list is called Five Things Nurses and Patients Should Question. Here it is in short form—full explanations of the rationale for each item are available at the above link.
- Don’t automatically initiate continuous electronic fetal heart rate monitoring during labor for women without risk factors; consider intermittent auscultation first.
- Don’t let older adults lay in bed or only get up to a chair during their hospital stay.
- Don’t use physical restraints with an older hospitalized patient.
- Don’t wake the patient for routine care unless the patient’s condition or care specifically requires it.
- Don’t place or maintain a urinary catheter in a patient unless there is a specific indication to do so.
The Choosing Wisely initiative encourages health care provider organizations to create their own lists of tests and procedures that may be overused, unsafe, or duplicated elsewhere. Using these lists, providers can initiate conversation with their patients to help them choose the most necessary and evidence-based care for their individual situations. The lists are not meant to be proscriptive, and also address situations where the procedures may be appropriate.
The Choosing Wisely campaign is in alignment with the recent focus on patient-centered care, identified as one of the factors necessary for high-quality health care in a 2001 report from the Institute of Medicine. It is also worth noting that the initiative is in accord with goals of the Affordable Care Act (ACA), which has focused attention on improving quality of care while also controlling costs by reducing the use of unnecessary and sometimes harmful procedures and tests.
The AAN joins nearly 100 other health care organizations, which have together identified more than 250 different tests, procedures, and practices that should be discussed with patients to help them make the best decisions for their care. All of the lists can be found here. No doubt the nursing-specific list could be a lot longer. Feel free to let us know your ideas.—Michael Fergenson, senior editorial coordinator, and Jacob Molyneux, senior editor