The ‘Choose Wisely’ campaign has its origins in the United States and is an initiative of the American Board of Internal Medicine Foundation ‘… designed to spark conversations among patients, physicians and other health professionals about appropriate tests and procedures …’ (Mason, 2015, p. 657).  It is now a global initiative with the New Zealand campaign http://choosingwisely.org.nz/ being promoted by the Health Quality and Safety Commission and Consumer NZ and endorsed by a number of the Australasian medical specialist colleges, the Council of Medical Colleges in New Zealand, and the New Zealand College of Midwives among others.

The New Zealand Nurses Organisation/Tōpūtanga Tapuhi Kaitiaki o Aotearoa (NZNO) needs to decide if it will also endorse the campaign and the position it would take in doing so.

Questions to consider:

1. Is there a problem in New Zealand about how tests, treatments and procedures are explained to patients including their impact on providing best quality care for the patient?  If so, is that problem greater for health services and care for some groups, particularly Maori and Pacific communities and those experiencing mental health challenges?

2. How do nurses advocate in a culturally safe way for care recipients who have either been referred for tests/procedures/treatments that seem unnecessary or who should have tests/procedures/treatments for which they have not been referred?

3. What is the potential for unintended consequences of the ‘choose wisely’ campaign?  Is one of those potential unintended consequences the possibility that care recipients will see this campaign as a rationing exercise and as a sequelae of an under-resourced healthcare system?

Barriers to access, for example those proposed by PHARMAC in 2016 to the long-acting intra-uterine system (LIUS) ‘Mirena’, resulted in subsidised mirenas primarily being used by older, peri-menopausal women to reduce the need for hysterectomy, while younger women with similar symptoms who were seeking safe, long-term reversible contraception, were excluded. (See: NZNO Submission to PHARMAC re Mirena sole supply (PDF 388KB) While benefiting one group, another is excluded for cost control reasons.  Over the productive lifetime of women impacted, the benefits of funded access to such products needs to be factored into analyses.

4. What evidence is there that nurses inappropriately order and administer unnecessary tests, procedures and treatments?  There is evidence to the contrary – that Nurse Practitioners prudently prescribe and order tests and procedures. (see Gardner, Gardner & O’Connell, 2014)

References:

Gardner, G.; Gardner, A. and O’Connell, J. (2014) Using the Donabedian framework to examine the quality and safety of nursing service innovation. Journal of Clinical Nursing 23, 145-155 doi: 10.1111/jocn.12146

Mason, D. (2015) Choosing Wisely: Changing clinicians, patients or policies? The JAMA Forum 313:7 p. 657-658

Feedback due: Please send feedback to Sue Gasquoine, Nursing Policy Adviser/Researcher sueg@nzno.org.nz by 30 September 2017.