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What do nurses know about choosing wisely?--What the survey data reveals ...

A national campaign led by the American Board of Internal Medicine, Choosing Wisely[R] is focused on educating the general public about making informed health care decisions. The campaign began in April 2012 with the goal of promoting communication that would help patients choose care that is supported by evidence, avoids unnecessary care by avoiding duplicate tests or procedures that have already been completed, does not cause harm and is truly needed to guide care. Examples of unnecessary care might include prescribing antibiotics for conditions typically associated with a virus or completing a full body diagnostic computed tomography (CT) scan for minor or single system trauma. Currently, there are more than 70 specialty society partner health care provider organizations that have released a list of tests or procedures to consider.

There are many stories about how the Choosing Wisely[R] campaign has positively impacted care provided for patients. Dr. Lokale, a family practice provider in Tuscon, AZ, shares an anecdote in which a woman presented to his practice with a cough. The patient had previously been through three rounds of antibiotics for abdominal illness and had been diagnosed with Clostridium difficile infection (C. difficile), which had eventually resolved. However, she was not aware that going on another antibiotic for her cough, which might have been viral in origin, would increase her risk for a C. difficile recurrence. "That suggests to me that patients' awareness of the Choosing Wisely recommendations is still low," he says. "Most doctors are familiar with the recommendations, but in reality, sometimes the guidelines are not followed because the patient wants treatment." When Dr. Lokale explained to the patient that taking another antibiotic would raise her risk for C. difficile, she readily followed his advice (DeMaio, 2015).

Texas is engaged in executing a multi-year pilot initiative focused on assessing nurses' knowledge of the Choosing Wisely[R] campaign and then educating nurses based on survey findings. Multiple stakeholders, both nationally and across the state of Texas, are involved in the successful implementation of this pilot project. Texas participants in the project include the Texas Nurses Association, the Texas Organization of Nurse Executives and the Texas Team: Advancing Health through Nursing, a state action coalition focused on achieving the Institute of Medicine's Future of Nursing goals. The first step in the campaign was to develop and conduct a survey to assess the knowledge of professional registered nurses (RNs) and advanced practice registered nurses (APRNs) across the state of Texas. The survey was conducted in late 2015. Over a period of approximately six weeks, 374 nurses completed the survey. Of the participants, 295 were RNs and 79 were APRNs.

RN Survey Results

Approximately 45% of RNs that participated in the survey responded that unnecessary nursing care was a somewhat serious problem, while 52% felt a great deal of responsibility to ensure their patients avoided unnecessary care. When asked who was in the best position to address the problem of unnecessary nursing care, the overwhelming response was the RN (70%). The top three reasons that RNs identified as leading to the overuse of unnecessary care and tests and procedures include not having enough time with a patient for meaningful discussion, concern about malpractice issues, and "just to be safe".

The cost of tests and procedures are often not addressed by the RN--over half responded that the cost is never or rarely discussed. The majority of RNs (55%) believe the MD or APRN is in the best position to address unnecessary tests and procedures. According to those surveyed, 78% indicated the most effective way to address unnecessary nursing care is by using evidence based practices (EBP) but when asked to assess their knowledge of EBP, 52% indicated some knowledge with 20% indicating not much knowledge. It is encouraging that 95% are interested in learning more. Only 21% of RNs have heard of the Choosing Wisely[R] campaign.

APRN Survey Results

Over half of APRNs that participated in the survey responded that unnecessary nursing care was a somewhat serious problem and that the person in the best position to address the issue is the MD or APRN. The top three reasons that APRNs identified as leading to the overuse of unnecessary care and tests and procedures include concern about malpractice issues, patients insisting on getting the test or procedure, and not having enough time with a patient for meaningful discussion.

The cost of tests and procedures are often addressed by the APRN--48% responded that the cost is often or frequently discussed. The majority of APRNs (74%) believe the MD or APRN is in the best position to address unnecessary tests and procedures. Only 26% of APRNs have heard of the Choosing Wisely[R] campaign.

Of the APRNs who have heard of the Choosing Wisely[R] campaign, 90% believe the recommendations were helpful, 67% have discussed the recommendations with their patients and all felt the information was valuable when talking to patients. Over the next 12 months, approximately half of the APRNs plan to talk to their patients often or frequently about avoiding unnecessary tests and procedures.

The next steps in the Choosing Wisely[R] campaign include distribution of education across the state at various venues. If you would like to learn more about Choosing Wisely[R], you can visit www.choosingwisely. org. You can also see the video developed in Texas at www.txactioncoalition.org/ choosing-wisely.

References

Choosing Wisely (n.d.). Retrieved from www.choosingwisely.org/about-us/

DeMaio, S. (2015). "Choosing Wisely" in the daily practice of family medicine. New England Journal of Medicine. Retrieved from http://knowledgeplus.nejm.org/ choosing-wisely-in-the-daily-practice-of-family-medicine/

Pam Bradshaw, DNP, MBA, RN, NEA-BC, CCRN-K
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Author:Bradshaw, Pam
Publication:Texas Board of Nursing Bulletin
Date:Jul 1, 2016
Words:935
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