Choosing Wisely

Question 1

What are the 7 Choosing Wisely principles for LTC?

Answer 1

1. Don’t send frail resident to hospital unless urgent comfort/medical needs can’t be met at LTC
2. Don’t use antipsychotics as first choice for BPSD
3. Don’t do urine dip or culture unless clear signs/symptoms of UTI
4. No feeding tube for advanced dementia
5. Don’t continue or add long term meds unless appropriate indication
6. Don’t order screening or routine chronic disease testing just because blood draw being done
7. Don’t hesitate to do virtual care to complement in person visits during pandemic

Question 1

What are the 8 Choosing Wisely recommendations for Geriatrics?

Answer 1

1. Don’t use ABx to treat asymptomatic bacteriuria
2. Don’t use benzos or sedative-hypnotics as first line for insomnia, agitation or delirium
3. Don’t use antipsychotics as first line for BPSD
4. Avoid physical restraints for BPSD
5. Avoid medications known to cause hypoglycemias to achieve A1c <7.5% if 65+, moderate control is better
6. Don’t recommend percutaneous feeding tubes in advanced dementia, offer oral
7. Don’t continue CHEi or memantine for dementia without periodic R/A for benefits, AEs, consider desprescribing
8. Don’t prescribe med without medication review, consider deprescribing at all interfaces of care