Issue link: https://beckershealthcare.uberflip.com/i/1529883
18 QUALITY IMPROVEMENT & MEASUREMENT Studies unravel 3 common medical practices By Paige Twenter R esearch is mounting against the common practices of prescribing thickened liquids, conducting spine implants for back pain and suspending blood pressure medicines before surgery, e New York Times reported Sept. 14. ese practices are commonplace, but some healthcare workers have cast caution for years because of poor clinical results. More studies now present evidence backing these doubts, the Times reported: 1. ickened liquids are used in the hopes of preventing aspiration pneumonia, but researchers at Northwell Health's Feinstein Institutes for Medical Research in Manhasset, N.Y., found no mortality difference between thick and thin liquid diets in about 8,000 hospital patients. JAMA published the results May 6. e researchers also discovered no significant difference in length of stay, readmissions or death rates, according to findings published in July. 2. A discourse among spine care experts targets the efficacy of implanting spinal cord stimulators in patients with chronic back pain. Research has shown little benefit of the practice, but evaluating pain is a tricky task. e methodology of a new spine stimulation study of 7,500 patients has also been questioned because of how it tests pain relief. 3. Patients who take ACE inhibitors or angiotensin II receptor blockers are oen advised to skip their blood pressure medication doses before scheduled surgeries. e reasoning is a patient's blood pressure might drop too low and cause complications, but three recent studies found complication frequency was similar among those who did and did not halt their regimen. Cardiac operations are the exception, Matthieu Legrand, MD, PhD, lead author of one of the studies, told the Times. "ere are plenty of things we do in medicine that have no evidence," Dr. Legrand, an anesthesiologist and critical care physician at the University of California San Francisco, told the Times. Medical practices continue "because we have always done them, so they just keep on happening," Dr. Legrand said. ese practices might work for some patients, but experts said they are blanket generalizations and should be unraveled. n When DNRs are misunderstood as 'do not treat' By Mariah Taylor C onceptually, "do not resuscitate" orders are straightforward medical documents. However, confusion among medical staff can lead to inappropriate care or patient harm, The New York Times reported Aug. 26. In the 1960s, "resuscitation" referred primarily to CPR, but by the '90s, medical literature began using the term as a catchall for other medical interventions that would be to bring back a patient outside of cardiac arrest. The scope of the standard DNR did not change, but liberal usage of "resuscitation" created confusion, leading some physicians to administer or withhold care differently according to their interpretations. Some research found that patients with DNR orders may not have received lifesaving treatment even before cardiac arrest and mortality rates are worse for DNR patients. Some clinicians interpret DNR orders as declining necessary treatment, leading them to withhold interventions such as transfusions, antibiotics and dialysis. A 2017 survey of 553 residents found 41% said they would not transfer a DNR patient to the ICU and 62% said they would not have administered dialysis to a DNR patient. Some said they would not order diagnostic tests even if these procedures are permitted under the order. "Do not resuscitate does not mean do not treat," Mathew Pauley, a bioethicist at Oakland, Calif.-based Kaiser Permanente, told the Times. The majority of patients with a DNR are older adults with severe underlying medical conditions. Some research estimated that between 10% and 20% of hospitalized adults have a DNR, with those older than 85 being four times as likely to have one compared to adults younger than 65, according to the Times. Because resuscitation lacks a clear definition, some health systems are clarifying the language of DNR orders to "do not attempt resuscitation" or "allow natural death." n