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Choosing Wisely®

American Society of Consultant Pharmacists

Transitions of care can contribute to serious medication-related problems when transitioning between different care settings. Older adults with complex health care problems appear to be a group particularly at risk for increased adverse events. To mitigate errors in prescribing and transcribing, routine assessments should include a comprehensive medication review, medication reconciliation, and an accurate medication history with the patient and his or her advocate. A thorough medication ...

Choosing Wisely®

American Society of Consultant Pharmacists

Many medications have strong anticholinergic activity including first generation antihistamines (e.g. diphenydramine, doxylamine), tricyclic antidepressants, gastrointestinal antispasmodics, antiemetics, muscle relaxants, medications for urinary incontinence and medications to treat Parkinson disease. Older adults are more sensitive to adverse events associated with anticholinergics including confusion, dry mouth, blurry vision, constipation, urinary retention, decreased perspiration and excess ...

Choosing Wisely®

American Society of Consultant Pharmacists

Anticholinergics (e.g. overactive bladder medications and first-generation antihistamines) competitively inhibit binding of the neurotransmitter acetylcholine, thus reducing the effects of acetylcholine. Cholinesterase inhibitors, used in the treatment of dementia, act by blocking the enzyme acetylcholinesterase thereby inhibiting acetylcholine degradation. Therefore, pharmacologic actions of anticholinergics and cholinesterase inhibitors oppose each other. Concomitant use of anticholinergics ...

Choosing Wisely®

Society of Critical Care Medicine

Although mechanical ventilation is frequently lifesaving, it is also associated with numerous complications. Discontinuation of mechanical ventilation support is frequently the rate limiting step in ICU discharge. Current guidelines recommend removing patients from mechanical ventilation support as soon possible, utilizing mechanical ventilation liberation and sedation interruption protocols in concert with structured multidisciplinary rounds.

Choosing Wisely Canada

Canadian Obstetrical and Pediatric Transfusion Network Canadian Society for Transfusion Medicine

The DAT is not a screening test for hyperbilirubinemia or hemolytic disease. Routine assessment of the DAT may reveal cases of ABO incompatibility which are clinically insignificant; conversely the DAT may fail to identify significant hemolysis due to non immune causes. The DAT should be performed only when anemia or hyperbilirubinemia is suspected or when maternal alloantibodies are present.