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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)
E AF P C CQ H L M MP O S T TI  
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
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           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
No
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.
No
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
Yes
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
Yes
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
Yes
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
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       X         Health Information System:
- Blood test form
Yes
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
Yes
  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