186 Chapter 6 Discussion To our knowledge, this is the first systematic review on de-implementation strategies for low-value nursing procedures. This systematic review identified both uncontrolled and controlled studies for the reduction of a limited range of low-value nursing procedures, namely physical restraint use, antibiotic and antipsychotic prescribing, requests for liver function tests and urinary catheter use. The majority of the controlled and uncontrolled studies with a positive significant effect used a de-implementation strategy with an educational component (educational meetings, educational materials, educational outreach visits, and educational games) and focused their de-implementation strategy at reducing the use of restraints. An important difference between the controlled and uncontrolled studies with a positive significant effect is that the majority of the controlled studied used a multifaceted de-implementation strategy, and the majority of the positive significant uncontrolled studies used a single faceted de-implementation strategy. However, the use of educational components cannot be directly linked to successful de-implementation since both studies with a positive significant effect and studies without an effect or with a negative effect included these components. Due to heterogeneity and a lack of same strategies in the controlled studies no conclusions can be drawn from the meta-analyses about the effectiveness of de-implementation strategies for low-value nursing procedures. Despite increasing attention for the de-implementation of low-value nursing procedures, we only found 27 articles that we could include in our systematic review. However, the number of studies increased within the last decade. Only one study was found in the nineties, where seven studies were found from 2000 till 2010, and eighteen studies from 2010 till 2020. This shows the attention for this important topic, however more variation in the strategies to be evaluated is needed to get a full picture of effective or non-effective de-implementation strategies for nurses. Additionally, this study showed from the high number of excluded studies in which dependent nursing procedures are de-implemented, i.e. nursing procedures that require an order of another healthcare professional, that nurses have an important role in the de-implementation of lowvalue care. Due to differences in responsibilities in different countries some nursing procedures are in some countries independently and in other countries dependently performed, for example the use of urinary catheters. As a consequence, some studies on this kind of topics are included in this review (as nurses are allowed independently to decide) or excluded (as nurses need an order for the nursing procedure). The results of this systematic review showed some similarities and differences with previous findings in the literature regarding effective types of de-implementation strategies. A similarity is that our review showed as in a previous study of Colla et al. [7]
RkJQdWJsaXNoZXIy MTk4NDMw