Leaving a urinary catheter (UC) in place without indication has been identified as one of "Five Things Physicians and Patients Should Question" by the Society of Hospital Medicine and the Canadian Society of Internal Medicine. 1,2 On a busy general medical (GM) ward, delays in reassessment of UCs can lead to catheter-associated urinary tract infection (CAUTI). 3 Interventions aimed at physicians reduce unnecessary UC use, 4 but empowering nurses to remove UCs through the use of medical directives remains an underused strategy. 5 Methods | A controlled before-and-after study in GM patients admitted to a large academic hospital was performed to evalu-Figure. Postcatheter Care Algorithm A medical directive for nurses to remove urinary catheters among general medical patients lacking prespecified exclusion criteria, and provide postcatheter care.
The Choosing Wisely Canada campaign is an initiative that aims to involve physicians and patients in collaborative decision making to avoid unnecessary tests and treatments. The Rhinology Subspecialty Group of the Canadian Society of Otolaryngology-Head & Neck Surgery developed a list of five evidence-based recommendations for the management of acute rhinosinusitis and nasal fractures: (1) don't prescribe antibiotics to patients with acute sinusitis who do not meet the diagnostic criteria for acute bacterial rhinosinusitis; (2) don't order a CT scan for uncomplicated acute rhinosinusitis; (3) don't order plain film sinus x-rays; (4) don't swab the nasal cavity as part of the work up for rhinosinusitis; and (5) don't order a plain film x-ray in the evaluation of nasal fractures.
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