Choosing Wisely Canada: Why was it important to develop a critical care nursing list?

Kathy Bouwmeester: The ICU is a complex environment for nurses and patients receiving care. 8 out of 10 ICU admissions are unplanned and may require invasive procedures and numerous interventions such as intubation or multiple surgeries. The increased pressure of COVID-19 on ICUs and capacity issues are now top of mind for health system leaders and decision makers. This has increased awareness that ICUs are one of the most vital resource to our health care system.

With such a complex environment, nurses are constantly using their critical decision-making skills to ensure patients are receiving appropriate, safe, and quality care. When developing the critical care nursing list that was released in Summer 2020, we identified areas where we could best enhance the care we already provide. For example, recommendation #2 on our list says inappropriate administration of benzodiazepines to treat symptoms of delirium may harm a critically ill patient by inadvertently increasing delirium or the length of stay in an ICU. We can look for other opportunities to avoid using benzodiazepines such as improving the sleeping environment for patients instead of medications that may cause harm.

CWC: How do you encourage Choosing Wisely conversations between nurses and patients?

KB: When you think about the journey of a patient, their first interaction is often with a paramedic or admission in the emergency department. Following that admission, a majority of their time and hospital experience is spent with nursing professionals. This means our involvement in these conversations is critical to ensure patients and their loved ones are aware of the risks and benefits associated with tests and treatments.

In the ICU environment, many of our patients are unable to communicate based on their condition. In these instances, it is often nurses who are communicating with family members or loved ones about a patient’s health status. We become advocates for patients in these situations as we are aware of their condition and potential next steps for care.

 CWC: Why is it important to encourage Choosing Wisely?

KB: Nurses are involved in so many areas of care.  We are often with patients for long periods of time and understand their conditions throughout their journey in the hospital. The critical care recommendations are unique because they are based on nursing research. The art of nursing has now evolved into the science and evidence we need to best care for our patients.

Also, now more than ever before, health professionals have become further aware of their practices. The impact of COVID-19 has added pressure to the ICU environment, making teamwork and communication so important. There is a unique opportunity for nurses to utilize these recommendations and help support care that is truly necessary. If we continue this holistic approach to patient care, we can lead to better outcomes.