Strategic De-Implementation: Strengthening Patient Safety by Eliminating Low-Value Care Practices

Nurses function within finite time constraints to provide care. Therefore, examining what nursing practices necessitate increased frequency, moderation, or discontinuation is critical. This is imperative to promote patient safety and optimise nursing time and decrease low-value or potentially harmful care. Globally, maintaining patient safety and care quality are universal goals all healthcare professionals embrace. As nurses, we strive to provide the right care, to the right patient at the right time. We strive to deliver the safest, most efficient, patient-centered, and cost-effective care possible, grounded in the highest-level, most reliable evidence. Nevertheless, we may encounter challenges where the evidence may be unavailable, inaccessible, controversial, or contested. Furthermore, where robust evidence exists, there can be failures or inadequate implementation, whilst existing interventions raise concerns or be questionable.
It is difficult to understand the effect of interventions applied across different healthcare levels on patients’ needs. As nurses, we sometimes face insecurity in the effectiveness of interventions, given that they do not yield the intended or expected benefits. Some interventions may pose risks to a patient’s health and well-being. Further, the resource cost (or opportunity cost – opting for ‘X’ over ‘Y’) of others are unjustifiable due to their uncertain efficacy, or benefit. It is estimated that 30% of care provided is of low value and that 10% represents harmful practices, and these statistics have not changed for many decades (Braithwaite et al., 2020). There is a discrepancy between evidence-based care and the everyday challenges faced by healthcare professionals. This discrepancy highlights the need to address ineffective care, minimise harm, and maximise the efficacy of healthcare interventions. There needs to be greater adoption of strategies that ensure the delivery of optimal and evidence-based care while mitigating potential risks and ineffective practices.