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Table 4 Type of intervention of the uncontrolled studies (n = 12)

From: Effects of de-implementation strategies aimed at reducing low-value nursing procedures: a systematic review and meta-analysis

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)
Alexaitis et al. 2014 [27] Catheter use Multifaceted X X   X    X        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
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           X    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
Davis et al. 2008 [30] Antibiotic prescribing Multifaceted X X             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.
Eskandaria et al. 2018 [31] Restraint use Single X              Educational meetings:
- Lectures
- Group discussion
- Demonstration on some types of physical restraint and proper use of physical restraint
- Three video demonstrations
Hevenver et al. 2016 [32] Restraint use Multifaceted X      X         Educational meetings:
- 1-on-1 discussion about proper use of restraints and alternatives
Educational materials:
- Online educational activity
Health information system:
- Restraint decision tool
Link et al. 2016 [33] Antibiotic prescribing Single X              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
McCue et al. 2004 [34] Restraint use Multifaceted X     X   X      X   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
- Crisis response team
- Incentive system for the staff
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       X         Health Information System:
- Blood test form
Thakker et al. 2018 [36]a Catheter use Multifaceted X X             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              Educational meetings:
- Educational session used evidence-based guidelines and a local antibiogram to provide specific recommendations for the best prescribing practices
  1. Intervention strategies are classified using the EPOC Taxonomy [21]: E education (meetings, materials, games, and outreach visits), AF audit and feedback, P packages of care, C clinical guidelines, CQ continuous quality improvement, H health information system, L local consensus processes, M monitoring, MP monitoring the performance of the delivery of healthcare, O organizational culture, S sensory modalities for patients, T team, TI tailored interventions
  2. aNo statistical testing