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Choosing Wisely – Time to Act?

Paula Bolton-Maggs


About Choosing Wisely UK
from the website www.choosingwisely.co.uk

Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.  By having discussions that are informed by the doctor, but take into account what’s important to the patient too, both sides can be supported to make better decisions about care. Often, this will help to avoid tests, treatments or procedures that are unlikely to be of benefit. 

Across the UK, there is a growing culture of overuse of medical intervention, with variation in the use of certain treatments across the country. For example, the prescribing of antibiotics can vary by as much as two and a half times between one part of the country and another. 

Choosing Wisely was created in part to challenge the idea that more is better or in the case of medical intervention: just because we can, doesn’t always mean we should.

The Choosing Wisely principles encourage patients get the best from conversations with their doctors and nurses by asking four questions.

  1. What are the benefits?
  2. What are the risks?
  3. What are the alternatives?
  4. What if I do nothing?

This is what healthcare professionals refer to as ‘shared decision making’ which is also summed up by the phrased “no decision about me, without me.”

Choosing Wisely UK brings together a range of patient and health related organisations from across the country and is hosted at the Academy of Medical Royal Colleges,the coordinating body for the UK and Ireland’s 23 medical royal colleges and faculties.

Choosing Wisely’s key aim is to change the culture when it comes to prescribing. We know this takes time, but we know it can work. In Italy, for example, Choosing Wisely is known as ‘slow medicine’ The Academy will continue to work with doctors to further develop the list of tests, treatments and procedures to support patients to get the most out of their care.


CHOOSING WISELY – TRANSFUSION 

Five recommendations related to transfusion have been submitted via the Royal College of Pathologists and approved. The full versions include the evidence, but in summary these are as follows:

  1. Only consider transfusing platelets for patients with chemotherapy-induced thrombocytopenia where the platelet count is < 10 x 109/L except when the patient has clinically significant bleeding or will be undergoing a procedure with a high risk of bleeding.

  2. Use restrictive thresholds for patients needing red cell transfusions and give only one unit at a time except when the patient has active bleeding.

  3. Only transfuse O Rh D negative red cells to O Rh D negative patients and in emergencies for females of childbearing potential with unknown blood group.

  4. Don’t give a patient a blood transfusion without informing them about the risks and benefits (although do not delay emergency transfusions)

  5. Don’t transfuse red cells for iron deficiency anaemia without haemodynamic instability

What next? Very little has been done so far to publicise and promote these.  After discussion with the Academy of Medical Royal Colleges it is apparent that they are expecting the relevant Colleges and organisations to take up the challenge.


What can we do to promote this?

In Canada there is very effective national promotion –their Chair is  Wendy Levinson, Professor of Medicine, Toronto. Their campaign targeted clinicians via specialist societies (more than 70), patients, medical students (students and trainees advocating for resource stewardship – STARS), supporting adoption of recommendations in care settings and measurement of overuse. They also developed toolkits which are available on their website www.choosingwiselycanada.org  (including ‘why give two when one will do?’ and have demonstrated a 31% reduction in unnecessary transfusion).


Extract from the Royal College ofPathologists website related to National Pathology Week:

This year’s National Pathology Week (NPW) will run from 5 – 11 November #pathologyweek

As 2018 marks the 10th birthday of National Pathology Week and the 70th  Anniversary of the NHS, we are launching lots of exciting new resources to support our members and supporters to run their own events and activities. You can keep up to date with everything NPW by following #pathologyweek on Facebook, Twitter and Instagram.


GETTING INVOLVED IS EASY

Check out our current resource library and, once you’ve decided what event you would like to organise, please register it. This is so we can help you promote your event to public audiences, send you promotional materials, and, where appropriate, help you invite your local MP or councillor. Don't forget to tag us in your social media posts about your events and use #pathologyweek.

Your Comments


10 Dec 2018
1:30 pm