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Choosing Wisely Canada

Long Term Care Medical Directors Association of Canada

People with dementia can sometimes be disruptive, behaving aggressively and resisting personal care. There is often a reason for the behaviour (pain, for example) and identifying and addressing the causes can make drug treatment unnecessary. When drug treatment is chosen, antipsychotic medicines are often prescribed, but they provide limited benefit and can cause serious harm, including premature death. These medications should be limited to cases where non-drug measures have already been tried ...

Choosing Wisely Canada

Long Term Care Medical Directors Association of Canada

Transfers to hospital for assessment and treatment of a change in condition have become customary. However, they are often of uncertain benefit, and may result in increased morbidity. In one Canadian study, 47% of hospitalizations were considered avoidable, while a recent US study found 39% to be ‘potentially avoidable’. Transfer often results in long periods in an unfamiliar and stressful environment for the patient. Other hazards include delirium, hospital acquired infections, medication ...

Choosing Wisely Canada

Canadian Critical Care Society Canadian Association of Critical Care Nurses Canadian Society of Resp

Unnecessary transfusion of red blood cells (RBCs) is more harmful than helpful, and wastes a limited resource, which should be reserved for patients with proven indications. Transfusing RBCs at a threshold higher than 70 g/L does not improve survival in ICU patients, and is associated with more complications and higher costs. This has been extensively studied and a restrictive transfusion strategy results in similar or lower mortality compared with higher thresholds, and other complications, ...

Choosing Wisely Canada

Canadian Critical Care Society Canadian Association of Critical Care Nurses Canadian Society of Resp

Chest radiographs (“X-rays”, CXRs) are not indicated for routine assessment of critically-ill patients except when indicated for specific procedures (e.g., endotracheal tube, naso- or orogastric tube, central vein catheter, pulmonary artery catheter, or other procedure requiring verification after insertion), or to provide information for a specific question related to a change in a patient’s clinical condition, and if the information will likely impact a specific decision related to ...

Choosing Wisely Canada

Canadian Critical Care Society Canadian Association of Critical Care Nurses Canadian Society of Resp

Screening for readiness for liberation from mechanical ventilation with spontaneous breathing trials allows clinicians earlier recognition of patients that may be liberated from mechanical ventilation.