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De-adopting low-value care: The missing step in evidence-based practice?

Kerri Ann Fournier1, Patricia A Dwyer2, Judith A Vessey3

  • 1Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.

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Summary

Nurses can identify and remove low-value care practices that offer little benefit to pediatric patients. Implementing standardized evidence-based practice processes and education is crucial for successful de-adoption and improved quality of care.

Keywords:
De-adoption processesEvidence-based practiceImplementation scienceLow-value careNursing

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Area of Science:

  • Pediatric Nursing
  • Evidence-Based Practice
  • Healthcare Quality Improvement

Background:

  • Low-value care offers minimal benefit to pediatric patients, potentially causing harm and increasing costs.
  • Nursing professionals have a key role in identifying and discontinuing ineffective healthcare practices.
  • De-adoption of low-value care is essential for promoting high-quality pediatric healthcare.

Purpose of the Study:

  • To outline the methodology for identifying and de-adopting low-value clinical practices using a conceptual model and case study.
  • To determine the factors that facilitate or hinder de-adoption, including stakeholder involvement and evidence quality.

Main Methods:

  • An evidence-based practice project in a pediatric infusion center identified the low-value use of antihistamines for infliximab infusion reactions.
  • The Synthesis Model for the Process of De-adoption guided the discontinuation of this practice.
  • Case study analysis examined facilitators and barriers encountered during the de-adoption process.

Main Results:

  • The case study identified specific facilitators and barriers to de-adopting low-value care in a pediatric setting.
  • Stakeholder engagement and organizational structures influenced the success of de-adoption efforts.

Conclusions:

  • De-adoption of care is a critical component of evidence-based practice (EBP) and requires standardized processes and education.
  • Nurses are pivotal in identifying, assessing, and facilitating the de-adoption of low-value practices impacting pediatric patients.
  • Successful and sustainable de-adoption relies on nursing workforce preparedness, continuous evaluation, and context-specific resources.