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Table 5 Type of intervention of the controlled studies (n = 15)

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 significant effect (p ≤ 0.05) (Yes/No)
E AF P C CQ H L M MP O S T TI
Desveaux et al. 2017 [38] Antipsychotic prescribing Multifaceted X              Educational outreach visits:
- Academic detailing (educational outreach) intervention delivered by registered health professionals following an intensive training program including relevant clinical issues and techniques to support health professional behavior change
Educational materials:
- Online practice reports
No
Evans et al. 1997 [39] Restraint use Single and multifaceted X              Restraint education (RE) group
Educational meetings:
- Intensive education by a masters-prepared gerontologic nurse on restraint use
Restraint education-with-consultation (REC) group
Educational meetings:
- Intensive education by a masters-prepared gerontologic nurse
Educational outreach visits:
- Unit-based nursing consultation
Yes
Fitzpatrick 1997 [40] Restraint use Single and Multifaceted (2 groups) X              Single faceted group
Educational materials:
- Educational program: restraint education in service administered in the form of a self-learning module and the option to construct a poster in each unit
Multifaceted group
Educational materials:
- Educational program: restraint education in service administered in the form of a self-learning module and the option to construct a poster in each unit.
- Critical care restraint decision guide (CCRDG).
No
Gulpers et al. 2011 [41] Restraint use Multifaceted X       X        Educational meetings:
- Nursing home staff education
- Availability of alternative interventions
Educational outreach visits:
- Consultation by a nurse specialist aimed at nursing home staff
Local consensus processes:
- Promotion of institutional policy change that discourages use of belt restraint
Yes
Gulpers et al. 2013 [42] Restraint use Multifaceted X       X        Educational meetings:
- Intensive educational program offered by two registered nurses with extensive experience in physical restraint reduction
- Availability of alternative interventions
Educational outreach visits:- Consultation from the two nurse specialists (who delivered the educational program) to individual nurses on the intervention wards
Local consensus processes:
- Policy change by the nursing home management, with new use of belts prohibited and current use reduced
Yes
Huang et al. 2009 [43] Restraint use Single X              Educational meetings:
- Power-Point presentations
- Discussion
- Scenario reflections
Yes
Huizing et al. 2009 [45] Restraint use Multifaceted X              Educational meetings:
- Educational program
Educational outreach visits:
- Consultation with a nurse specialist
No
Huizing et al. 2009 [44] Restraint use Multifaceted X              Educational meetings:
- Educational program
Educational outreach visits:
- Consultation with a nurse specialist
No
Koczy et al. 2011 [46] Restraint use Multifaceted X      X        X Educational meetings:
- The training course included information on epidemiology, the side effects of restraint use, legal aspects and alternatives
Health information system:
- Technical aids, such as hip protectors and sensor mats
Tailored interventions:
- Problem-Solving Tools
- Advice by telephone from the research team
No
Kopke et al. 2012 [47] Restraint use Multifaceted X              Educational meetings:
- Group sessions for all nursing staff
- Additional training for nominated key nurses
Educational materials:
- Supportive material for nurses, residents, relatives, and legal guardians.
Yes
Kwok et al. 2005 [48] Restraint use Multifaceted X      X         Educational meetings:
- Education about how to use of the bed-chair pressure sensors and the importance of restraint reduction in improving patients’ outcomes
Health information system:
- Bed-chair pressure sensors
No
Lai et al. 2011 [49] Restraint use Multifaceted X          X     Educational meetings:
- Staff education package
Educational outreach visits:
- Consult with the project team for uncertainties and on an individual
Organizational Culture
- The setup of a restraint reduction committee (RRC)
No
Pellfolk et al. 2010 [50] Restraint use Multifaceted X              Educational meetings:
- One volunteer from each unit attended the whole education program
- Educational seminar
Educational materials:
- Videotaped lectures. Three of the lectures also included a clinical vignette presented in writing, which could be used for group discussions.
Yes
Testad et al. 2010 [51] Restraint use Multifaceted X              Educational meetings:
- Two day seminar
- Monthly group guidance for six months
Educational materials:
- Teaching manual
Yes
Testad et al. 2016 [52] Restraint use Multifaceted X              Educational meetings:
- Two day seminar
- Monthly seven step guidance groups for six months
Educational materials:
- Manual of the updated intervention and the seven-step guidance group
- Poster DMP model
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. No statistical testing