Implementation

Choosing Wisely Implementation Hub

Choosing Wisely Implementation Hub provides links to helpful information on designing and implementing quality improvement activities in line with Choosing Wisely principles including specific recommendations. The purpose of the hub is to assist members and supporters, particularly Champion Health Services, to undertake quality improvement activities tailored to their local requirements.

General quality improvement resources

  1. NPS MedicineWise: QI Hub – Quality improvement in general practice ➔
    Practical information, tools and resources for health professionals and staff in general practice to help improve the quality of health care and safety for patients.
  2. NSW Therapeutic Advisory Group: Resource Kit for Measuring Strategies to Reduce Harm from Polypharmacy in Australian Hospitals ➔
    Includes a full set of resources, polypharmacy Quality Use of Medicines indicators and Patient Reported Experience Measures lists, data collection tools and user guide.
  3. National Safety and Quality Health Service Standards: User Guide for the Review of Clinical Variation in Health Care ➔
    Explains how health services and clinicians can use data to improve the appropriateness of clinical care.
  4. The Victoria Quality Council: A guide to using data for health care quality improvement ➔
    Outlines how to use data for health care quality improvement projects.
  5. The NSW Clinical Excellence Commission: Quality improvement tools ➔
    Includes graphs, charts, diagrams and mapping tools designed to help plot data for intended quality improvement initiatives.
  6. The Institute for Healthcare Improvement: Quality Improvement Essentials Toolkit ➔
    Includes the tools and templates required to launch a successful quality improvement project and manage performance improvement.
  7. Australian Commission on Safety and Quality in Health Care: Clinical care standards ➔
    A clinical care standard is a small number of quality statements that describe the care patients should be offered by health professionals and health services for a specific clinical condition or defined clinical pathway in line with current best evidence.
  8. National Health and Medical Research Council: Clinical Guideline Portal ➔
    Provides a single-entry point for access to clinical practice guidelines developed for use in Australian health care settings.
  9. The Australian Register of Clinical Registries ➔
    Provides summary information on the purpose and organisation of clinical registries at all stages of development.
  10. Evolve Recommendations on Low Value Care ➔
    An initiative led by physicians and the Royal Australasian College of Physicians (RACP) to drive high-value, high-quality care in Australia and New Zealand.
  11. The Australian Council on Healthcare Standards: Clinical indicator program ➔
    It is a data repository, analysis and reporting service provided to member organisations.
  12. The Improvement Exchange ➔
    This web-based collaboration site is designed to connect people who share similar interests and generate conversations about small and largescale projects in Queensland Health.
  13. National Surgical Quality Improvement Program ➔
    The American College of Surgeons National Surgical Quality Improvement Program data enhances a hospital’s ability to zero in on preventable complications, using validated, risk-adjusted clinical and administrative data.
  14. The PIP Quality Improvement (QI) Incentive guidance ➔
    General practices work with their local Primary Health Network (PHN) to undertake continuous quality improvement activities through the collection and review of practice data on specified Improvement Measures.
  15. National Quality Use of Medicines Indicators for Australian Hospitals ➔
    Supports measurement of safety and quality of medicines use for quality improvement purposes, and to help health services to drive changes in healthcare practice.

Implementation resources for Choosing Wisely recommendations

  1. Opiod presribing
    1. Clinical Excellence Queensland: Opioid Prescribing Toolkit ➔
      Related ChoosingWisely recommendations:
      1. Don't recommend the use of medicines with sub-therapeutic doses of codeine (<30mg for adults) for mild to moderate pain.
      2. Do not continue opioid prescription for chronic non-cancer pain (CNCP) without ongoing demonstration of functional benefit, periodic attempts at dose reduction and screening for long-term harms.
      3. Avoid prescribing opioids (particularly long-acting opioids) as first-line or monotherapy for chronic non-cancer pain (CNCP).
    2. NPS MedicineWise: Quality improvement for opioids ➔
      Information, tools and resources for making changes to achieve optimal safety and health outcomes in your use of opioids for patients with chronic non-cancer pain.
  2. Antimicrobial Stewardship Clinical Care Standard ➔
    Related ChoosingWisely recommendations:
    1. Don’t treat otitis media (middle ear infection) with antibiotics, in non-Indigenous children aged 2-12 years, where reassessment is a reasonable option.
    2. Don’t initiate an antibiotic without an identified indication and a predetermined length of treatment or review date.
    3. Do not prescribe antibiotics for exacerbation of asthma.
    4. Do not give routine prophylactic antibiotics to a child after the first urinary tract infection if at low risk of recurrent urinary tract infections.
    5. Do not use topical antibiotics pre or post intravitreal injections.
    6. Do not routinely prescribe antibiotics for inflamed epidermoid cysts (formerly called sebaceous cysts) of the skin.
    7. Monotherapy for acne with either topical or systemic antibiotics should be avoided.
    8. Don’t prescribe oral antibiotics for uncomplicated acute otitis externa.
    9. Don’t prescribe oral antibiotics for uncomplicated acute discharge from grommets.
    10. Do not routinely prescribe oral antibiotics to children with fever without an identified bacterial infection.
    11. Do not dispense a repeat prescription for an antibiotic without first clarifying clinical appropriateness.
    12. Once patients have become afebrile (non-feverish) and are clinically improving, don’t continue prescribing intravenous antibiotics to those with uncomplicated infections and no high-risk features if they are tolerant of oral antibiotics.
    13. Consider antibiotic de-escalation daily.
    14. Do not use antimicrobials to treat bacteriuria in older adults where specific urinary tract symptoms are not present.
    15. Consider antibiotic de-escalation daily.
    16. Do not use antibiotics in asymptomatic bacteriuria.
    17. Avoid prescribing antibiotics for upper respiratory tract infection.
  3. Delirium Clinical Care standard ➔
    Related ChoosingWisely recommendations:
    1. Do not continue benzodiazepines, other sedative hypnotics or antipsychotics in older adults for insomnia, agitation or delirium for more than three months without review.
    2. Limit routine use of antipsychotic drugs to manage symptoms of delirium.
    3. Do not use physical restraints to manage behavioural symptoms of hospitalized older adults with delirium except as a last resort.
    4. Do not prescribe benzodiazepines or other sedative-hypnotics to older adults as first choice for insomnia, agitation or delirium.
  4. Colonoscopy Clinical Care Standard ➔
    Related ChoosingWisely recommendations:
    1. Do not repeat colonoscopies more often than recommended by the National Health and Medical Research Council (NHMRC) endorsed guidelines.
    2. Don’t order colonoscopy as a screening test for bowel cancer in people at average or slightly above average risk. Use faecal occult blood screening instead.
  5. Osteoarthritis of the Knee Clinical Care Standard ➔
    Related ChoosingWisely recommendations:
    1. Do not perform arthroscopy with lavage and/or debridement or partial meniscectomy for patients with symptomatic osteoarthritis of the knee and/or degenerate meniscal tear.

5 Questions

5 questions to ask your doctor or other healthcare provider to make sure you end up with the right amount of care.

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