Professional News 2006

October 2006

Introducing ‘appropriateness’ to health care

There is a new tool in the quest for quality and safety in health care: the concept of appropriateness. Essentially ‘appropriateness’ is about ensuring that the health care intervention provided is the most appropriate response to an individual’s need – that is: evidence-based, economical, necessary, likely to be effective, and achieve a positive outcome.

For many people, the question might seem surreal: surely this the first step in health care decision-making? However as many people will also be aware, many choices are made and decisions taken in health that are not always consistent with best practice – take for example the previously common practice of tonsillectomy 20-30 years ago, now no longer considered ‘appropriate’ in any but the worst cases of tonsillitis.

In contemporary practice, the rates of caesarean sections are an example of where measures of ‘appropriateness’ could well be considered. But appropriateness is not, and should not be, limited to surgical interventions, although that has been the focus for much of the appropriateness activities in the USA and, to a lesser extent, in Australia to date. New emphasis is being brought to bear on appropriateness here in Australia however, with the recent decision of the Australian Council of Health Care Standards (ACHS) to include appropriateness as a standard in the new EQuIP (edition 4) accreditation standards to commence in 2007.

The ANF was invited to attend a forum recently to discuss the concept of appropriateness and its application in Australia. There was widespread consensus among health care leaders that appropriateness was an important element in the national effort to improve safety and quality of care, however how this would be effected remains unclear. Improving the quality and safety of health care in Australia is of paramount importance – and as with all approaches to national health policy, the ANF considers the views of nurses and the impact of nursing practice must be considered. With regard to appropriateness, the ANF will continue to advocate measures to determine appropriateness are applied to all health care interventions, so that the value and capacity of nursing interventions in the national effort to improve safety and quality of care are understood.

In other news, the ANF and Royal College of Nursing, Australia (RCNA) continue to contribute to national plans for the management of an influenza pandemic. The ANF and RCNA have joint representatives on the primary care working group, clinical care working group and the infection control sub-committee of the National Influenza Pandemic Action Committee (NIPAC). These groups are involved in developing specific information resources to help nurses and other health care professionals during a pandemic.

Fiona Armstrong
ANF Professional Officer