Deimplementation of Practice

Journal Club Articles: 

Niven, D. J., Mrklas, K. J., Holodinsky, J. K., Straus, S. E., Hemmelgarn, B. R., Jeffs, L. P., & Stelfox, H. T. (2015). Towards understanding the de-adoption of low-value clinical practices: a scoping reviewBMC medicine13(1), 255.

Niven, D. J., Rubenfeld, G. D., Kramer, A. A., & Stelfox, H. T. (2015). Effect of published scientific evidence on glycemic control in adult intensive care unitsJAMA internal medicine175(5), 801-809.

Background

Evidence Based Practice (EBP) is the cornerstone for nursing practice, to ensure quality care and interventions are initiated based on research and not ritualistic practices.

Dissemination of Practice: The translation of practice from research into the clinical domain is known to take a long time. 17 years is the time lag (Morris et al., 2011).

Now if it takes 17 years to translate research into practice how long does it take healthcare to deimplementate practice that may be out of date and lacking in evidence?

Deimplementation of Practice

The process of the deadoption of healthcare practices with evidence of ineffectiveness or harm.

An excellent example by Niven et al., (2015) large multi-centre database time-series analysis to determine whether tight glycaemic control (supporting adoption) and NICE-SUGAR trial (supporting deadoption) was influencing the practice of glycaemic control in adult ICU’s.

Niven et al., (2015) conclusion form the review of deadoption on tight glycaemic control states “there was a slow steady adoption of tight glycaemic control following publication of a clinical trial that suggested benefit, with little to no deadoption following a subsequent trial that demonstrated harm. There is an urgent need to understand and promote deadoption of ineffective clinical practices.”

Practice Considerations

Take a few minutes to reflect on practice in your clinical setting and if your unit has guidelines that support old evidence, traditional and not supported with evidence based grounding. This is where the local clinical audit could help benchmark to current evidence and aid the change process to update practice. Happy PDSA cycling (plan-do-study-act).

Keywords: Deadoption; Deimplementation; EBP; ineffective practice.

References

Courtney, M. D. & McCutcheon, H. (2009). Using evidence to guide nursing practice. Elsevier Australia.

Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.

Morris, Z. S., Wooding, S., & Grant, J. (2011). The answer is 17 years, what is the question: understanding time lags in translational researchJournal of the Royal Society of Medicine104(12), 510-520.

Niven, D. J., Mrklas, K. J., Holodinsky, J. K., Straus, S. E., Hemmelgarn, B. R., Jeffs, L. P., & Stelfox, H. T. (2015). Towards understanding the de-adoption of low-value clinical practices: a scoping reviewBMC medicine13(1), 255.

Niven, D. J., Rubenfeld, G. D., Kramer, A. A., & Stelfox, H. T. (2015). Effect of published scientific evidence on glycemic control in adult intensive care unitsJAMA internal medicine175(5), 801-809.

Polit, D. F., & Beck, C. T. (2008). Nursing research: Generating and assessing evidence for nursing practice. Lippincott Williams & Wilkins.

Sackett, D. L. (1997). Evidence-based Medicine How to practice and teach EBM. WB Saunders Company.

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