On Low-Value Nursing Care: Part 2, De-implementing Practices in Your Unit

Implementing evidence-based practices and de-implementing outdated practices occur on the same continuum. Both align with the culture of safety of high-reliability organizations. Adopting best practices is triggered when new science demonstrates that the procedures are safe and effective. De-implementing practices (ie, removal, replacement, reduction, or restriction) is indicated as evidence no longer confirms the benefit or shows harm of those practices.1-4 High-reliability organizations' principle of preoccupation with failure (or anticipation of risk) is fundamental to disinvesting in lowvalue care to attain zero harm.5 Much like the implementation of evidence-based practices, de-implementation of outdated practices requires behavior change. As little is known about eliciting behavior supportive of de-implementation, the PICO (patient/population/problem, intervention, comparison, and outcome) question for this synthesis was this: What de-implementation interventions are effective in reducing low-value practices in high-acuity and critical care nursing?