SynthesisImplementation science : IS2020
Effects of de-implementation strategies aimed at reducing low-value nursing procedures: a systematic review and meta-analysis.
Synthesis in Implementation science : IS, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 1 synthesis or guideline pooled it, 55 citations in OpenAlex.
- Effects of implementation strategies aimed at improving high-value verification methods of nasogastric tube placement: A systematic review.Frontiers in nutrition · 2022Pooled it
- De-implementation of low-value care: contrasting theories, models, and frameworks to generate methodological guidance.Implementation science communications · 2026Article
- Hospital Fall Prevention Practices and Implementation Strategies: A Multisite Observational Study.Journal of patient safety · 2026Article
- Selecting and tailoring implementation strategies for deimplementing fall prevention alarms in US hospitals: a group concept mapping study.BMJ quality & safety · 2026Article
- A Tailored De-Implementation Strategy to Reduce Low-Value Home-Based Nursing Care: A Mixed-Methods Feasibility Study.Journal of advanced nursing · 2025Article
- Improvement in clinicians' perceptions of inpatient urinary continence care following an implementation study: a before and after study using a questionnaire aligned to the Theoretical Domains Framework with practical methods for analysing and presenting barrier and enabler data.BMC health services research · 2025Article
- De-implementation of low-value home-based nursing care: an effect and process evaluation.Implementation science communications · 2025Article
- Low-value and high-value care recommendations in nursing: A systematic assessment of clinical practice guidelines.Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing · 2025Review
- Development and usability testing of a multifaceted intervention to reduce low-value injury care.BMC health services research · 2025Article
- Tailored Multifaceted Strategy for Implementing Fundamental Evidence-Based Nursing Care: An Evaluation Study.Nursing reports (Pavia, Italy) · 2024Article
- Effectiveness of de-implementation of low-value healthcare practices: an overview of systematic reviews.Implementation science : IS · 2024Review
- Alarm with care-a de-implementation strategy to reduce fall prevention alarm use in US hospitals: a study protocol for a hybrid 2 effectiveness-implementation trial.Implementation science : IS · 2023Article
- Deimplementation Strategies to End Sexual Orientation and Gender Identity and Expression Change Efforts: Undoing a Harmful Legacy of Behavior Therapy.The Behavior therapist · 2023Article
- The Cost Utility of Nonpregnancy Laboratory Monitoring for Persons on Isotretinoin Acne Therapy.JID innovations : skin science from molecules to population health · 2023Article
- Theories for interventions to reduce physical and verbal abuse: A mixed methods review of the health and social care literature to inform future maternity care.PLOS global public health · 2023Review
- Strategies to reduce low-value care - An applied behavior analysis using a single-case design.Frontiers in health services · 2023Article
- Organizational influences on the use of low-value care in primary health care - a qualitative interview study with physicians in Sweden.Scandinavian journal of primary health care · 2022Article
- Strategies for de-implementation of low-value care-a scoping review.Implementation science : IS · 2022Article
- The case of the disappearing librarians: analyzing documentation of librarians' contributions to systematic reviews.Journal of the Medical Library Association : JMLA · 2022Article
- Randomized controlled trials in de-implementation research: a systematic scoping review.Implementation science : IS · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn the last decade, there is an increasing focus on detecting and compiling lists of low-value nursing procedures. However, less is known about effective de-implementation strategies for these procedures. Therefore, the aim of this systematic review was to summarize the evidence of effective strategies to de-implement low-value nursing procedures.
methodsPubMed, Embase, Emcare, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar were searched till January 2020. Additionally, reference lists and citations of the included studies were searched. Studies were included that described de-implementation of low-value nursing procedures, i.e., procedures, test, or drug orders by nurses or nurse practitioners. PRISMA guideline was followed, and the 'Cochrane Effective Practice and Organisation of Care' (EPOC) taxonomy was used to categorize de-implementation strategies. A meta-analysis was performed for the volume of low-value nursing procedures in controlled studies, and Mantel-Haenszel risk ratios (95% CI) were calculated using a random effects model.
resultsTwenty-seven studies were included in this review. Studies used a (cluster) randomized design (n = 10), controlled before-after design (n = 5), and an uncontrolled before-after design (n = 12). Low-value nursing procedures performed by nurses and/or nurse specialists that were found in this study were restraint use (n = 20), inappropriate antibiotic prescribing (n = 3), indwelling or unnecessary urinary catheters use (n = 2), ordering unnecessary liver function tests (n = 1), and unnecessary antipsychotic prescribing (n = 1). Fourteen studies showed a significant reduction in low-value nursing procedures. Thirteen of these 14 studies included an educational component within their de-implementation strategy. Twelve controlled studies were included in the meta-analysis. Subgroup analyses for study design showed no statistically significant subgroup effect for the volume of low-value nursing procedures (p = 0.20).
conclusionsThe majority of the studies with a positive significant effect used a de-implementation strategy with an educational component. Unfortunately, no conclusions can be drawn about which strategy is most effective for reducing low-value nursing care due to a high level of heterogeneity and a lack of studies. We recommend that future studies better report the effects of de-implementation strategies and perform a process evaluation to determine to which extent the strategy has been used.
trial registrationThe review is registered in Prospero (CRD42018105100).
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.