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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