Author (year) | Type of low-value care | Single or multifaceted intervention strategy | Interventions from the EPOC taxonomy | Description of intervention strategy (sorted by EPOC Taxonomy) | Positive Significanteffect (p ≤ 0.05) (Yes/No) | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
E | AF | P | C | CQ | H | L | M | MP | O | S | T | TI | Â | ||||
Alexaitis et al. 2014 [27] | Catheter use | Multifaceted | X | X | Â | X | Â | Â | X | Â | Â | Â | Â | Â | Â | Educational meetings: - Education about alternatives to indwelling catheters and routine catheter care - Education about the protocol - Didactic education encompassed routine catheter maintenance, bedside bladder ultrasound indications, and criteria in the nurse-driven protocol. Simulation education to assess proficiency in using the bladder ultrasonography was provided to nurses by the clinical leaders and charge nurses Audit and Feedback: - Compliance monitoring to ensure adherence to the protocol and guidelines for routine catheter care - Analysis of identified CAUTIs - Daily catheter rounds to assess the need for catheter continuation Clinical guidelines: - Evidence-based, nurse-driven protocol for urinary catheter management Local consensus processes - Protocol approval by NSICU stakeholders | No |
Amato et al. 2006 [28]a | Restraint use | Multifaceted | X | X |  |  |  |  | X |  |  |  |  |  |  | Educational meetings: - Formal and informal information sessions for all levels of nursing staff about the restraint and seclusion policy as well as the hospital’s philosophy regarding restraint use - A local vendor demonstrated restraint alternatives - Training on proper use of the devices Educational outreach visits: - Consultation rounds of a clinical nurse specialist Audit and feedback: - The nurses’ adherence to the plan of care was monitored and reviewed during the ongoing consultation rounds, at which time individual nurse-to-nurse feedback was provided - The quality management department provided aggregate data in the form of monthly run charts for fall rates and physical restraint use on each unit Local consensus processes: - The administrative component involved gaining the active support of the director of nursing, nurse managers, patient care coordinators, physician leaders, and therapists prior to implementation of the program | / |
Andersen et al. 2017 [29] | Restraint use | Multifaceted | X | Â | Â | Â | Â | Â | Â | Â | Â | Â | X | Â | Â | Educational meetings: - Education by occupational therapists. The occupational therapists on the project unit completed a 3-day course and a 1-day workshop with the rest of the staff four months later Sensory modalities for the patient: - Access to a variety of sensory modalities located in the unit and a sensory room | No |
Davis et al. 2008 [30] | Antibiotic prescribing | Multifaceted | X | X | Â | Â | Â | Â | Â | Â | Â | Â | Â | Â | Â | Educational meetings: - The standards of care for the treatment of a viral upper respiratory tract infections were presented to the individual health care provider Audit and feedback: - Thirty randomly selected charts coded by the individual healthcare providers - Individual provider and group statistics regarding rates of prescribing. | No |
Eskandaria et al. 2018 [31] | Restraint use | Single | X | Â | Â | Â | Â | Â | Â | Â | Â | Â | Â | Â | Â | Educational meetings: - Lectures - Group discussion - Demonstration on some types of physical restraint and proper use of physical restraint - Three video demonstrations | Yes |
Hevenver et al. 2016 [32] | Restraint use | Multifaceted | X | Â | Â | Â | Â | X | Â | Â | Â | Â | Â | Â | Â | Educational meetings: - 1-on-1 discussion about proper use of restraints and alternatives Educational materials: - Online educational activity Health information system: - Restraint decision tool | Yes |
Link et al. 2016 [33] | Antibiotic prescribing | Single | X | Â | Â | Â | Â | Â | Â | Â | Â | Â | Â | Â | Â | Educational meetings: - The intervention consisted of a 60-min face to-face interactive provider education activity. - Small group discussion - Case studies with didactic lecture - Treatment algorithms | Yes |
McCue et al. 2004 [34] | Restraint use | Multifaceted | X | Â | Â | Â | X | Â | X | Â | Â | Â | Â | X | Â | Educational materials: - All clinical staff on the psychiatric inpatient service received training on crisis intervention techniques that can be used as an alternative to restraint (videotapes) - A stress/anger management group for patients was added to the inpatient service's therapeutic programming. Continuous quality improvement: - Daily review of all restraints Local Consensus processes: - Identification of restraint prone patients Team: - Crisis response team - Incentive system for the staff | Yes |
Mitchell et al. 2018 [9]a | Restraint use | Multifaceted | X |  |  |  |  |  |  |  | X |  |  |  |  | Educational meetings: - Presentations Educational materials: - Flyers - Posters Monitoring the performance of the delivery of healthcare: - Monthly prevalence is determined on all units by bedside nurses. If a patient has restraints in place, the patient’s chart is reviewed for orders and proper documentation | / |
Sinitsky et al. 2017 [35] | Liver function tests | Single | Â | Â | Â | Â | Â | X | Â | Â | Â | Â | Â | Â | Â | Health Information System: - Blood test form | Yes |
Thakker et al. 2018 [36]a | Catheter use | Multifaceted | X | X | Â | Â | Â | Â | Â | Â | Â | Â | Â | Â | Â | Educational meetings: - Education about the guidelines to ensure adherence and to standardize the criteria for catheter use. Audit and Feedback: - Reminders about adhering to the CAUTI prevention guidelines in daily safety huddles and weekly staff meetings | / |
Weddle et al. 2016 [37] | Antibiotic prescribing | Single | X | Â | Â | Â | Â | Â | Â | Â | Â | Â | Â | Â | Â | Educational meetings: - Educational session used evidence-based guidelines and a local antibiogram to provide specific recommendations for the best prescribing practices | Yes |