My latest blog post on JAMA News Forum is on the Choosing Wisely initiative that was started by the ABIM (American Board of Internal Medicine) Foundation. The initiative identifies unnecessary and sometimes harmful and costly tests and procedures that should be eliminated or seldom done. The aim is to have physicians and patients use the lists (developed by various professional societies) to have conversations about testing and treating that can reduce unnecessary care. My JAMA blog discusses whether we need policy changes to be able to move more quickly on incorporating these discussions into care, whether through penalizing their use or incentivizing the crucial conversations about what care is necessary and safe and what care is not.
As of October, the initiative now includes the first-five list of nursing-identified unnecessary care, through work being led by the American Academy of Nursing (disclosure: I’m the Academy’s president). That list includes:
“1. Don’t automatically initiate continuous electronic fetal heart rate monitoring during labor for women without risk factors; consider intermittent auscultation first.
2. Don’t let older adults lay in bed or only get up to a chair during their hospital stay.
3. Don’t use physician restraints with an older hospitalized patient.
4. Don’t wake the patient for routine care unless the patient’s condition or care specifically requires it.
5. Don’t place or maintain a urinary catheter in a patient unless there is a specific indication to do so.”
I hope that all health care professionals and organizations will share the Choosing Wisely work with colleagues, health care organizations, and the public.
Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing