Table 5.
Type of intervention of the controlled studies (n = 15)
| Author (year) | Type of low-value care | Single or multifaceted intervention strategy | Interventions from the EPOC taxonomy | Description of intervention strategy (sorted by EPOC Taxonomy) | Positive significant effect (p ≤ 0.05) (Yes/No) | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| E | AF | P | C | CQ | H | L | M | MP | O | S | T | TI | |||||
| Desveaux et al. 2017 [38] | Antipsychotic prescribing | Multifaceted | X |
Educational outreach visits: - Academic detailing (educational outreach) intervention delivered by registered health professionals following an intensive training program including relevant clinical issues and techniques to support health professional behavior change Educational materials: - Online practice reports |
No | ||||||||||||
| Evans et al. 1997 [39] | Restraint use | Single and multifaceted | X |
Restraint education (RE) group Educational meetings: - Intensive education by a masters-prepared gerontologic nurse on restraint use Restraint education-with-consultation (REC) group Educational meetings: - Intensive education by a masters-prepared gerontologic nurse Educational outreach visits: - Unit-based nursing consultation |
Yes | ||||||||||||
| Fitzpatrick 1997 [40] | Restraint use | Single and Multifaceted (2 groups) | X |
Single faceted group Educational materials: - Educational program: restraint education in service administered in the form of a self-learning module and the option to construct a poster in each unit Multifaceted group Educational materials: - Educational program: restraint education in service administered in the form of a self-learning module and the option to construct a poster in each unit. - Critical care restraint decision guide (CCRDG). |
No | ||||||||||||
| Gulpers et al. 2011 [41] | Restraint use | Multifaceted | X | X |
Educational meetings: - Nursing home staff education - Availability of alternative interventions Educational outreach visits: - Consultation by a nurse specialist aimed at nursing home staff Local consensus processes: - Promotion of institutional policy change that discourages use of belt restraint |
Yes | |||||||||||
| Gulpers et al. 2013 [42] | Restraint use | Multifaceted | X | X |
Educational meetings: - Intensive educational program offered by two registered nurses with extensive experience in physical restraint reduction - Availability of alternative interventions Educational outreach visits:- Consultation from the two nurse specialists (who delivered the educational program) to individual nurses on the intervention wards Local consensus processes: - Policy change by the nursing home management, with new use of belts prohibited and current use reduced |
Yes | |||||||||||
| Huang et al. 2009 [43] | Restraint use | Single | X |
Educational meetings: - Power-Point presentations - Discussion - Scenario reflections |
Yes | ||||||||||||
| Huizing et al. 2009 [45] | Restraint use | Multifaceted | X |
Educational meetings: - Educational program Educational outreach visits: - Consultation with a nurse specialist |
No | ||||||||||||
| Huizing et al. 2009 [44] | Restraint use | Multifaceted | X |
Educational meetings: - Educational program Educational outreach visits: - Consultation with a nurse specialist |
No | ||||||||||||
| Koczy et al. 2011 [46] | Restraint use | Multifaceted | X | X | X |
Educational meetings: - The training course included information on epidemiology, the side effects of restraint use, legal aspects and alternatives Health information system: - Technical aids, such as hip protectors and sensor mats Tailored interventions: - Problem-Solving Tools - Advice by telephone from the research team |
No | ||||||||||
| Kopke et al. 2012 [47] | Restraint use | Multifaceted | X |
Educational meetings: - Group sessions for all nursing staff - Additional training for nominated key nurses Educational materials: - Supportive material for nurses, residents, relatives, and legal guardians. |
Yes | ||||||||||||
| Kwok et al. 2005 [48] | Restraint use | Multifaceted | X | X |
Educational meetings: - Education about how to use of the bed-chair pressure sensors and the importance of restraint reduction in improving patients’ outcomes Health information system: - Bed-chair pressure sensors |
No | |||||||||||
| Lai et al. 2011 [49] | Restraint use | Multifaceted | X | X |
Educational meetings: - Staff education package Educational outreach visits: - Consult with the project team for uncertainties and on an individual Organizational Culture - The setup of a restraint reduction committee (RRC) |
No | |||||||||||
| Pellfolk et al. 2010 [50] | Restraint use | Multifaceted | X |
Educational meetings: - One volunteer from each unit attended the whole education program - Educational seminar Educational materials: - Videotaped lectures. Three of the lectures also included a clinical vignette presented in writing, which could be used for group discussions. |
Yes | ||||||||||||
| Testad et al. 2010 [51] | Restraint use | Multifaceted | X |
Educational meetings: - Two day seminar - Monthly group guidance for six months Educational materials: - Teaching manual |
Yes | ||||||||||||
| Testad et al. 2016 [52] | Restraint use | Multifaceted | X |
Educational meetings: - Two day seminar - Monthly seven step guidance groups for six months Educational materials: - Manual of the updated intervention and the seven-step guidance group - Poster DMP model |
Yes | ||||||||||||
Intervention strategies are classified using the EPOC Taxonomy [21]: E education (meetings, materials, games, and outreach visits), AF audit and feedback, P packages of care, C clinical guidelines, CQ continuous quality improvement, H health information system, L local consensus processes, M monitoring, MP monitoring the performance of the delivery of healthcare, O organizational culture, S sensory modalities for patients, T team, TI tailored interventions
No statistical testing