De-implementation: A concept analysis

Upvall, Michele J.; Bourgault, Annette M.

doi:10.1111/nuf.12256

Cited by 52 publications

(34 citation statements)

References 42 publications

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“…Given the groundswell of interest in deimplementation research, guidance on how to optimally conceptualize and conduct this type of research is needed. To date, researchers have offered guidance on topics such as defining de-implementation and determining what practices or interventions should be targeted for de-implementation [5,6,[10][11][12]. While these efforts are imperative for moving the area forward, there are still critical gaps that may be inhibiting the advancement of de-implementation research.…”

Section: Introductionmentioning

confidence: 99%

Defining and conceptualizing outcomes for de-implementation: key distinctions from implementation outcomes

Prusaczyk

Swindle

Curran

2020

Implement Sci Commun

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Background: Increasingly, scholars argue that de-implementation is a distinct concept from implementation; factors contributing to stopping a current practice might be distinct from those that encourage adoption of a new one. One such distinction is related to de-implementation outcomes. We offer preliminary analysis and guidance on de-implementation outcomes, including how they may differ from or overlap with implementation outcomes, how they may be conceptualized and measured, and how they could be measured in different settings such as clinical care vs. community programs. Conceptualization of outcomes: We conceptualize each of the outcomes from Proctor and colleagues' taxonomy of implementation outcomes for de-implementation research. First, we suggest key considerations for researchers assessing de-implementation outcomes, such as considering how the cultural or historical significance to the practice may impact de-implementation success and, as others have stated, the importance of the patient in driving healthcare overuse. Second, we conceptualize de-implementation outcomes, paying attention to a number of factors such as the importance of measuring outcomes not only of the targeted practice but of the deimplementation process as well. Also, the degree to which a practice should be de-implemented must be distinguished, as well as if there are thresholds that certain outcomes must reach before action is taken. We include a number of examples across all outcomes, both from clinical and community settings, to demonstrate the importance of these considerations. We also discuss how the concepts of health disparities, cultural or community relevance, and altruism impact the assessment of de-implementation outcomes. Conclusion: We conceptualized existing implementation outcomes within the context of de-implementation, noted where there are similarities and differences to implementation research, and recommended a clear distinction between the target for de-implementation and the strategies used to promote de-implementation. This critical analysis can serve as a building block for others working to understand de-implementation processes and de-implement practices in real-world settings.

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Section: Introductionmentioning

confidence: 99%

Defining and conceptualizing outcomes for de-implementation: key distinctions from implementation outcomes

Prusaczyk

Swindle

Curran

2020

Implement Sci Commun

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“…One routine lacking evidence is the routine of preparing a separate table and/or separate instruments for the vein harvesting, mentioned above. De-implementation is a process for identifying and removing practices based on tradition and habits which lack adequate scientific support [30]. In the pursuit of evidence-based health care, deimplementation of old routines is just as important as the implementation of new evidence.…”

Section: Discussionmentioning

confidence: 99%

Perioperative routines and surgical techniques for saphenous vein harvesting in CABG surgery: a national cross-sectional study in Sweden

Larsson

Nyman

Friberg

et al. 2020

J Cardiothorac Surg

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Background: The saphenous vein is the most commonly used conduit for coronary artery bypass grafting (CABG). Wound healing complications related to saphenous vein harvesting are common, with reported surgical site infection rates ranging from 2 to 20%. Patients' risk factors, perioperative hygiene routines, and surgical technique play important roles in wound complications. Here we describe the perioperative routines and surgical methods of Swedish operating theatre (OT) nurses and cardiac surgeons. Methods: A national cross-sectional survey with descriptive design was conducted to evaluate perioperative hygiene routines and surgical methods associated with saphenous vein harvesting in CABG. A web-based questionnaire was sent to OT nurses and cardiac surgeons at all eight hospitals performing CABG surgery in Sweden. Results: Responses were received from all hospitals. The total response rate was 62/119 (52%) among OT nurses and 56/111 (50%) among surgeons. Chlorhexidine 5 mg/mL in 70% ethanol was used at all eight hospitals. The OT nurses almost always (96.8%) performed the preoperative skin disinfection, usually for three to 5 minutes. Chlorhexidine was also commonly used before dressing the wound. Conventional technique was used by 78.6% of the surgeons, "no-touch" by 30.4%, and both techniques by 9%. None of the surgeons used endoscopic vein harvesting. Type of suture and technique used for closing the wound differed markedly between the centres. Conclusions: In this article we present insights into the hygiene routines and surgical methods currently used by OT nurses and cardiac surgeons in Sweden. The results indicate both similarities and differences between the centres. Local traditions might be the most important factors in determining which procedures are employed in the OT. There is a lack of evidence-based hygiene routines and surgical methods.

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“…Research has focused on EBP implementation with little consideration for the process required to stop routine TBP (Niven et al, ; van Bodegom‐Vos, Davidoff, & Marang‐van de Mheen, ). De‐implementation refers to terminating, reducing, or substituting a clinical practice that is harmful, non‐efficient, or noncost effective (Helfrich et al, ; Prasad & Ioannidis, ; Upvall & Bourgault, ). Confusion may exist because of the plethora of terms used to describe de‐implementation, such as de‐adoption, divest, de‐innovation, undiffusion, exnovation, disinvestment, and withdrawal (Harvey & McInnes, ; Niven et al, ; Wang, Gamble, & Grey, ).…”

Section: Introductionmentioning

confidence: 99%

De‐implementation of tradition‐based practices in critical care: A qualitative study

Bourgault

Upvall

2019

Int J of Nursing Practice

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Aim To explore the process of tradition‐based practice (TBP) de‐implementation by critical care nurses. Background Ritualistic and routine practices have been described as sacred cows or TBPs. Many clinical practices have insufficient or no evidence and may lead to poor patient outcomes. De‐implementation (termination) of potentially harmful, ineffective, or non cost‐effective TBP is necessary to facilitate evidence‐based practice (EBP) in the clinical setting. Design Descriptive qualitative inquiry guided this study. Methods Twenty‐two critical care nurses from an acute care hospital in central Florida participated. Individual and focus group interviews were performed March to July 2016 and analysed using thematic analysis. Results Three themes were identified: (a) uncertainty, (b) desire to know, and (c) preparing for practice change. Nurses were uncertain about the scientific underpinnings of everyday clinical practices and had difficulty differentiating TBP from EBP. De‐implementation processes and strategies appeared to replicate implementation processes. Conclusion More research is needed to evaluate de‐implementation processes and strategies used for de‐implementation. An emphasis should be placed on ensuring that nurses are knowledgeable about fundamental EBP skills to encourage assessment of clinical practices for supporting research evidence. Awareness and understanding of TBPs will facilitate a more comprehensive approach towards achieving the gold standard of EBP.

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De-implementation: A concept analysis

Abstract: The analysis provided further refinement of de-implementation as a significant concept for ongoing theory development in implementation science and clinical practice.

Cited by 52 publications

References 42 publications

Defining and conceptualizing outcomes for de-implementation: key distinctions from implementation outcomes

Defining and conceptualizing outcomes for de-implementation: key distinctions from implementation outcomes

Perioperative routines and surgical techniques for saphenous vein harvesting in CABG surgery: a national cross-sectional study in Sweden

De‐implementation of tradition‐based practices in critical care: A qualitative study

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