Transcript Golden Opportunities for Nurse Graduates

Choosing Wisely—or Not?
Jeri A. Milstead
PhD, RN, NEA-BC, FAAN
Choosing Wisely® Program
Created by American Board of Internal
Medicine (ABIM)
To encourage conversations between
physicians and patients
Question if tests/procedures needed?
duplicative? costly?
Choosing Wisely Was a Response to RWJ
Survey to Physicians to Discover:
What issues are most frequently
questioned by patients
RJW extended funding to create lists of
questions
Funding available: apply directly to RWJ
Idea Expanded from Physician-Pt.
to Provider-Pt.
Currently nearly 100 health-related and
consumer organizations participate
(including American Academy of Nursing)
Over 300 medically-directed
tests/procedures targeted as possibly
overused or inappropriate (Nursing
Outlook, 2015)
Organizations Have Created Lists of 5-10
Items Each
Each organization lists items, a brief
explanation as to how the list was
created, and sources used to compile the
list.
All items are founded on evidence as
noted in the ‘sources’ section
All Lists Are Available at:
http://www.choosingwisely.org
American Academy of Nursing
List (Mason, 2015)
1. Don’t automatically use continuous
electronic fetal heart rate (FHR)
monitoring during labor except for
women without risk factors; consider
intermittent auscultation (IA) first;
AAN List (contd)
2. Don’t let older adults lay in bed or only
get up to chair during their hospital stay;
3. Don’t use hospital restraints with an
older hospitalized patient.
AAN List (contd)
4. Don’t wake the patient for routine care
unless the patient’s condition or care
requires it;
5. Don’t place or maintain a urinary catheter
in a patient unless there is a specific
indication to do so.
Choosing Wisely® linked with
Consumer Reports
Disseminate brochures, articles, videos,
and online resources
ABIM reviews items and provides
template for selection of items
Each organization responsible for own list
Intended use of lists: to help pts &
providers become aware of research
Patients now acknowledged members of the
health care team
Many pts. bring medication inserts and
articles (electronic & hardcopy) to office
Smart providers accept or correct info.
Examples of Lists
1. Don’t routinely avoid influenza vaccines
in egg-allergic pts. (Am. Acad. of Allergy,
Ashtma, & Immunology)
2. Don’t require preliminary exam to
prescribe oral contraceptives or medications
(Am. Acad. of Family Physicians)
3. Don’t use glucosamine or chondroitin to
treat pts. With symptomatic osteoarthritis of
the knee (Am. Acad. of Orthopaedic
Surgeons)
4. Cough and cold medication should not be
prescribed for respiratory illness in children
under 4 yrs. (Am. Acad. of Pediatrics)
5. Infant home monitoring should not
routinely be used to prevent Sudden Infant
Death Syndrome (Am. Acad. of Pediatrics)
6. Do not delay engaging available palliative
& hospice car services for ED pts. liable to
benefit (Am. College of Emergency
Physicians)
7. Don’t use homeopathic medications, nonvitamin dietary supplements, or herbal
supplements as treatment for disease
preventive health measures. (Am. College of
Medical Toxicology and Am. Acad. of Clinical
Toxicology)
AAN and Oncology Nursing
Society – latest questions
Don’t neglect to advise patients with
cancer to get physical activity and
exercise during and after treatment to
manage fatigue and other symptoms.
Don’t use L-carnitine/acetyl-L-carnitine
supplements to prevent or treat
symptoms of peripheral neuropathy in
patients receiving chemotherapy for
treatment of cancer.
AAN/ONS contd
Don’t use mixed medication mouthwash,
commonly termed “magic mouthwash,” to
prevent or manage cancer treatmentinduced oral mucositis.
Don’t administer supplemental oxygen to
relieve dyspnea in patients with cancer
who do not have hypoxia.
Don’t use aloe vera on skin to prevent or
treat radiodermatitis.
Not all lists have been accepted by
all providers, pts., or organizations
Some believe tests/procedures are too
insignificant or questions are not robust
enough
Some fear items have already been deleted
from use because of evidence reported
Examples (contd)
Some fear items may be redirecting a focus
away from those tests/procedures that
actually drive up costs
E.g., Cardiac stress tests before low-risk
surgeries on 7 specialties’ lists of top
procedures to watch for overuse but were
rarely done before CW effort, (Frelick,
2015)
What Do YOU Think?
1. Do you use lists from trustworthy
organizations? How do you decide?
2. What are your options if the items on the
list you use are duplicative of other tests?
3. How do you determine if the cost of a
test exceeds the benefit?
4. What sources for seeking evidence do
you find reliable? Unreliable?
5. Who has input into what items are
chosen for a list?
Once you have discussed these & other
questions with your colleagues, consider:
1. What kinds of information do pts bring
with them or discuss with you?
2. What can you do to check the source of
the information pts. bring?
3. What can you do if you have inadequate
technology to find electronic resources?
4. How do you locate legitimate resources?
5. How can you differentiate reliable from
unreliable sources?
6. What do you say if a pt. is not willing to
accept that his/her source is not reliable?
Conclusion
Every nurse should seek opportunities to
talk with colleagues and pts.
Is Choosing Wisely® an approach you
would use?
References
www.aannet.org
www.abimfoundation.org
www.choosingwisely.org
www.consumerhealthchoices.org
www.consumerreports.org
References (contd)
Frelick, M. Do societies play it too safe with
Choosing Wisely® lists? Retrieved from
www.medscapedailynews.com Feb. 13,
2015.
Mason, D.J. (Jan/Feb 2015). Wisdom and
will. Nursing Outlook, 63(1): 6,7. President’s
message.
References (contd)
American Academy of Nursing announced
engagement in national Choosing Wisely®
campaign. (Jan/Feb 2015). Nursing Outlook,
(63)1, American Academy on Policy.
References (contd)
FAAN Mail. (AAN electronic newsletter).
(June 2015). American Academy of
Nursing Partners with Consumer Reports
to Bring Health Care Recommendations
Developed by Nurse Leaders to
Consumers.