A tailored de-implementation strategy to reduce low-value home-based nursing care: A multiple interrupted time series...

Area of Science:

• Nursing Research
• Healthcare Management
• Implementation Science

Background:

• Home-based nursing care teams often engage in low-value practices.
• Identifying and reducing these practices is crucial for efficient and effective patient care.
• The RENEW strategy was developed to de-implement specific low-value nursing activities.

Purpose of the Study:

• To evaluate the impact of the RENEW de-implementation strategy on time spent on three low-value nursing practices.
• To assess the effectiveness of the strategy in reducing care volume for specific interventions.

Main Methods:

• A multicenter, quasi-experimental study with a multiple interrupted time series design.
• The RENEW strategy, incorporating education, persuasion, enablement, incentives, and training, was implemented in 31 Dutch home-based nursing care teams.
• Data were collected pre- and post-implementation, analyzed using Auto Regressive Integrated Moving Average (ARIMA) models and meta-analysis.

Main Results:

• The RENEW strategy significantly reduced time spent on 'washing the client with water and soap by default' & 'washing the client from head to toe daily' (13.61 min/client/week).
• Time spent on 'assisting with putting on/taking off compression stockings' also decreased (4.42 min/client/week).
• However, time for 'application of zinc cream, powders or pastes when treating intertrigo' increased (1.25 min/client/week). Effects for two practices were sustained for three months.

Conclusions:

• The RENEW strategy effectively reduced two out of three targeted low-value nursing care practices.
• The overall time savings from reduced low-value care support reallocation to higher-value activities like health promotion and patient education.
• This study supports the hypothesis that de-implementing low-value care frees up nursing time for more appropriate and valuable patient interventions.