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Don’t collect urine specimens for culture from adults who lack symptoms localizing to the urinary tract or fever unless they are pregnant or undergoing genitourinary instrumentation where mucosal ...
Choosing Wisely Canada
Association of Medical Microbiology and Infectious Diseases Canada
Urine cultures are the most frequently ordered microbiologic test, with the majority of specimens submitted from asymptomatic patients. Urine cultures should only be ordered if patients have symptoms localizing to the urinary tract such as acute dysuria, urgency, frequency, suprapubic or flank pain or fever without an obvious alternate source. Outside of these specific symptoms, positive cultures indicate asymptomatic bacteriuria and frequently result in antimicrobial therapy that is of no ...
ver más ... 2017Don’t order screening or routine chronic disease testing just because a blood draw is being done.
Choosing Wisely Canada
Long Term Care Medical Directors Association of Canada
Unless you are sure treatment can be given that would add to quality of life, don’t do these tests. “Routine” testing may lead to harmful over-treatment in frail residents nearing the end of their life and lead to misusing healthcare resources that would do more good used wisely.
ver más ... 2017Don’t continue or add long-term medications unless there is an appropriate indication and a reasonable expectation of benefit in the individual patient.
Choosing Wisely Canada
Long Term Care Medical Directors Association of Canada
Long-term medications should be discontinued if they are no longer needed (e.g., heartburn drugs, antihypertensives) as they can reduce the resident’s quality of life while having little value for a frail elder with limited life expectancy (e.g., statins, osteoporosis drugs). Prescribing medications to meet lab test “targets” that apply to adults living in the community (e.g., blood sugar, blood pressure) may instead have dangerous effects on mobility, function, mortality and quality of ...
ver más ... 2017Don’t insert a feeding tube in individuals with advanced dementia. Instead, assist the resident to eat.
Choosing Wisely Canada
Long Term Care Medical Directors Association of Canada
Inserting a feeding tube does not prolong or improve quality of life in patients with advanced dementia. If the resident has been declining in health with recurrent and progressive illnesses, they may be nearing the end of their life and will not benefit from feeding tube placement. Feeding tubes are often placed because of fears that patients may aspirate food or become malnourished. Studies show that tube feeding does not make the patient more comfortable or reduce suffering. Tube feeding may ...
ver más ... 2017Don’t do a urine dip or urine culture unless there are clear signs and symptoms of a urinary tract infection (UTI).
Choosing Wisely Canada
Long Term Care Medical Directors Association of Canada
Unless there are UTI symptoms such as urinary discomfort, abdominal/back pain, frequency, urgency or fever, testing should not be done. Testing often shows bacteria in the urine, with as many as 50% of those tested showing bacteria present in the absence of localizing symptoms to the genitourinary tract. Over-testing and treating asymptomatic bacteriuria with antibiotics leads to increased risk of diarrhea and infection with Clostridium difficile. Overuse of antibiotics contributes to ...
ver más ... 2017