The work of the Choosing Wisely Oversight Committee to promote standardization and reduce unnecessary tests and treatments is only the tip of the iceberg. Many medical staff and providers in the community are committed to choosing wisely every day.
To highlight some of this amazing work expand the headings below and read more about physician and program led projects and initiatives that are underway to improve patient care.
- Small Changes, Big Impacts! Working with order sets to reduce opioid prescribing
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The dedication of medical staff is driving change island-wide as we Choose Wisely and follow best practice recommendations every day.
Read below to learn about the amazing work led by Dr. Kevin Martin at Nanaimo Regional General Hospital to reduce hydromorphone prescribing using order sets at admission.
The Oversight Committee has a keen interest in this work as there is potential for alignment with the Antipsychotic Use in Dementia in Acute Care project as we investigate “as required” (PRN) medication ordering.
Email MedStaffQI@islandhealth.ca if you would like to learn more about this important work.
Small Changes, Big Impacts! Order Set Revision Inspires Quality Improvement Project Infographic - Advanced Care Planning: Ensuring Patient Wishes and Goals are Expressed, Heard, and Respected
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Advanced Care Planning (ACP) is an increasing focus in healthcare and within the patient population. Campaigns including “Speak Up: Advanced Care Planning in Canada initiative” and the Choosing Wisely recommendation “Don’t delay advance care planning conversations” are ensuring the topic remains a priority.
ACP can improve patient and family satisfaction, increase the likelihood of receiving hospice care, and reduce the number of days spent in hospital receiving end of life care. Data suggests that 75% of Canadians would prefer to die at home, but a planned home death is impossible without engaging in a robust advance care planning process. It is estimated that less than one in five Canadians has an advance care plan.
Island Health considers ACP an essential component of good patient care. Advance Care Planning leaders work in partnership with programs across Island Health to ensure resources are in place for providers and patients to have conversations about patient values, goals, and preferences for their care and to utilize these to plan care for the present and the future. Using quality improvement methods the ACP/MOST Steering Committee is engaging with staff, medical staff, and programs island-wide to encourage provider-patient ACP conversations.
Metrics related to “Expressed, Heard, and Respected” components of patient care are available on the ReportPORTAL in the ACP MOST Quarterly Report so medical staff can see how their sites and programs are engaging with patients for ACP. *Island Health login is required.*
Resources are available to support health care providers in having conversations with patients on the Intranet Advanced Care Planning page. *Island Health login is required.*
Want to learn more about Advance Care Planning and Health Care Consent? An eLearning Course is available on the Learning Hub and is recommended for all health care providers governed by the Health Professions Act and Social Workers Act.
Sign up today to take "Advance Care Planning and Health Care consent". Report PORTAL
**Island Health login is required**The ACP MOST Quarterly Report can be accessed through this link.
It is located on the ‘Health Care Activity and Resources’ section of the Report PORTAL under the heading ‘Palliative & End of Life’.Visit the Island Health Intranet for more information and resources on Advanced Care Planning and how to make the MOST of patient care. *Island Health login is required*.
Email MedStaffQI@islandhealth.ca for more information.
Choosing Wisely for Planetary Health
Choosing Wisely advocates for resource stewardship through avoiding unnecessary medical tests, treatments and procedures and aligns with climate conscious healthcare. Reducing overuse and ensuring the right test at the right time benefits both patients and our planet.
On May 15, 2024, Choosing Wisely Canada released over 40 climate conscious recommendations that span more than 20 specialties. Understanding the role that overuse plays in planetary health is an important step towards choosing wisely for the patient and the planet.
To learn more about physician and program led climate conscious clinical work expand the headings below.
- Promoting Planetary Health and Reducing Unnecessary Waste
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Planetary Health is not currently a specific campaign of Choosing Wisely Canada, but reducing unnecessary waste and promoting a sustainable future is a shared goal and Choosing Wisely Canada is paying close attention to Climate Change initiatives.
Dr. Caroline Stigant and Dr. Jean Maskey presented The Climate Crisis and Working Towards a Model of Planetary Health Medical Practice in Victoria Hospitals – Getting it on Our Agenda on June 25, 2021 and again during the Choosing Wisely at Island Health Symposium on November 26, 2021 to discuss the impacts of health care to the climate crisis.
If you missed the talk, or if you attended and wish to revisit some of the points, please click here to view the slide deck.
Dr. Caroline Stigant and Dr. Jean Maskey are progressing this work through the South Island MSA FEI funding.
Want to learn more about Green Initiatives at Island Health? Visit the Green Island Health Intranet page. *Island Health login is required*.
We invite you as medical staff from all areas of practice to discuss ways you can reduce waste while providing optimal patient care and mitigating negative environmental impacts of the health care delivery system!
Email Dr. Caroline Stigant or Dr. Jean Maskey to learn more.
The Climate Crisis and Working Towards a Model of
Planetary Health Medical Practice in Victoria Hospitals – Getting it on Our Agenda
Presentation by Dr. Caroline Stigant and Dr. Jean Maskey
Resources on Environmental Sustainability:
Sustainable Health Systems Community of Practice:
Environmentally Sustainable Opportunities for Health Systems
Key areas of opportunity in sustainable healthcare.
Some of the opportunities highlighted, including strategies to
reduce waste in operating rooms, are in alignment with Choosing
Wisely Canada recommendations. Led by the Toronto Academic
Health Science Network (TAHSN) and the University of Toronto’s
Council of Health Science (CHS). - Promoting Appropriate and Sustainable Prescribing for Patients with Asthma
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A healthy planet contributes to a healthy population. The negative impacts of climate change are impossible to ignore and the healthcare sector contributes approximately ~5% of Canada’s total greenhouse gas emissions (2019).
Dr Valeria Stoynova and Dr Celia Culley are leading the way at Island Health and across BC to reduce the impacts of inhalers on healthcare waste by helping to define new pathways to reduce inhaler waste and encouraging appropriate prescribing.
Led by Drs. Stoynova and Culley, The Critical Air Project is changing the way we think about inhalers at Island Health to reduce waste through various methods starting with encouraging availability of low carbon alternatives alongside the traditional MDIs and following along the patient journey through the acute system. Island Health is committed to environmental sustainability and the work of The Critical Air Project is poised to make significant impacts.
In addition to their work to improve pathways for inhaler use in acute care, Drs Stoynova and Culley focus on appropriate prescribing for patients with asthma in the outpatient setting. Studies show that 1 in 4 Canadians prescribed an inhaler for asthma do not actually have asthma when formally tested. Choosing Wisely Canada recently launched the “Let’s Clear the Air” campaign to encourage conversation between providers and patients who have received a diagnosis of asthma to confirm the diagnosis using pulmonary function testing. Ensuring that patients prescribed inhalers for asthma also have a diagnosis of asthma helps to ensure the right treatment is available to treat the true cause of symptoms, limits the potential for negative side effects, and reduces the financial burden on patients.
Patient resources on asthma are available from Choosing Wisely Canada.
For patients with a formal diagnosis of asthma, many different inhaler options are available. By considering lower carbon alternatives such as DPIs or low-volume propellant MDIs where appropriate, we can engage in a safe, effective, low-cost treatment that significantly reduces individual impacts on climate change.
We always need to keep in mind that the best inhaler for asthma is the one you are willing and able to take! No one should feel bad about needing an inhaler to treat their asthma; for some patients, MDIs may be the safest or most effective treatment.
Treating asthma appropriately – with any inhaler, regardless of the carbon footprint! – will always be lower carbon impact than having an asthma exacerbation that leads to worsening health or hospital visits.
Want to learn more about Dr. Stoynova and Dr Culley’s commitment to “Mitigating the climate impact of asthma therapy”? Click here to read an article co-written by Dr. Stoynova and Dr. Celia Culley
This Changed My Practice (UBC CPD) “Mitigating the climate
impact of asthma therapy” by Dr. Valeria Stoynova and Dr. Celia Culley.CASCADES: Infographics and Posters – Inhalers
Infographic on MDIs: Environmentally Sustainable Opportunities
for Health SystemsPatient-Facing Resources on inhaler usage
Includes a poster with links to videos demonstrating the correct
technique for usage for different inhaler typesSustainable Inhalers
in Primary Care Playbook
Includes tools and templates to encourage correct and
sustainable prescribing for inhalers
Let’s Clear the Air - Choosing Wisely Canada Patient Resources:
Treating Breathing Issues: Asthma Treating Breathing Issues:
COPD Let’s Clear the Air Video - BC Medical Journal: BC anesthesiologists reduce carbon footprint by choosing wisely
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Physicians Choose Wisely at Island Health
BC Medical Journal: MDs to Be: BC
anesthesiologists reduce carbon footprint by choosing wisely
How Island Health Chooses Wisely: Initiatives that align with Choosing Wisely Climate Conscious Recommendations
The Environmental Support Services team are champions for reducing waste and improving our carbon footprint at Island Health. Expand the headings below to learn more about program-led work that aligns with improving planetary health as identified in the new Choosing Wisely Climate Conscious recommendations.
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Personal Protective Equipment Recycling (PPE)
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Aligns with Choosing Wisely Climate Conscious recommendations around proper waste segregation including avoiding disposing of non-contaminated materials in contaminated waste bins and advocating for use of recyclable alternatives to reduce clinical waste.
Island Health is excited to announce the launch of a new Ministry of Health funded PPE recycling program at the following acute-care sites: Royal Jubilee Hospital, Victoria General Hospital, Saanich Peninsula Hospital, Cowichan District Hospital, Nanaimo Regional General Hospital, Comox Valley Hospital, and Campbell River Hospital.
Accepted items for recycling encompass a wide range of PPE, including disposable masks, gowns, gloves, and eyewear, among others. Contaminated PPE saturated or dripping with blood, or contaminated by cytotoxic agents (Hazardous Drug 1) should continue to be disposed of in designated biowaste bins. More details on accepted PPE items can be found at the PPE Recycling intranet page. *Island Health login required.
Used PPE gets sent to Port Coquitlam at the Vitacore facility and gets recycled for a variety of uses, including construction materials like Trex® decking, piping, and concrete filler.
Click here to access a video on the New PPE Recycling Program for Housekeeping and Logistics.
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Assessments & Waste Stations
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Aligns with multiple Choosing Wisely Climate Conscious recommendations, including disposal of medical waste, appropriate recycling and disposal of equipment, and proper waste segregation through avoiding disposal of non-contaminated materials in contaminated waste bins.
In 2023, the Environmental Support Services team assessed the waste infrastructure in more than 1800 areas across the Island. The team assessed the following: uniformity, accessibility, signage, contamination, and waste station composition.
These assessments led to the following findings:
- The absence of signage or waste streams led to increased contaminated bins.
- Waste generators tend to opt for convenience over recycling.
- Common misconception that housekeepers sort recycling.
- Significant opportunity for improvement in clinical staff’s understanding of proper bio waste disposal processes.
From these findings, Island Health purchased a total of 332 waste and recycling bins as well as collaborated with the design team to create updated/relevant signage including decals. These waste stations were purchased for public areas for staff and visitors to use.
You can learn more by visiting the Waste and Recycling page on the Island Health Intranet. *Island Health login required
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Waste Audits and In-Services
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Aligns with multiple Choosing Wisely Climate Conscious recommendations, including disposal of medical waste, appropriate recycling and disposal of equipment, and proper waste segregation through avoiding disposal of non-contaminated materials in contaminated waste bins.
Waste audits were conducted at Victoria General Hospital, Royal Jubilee Hospital, Saanich Peninsula Hospital, The Summit, Cowichan District Hospital, Nanaimo Regional General Hospital, Comox Valley Hospital, and Campbell River Hospital within high waste generating units such as the ER, OR, ICU, Renal, and labs focusing on contamination.
With the findings from the waste audits, the Environmental Support Services team have created customized in-services to help educate staff on proper waste disposal and segregation practices.
The team have also updated the Waste, Recycling, and Biomedical Waste guides based on the assessments and audit findings. These updated guides can be found on the Waste and Recycling page on the Island Health Intranet. *Island Health login required
If you are curious to learn more about how to Choose Wisely for Planetary Health, we invite you to join our 5 day challenge! Spend 5-10 minutes a day over 5 days (self-paced) to learn about how Island Health Chooses Wisely. Together we can explore the perspectives that matter the most to you: as a healthcare worker, as a patient or family member of a patient, or as a member of the community. Everyone who completes the challenge by October 18, 2024 will be automatically entered to win a prize.
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Click here to join the challenge and Choose Wisely for Planetary Health |
Our aim to improve experience of care for patients and providers by choosing wisely is built on the 4 pillars of climate conscious healthcare, reducing unnecessary variation in practice, addressing resource challenges and using quality improvement methodology.
Are you involved in work to implement Choosing Wisely recommendations and spread awareness in your area? Do you Choose Wisely as a provider and incorporate recommendations into your every day practice? Spread the word by emailing MedStaffQI@islandhealth.ca and have your efforts highlighted on the website as we Choose Wisely together.
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Click here to return to the main Choosing Wisely at Island Health webpage |
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Click here to read more about Choosing Wisely and Climate Action |