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

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AIM(S): To evaluate the effects of a multifaceted de-implementation strategy (RENEW) on the volume (time in minutes) of care spent by home-based nursing care teams on three widely used low-value nursing practices: (1) 'washing the client with water and soap by default' & 'washing the client from head to toe daily', (2) 'application of zinc cream, powders or pastes when treating intertrigo' and (3) 'assisting with putting on/taking off compression stockings while the client can do this him/herself (possibly with an aid)'. DESIGN: A multicenter, quasi-experimental study using a multiple interrupted time series design. METHODS: The RENEW-strategy with components on education, persuasion, enablement, incentives and training was introduced in 31 Dutch home-based nursing care teams from two healthcare organisations. Data was collected before and after the implementation of the strategy (two before and three post measurements). For each team a separate Auto Regressive Integrated Moving Average model was fitted, looking for a difference in the underlying trend over time. The effect of the RENEW-strategy was based on a meta-analysis of the team effects using a weighted inverse-variance approach and stratified for the three low-value home-based nursing care practices. RESULTS: The RENEW-strategy reduced the weighted mean time per client per week, spent on (1) 'washing the client with water and soap by default' & 'washing the client from head to toe daily' by 13.61 min (95 % CI 12.04 to 15.18) and for the practice (3) 'assisting with putting on/taking off compression stockings while the client can do this him/herself (possibly with an aid) by 4.42 min (95 % CI: 2.49 to 6.35). However, the strategy increased the time spent on 'application of zinc cream, powders or pastes when treating intertrigo' by 1.25 min (95 % CI: 1.04 to 1.45). The small and limited changes in time trends indicate that the effects for practices (1) and (2) were sustained for three months after the implementation phase. CONCLUSION: The RENEW-strategy is capable to lead to a reduction of widely used low-value care for two of the three selected low-value care practices. The increase in time of one practice, is surpassed by the savings in time of the other two practices. By making use of available alternatives, care aids and working according to clinical nursing guidelines, this study supports the hypothesis that reducing low-value nursing care saves time to deliver more appropriate, high-value care (for example: health promotion and patient education) and work on professional development. REPORTING METHOD: Standards for Reporting Implementation Studies (StaRI) guidelines. REGISTRATION: Not registered.

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