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36 Effectiveness of interventions aiming to reduce low value care in nursing: a systematic review
  1. Tessa Rietbergen1,
  2. Denise Spoon2,
  3. Anja H Brunsveld-Reinders3,
  4. Jan W Schoones4,
  5. Erwin Ista2,
  6. Leti van Bodegom-Vos1
  1. 1Department of Biomedical Data Sciences, section Medical Decision Making, Leiden University Medical Center, Leiden, Netherlands
  2. 2Department of Internal Medicine, Nursing Science, Erasmus MC, Rotterdam, Netherlands
  3. 3Department of quality and patient safety, Leiden University Medical Center, Leiden, Netherlands
  4. 4University Library, Leiden University Medical Center, Leiden, Netherlands


Objectives In nursing, many unnecessary or potential harmful practices (low value care) are routinely performed. As it is hard to implement new innovations, it is even more difficult to get nurses give up older practices even in the face of lack of evidence for their value, and the lack of effectiveness of de-implementation strategies. Therefore, the aim of this systematic review was to summarize the overall evidence about effective de-implementation strategies aiming to reduce low value care in nursing.

Method We searched PubMed, Embase, Emcare, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science and Google Scholar for studies reporting the effectiveness of de-implementation strategies aiming to reduce low value care in nursing. There were no restrictions for language and publication date (inception to 27 November 2018). Reference lists and citations of the included studies are still being searched. Studies that were included in the review had the following design: randomized controlled trial (RCT), cluster randomized trials, quasi-randomized controlled trial, non-randomized controlled trial, controlled before and after study, interrupted time series study or uncontrolled before-after. Case studies of individual patients, letters and editorials were excluded. De-implementation strategies were classified according the Effective Practice and Organisation of Care (EPOC) taxonomy.

Results Of the 3896 studies screened, 20 met the inclusion criteria; three RCTs, six Cluster RCTs, one controlled before after study, nine uncontrolled before after studies, and one quasi-experimental study. Six types of low value care were found in our included studies: restraint use, urine catheters, liver function tests, antibiotic prescribing, antipsychotic prescribing, and peripherally inserted central catheter (PICC). Nine of the 20 studies showed a positive significant effect of a de-implementation strategy aiming to reduce low value care in nursing. Effective de-implementation strategies were educational meetings, educational outreach visits, educational materials, and health information systems.

Conclusions For both effective and non-effective interventions, educational meetings was found to be the most frequently used de-implementation strategy. Further research is needed to assess the differences between the effective and non-effective strategies.

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