Selecting and quantifying low‐value nursing care in clinical practice: A questionnaire survey

Abstract

Aims and objectives To evaluate the opinion of hospital nurses on a group of recommendations aimed at reducing low‐value nursing care and, based on these results, to detect low‐value practices probably existing in the hospital. Background Low‐value nursing care refers to clinical practices with poor or no benefit for patients that may be harmful and a waste of resources. Detecting these practices and understanding nurses' perceptions are essential to developing effective interventions to reduce them. Methods We conducted a survey in a tertiary hospital. STROBE guidelines were followed. The questionnaire appraised nurses' agreement, subjective adherence and perception of usefulness of a group of recommendations to reduce low‐value nursing care from Choosing Wisely and other initiatives. Practices described in recommendations with an agreement over 70% and a subjective adherence under 70% were categorised as low‐value practices probably existing in the hospital. Results A total of 265 nurses from eight areas of care participated in the survey. The response rate by area ranged between 2%–55%. From the 38 recommendations evaluated, agreement was 96% (95% confidence interval [95%CI], 95%–97%), median subjective adherence was 80% (95%CI, 80%–85%), and usefulness was 90% (95%CI, 89%–92%). Based on these results, we detected seven (0–15) low‐value practices probably existing in our hospital, mostly on general practice, pregnancy care and wound care. Conclusions We found a great understanding of low‐value care between nurses, given the high agreement to recommendations and perception of usefulness. However, several low‐value practices may be present in nursing care, requiring actions to reduce them, for instance, reviewing institutional protocols and involving patients in de‐implementation. Relevance to clinical practice Hospitals and other settings should be aware of low‐value practices and take actions to identify and reduce them. A survey may be a simple and helpful way to start this process.

Effects of de-implementation strategies aimed at reducing low-value nursing procedures: a systematic review and meta-analysis

“…The next step is to translate these 'Choosing Wisely' lists into action [13]. To actually reduce the use of low-value nursing procedures, awareness should be created for the 'Choosing Wisely' lists and effective de-implementation strategies need to be developed and executed [7,14,15]. These deimplementation strategies should be theory-and evidencebased and informed by analysis of barriers and facilitators that influence the use of low-value care, since this is expected to increase the adherence, adoption, and effectiveness of these de-implementation strategies [5,16,17].…”

Low‐value wound care: Are nurses and physicians choosing wisely? A mixed methods study

“…Seven of the 38 recommendations they evaluated needed further implementation. The recommendation with the greatest participant disagreement (21%) was Recommendation 5 ‘covering a closed wound’ (Osorio et al, 2019). The following literature also supports our finding that there could be a gap between being aware of the recommendations and applying them in daily practice.…”

“…The following literature also supports our finding that there could be a gap between being aware of the recommendations and applying them in daily practice. A study in Spain found that even though nurses agree with a recommendation, adherence can be low (Osorio et al, 2019). Only part of the US physicians sees the campaign as a legitimate source of guidance (Colla et al, 2016).…”

What not to do: Choosing wisely in nursing care

“…However, for some nursing interventions high-quality evidence is available (e.g. omitting routine hair removal to prevent surgical site infections; omitting the routine use of urinary catheters in patients with acute stroke and urinary incontinence; and omitting the use of dressings for wounds closed by primary intention (Osorio et al, 2019). These recommendations are incorporated in 'do not do' lists (Osorio et al, 2019).…”

“…omitting routine hair removal to prevent surgical site infections; omitting the routine use of urinary catheters in patients with acute stroke and urinary incontinence; and omitting the use of dressings for wounds closed by primary intention (Osorio et al, 2019). These recommendations are incorporated in 'do not do' lists (Osorio et al, 2019). However, the question arises if the use and uptake of these lists in daily practice is more or less rapid than it is for 'do lists' included in clinical guidelines.…”