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Low-value care provides little or no benefit to the patient, causes harm and wastes limited resources. Reducing it is therefore important for safer and more sustainable care. Internationally and nationally list of low-value care are composed and available. For example the list of 25 low-value nursing activities of the American Academy of Nurses, the list of nine things nurses and patients should question by the Canadian Nurses Association or the recommendation by the Australian College of Nursing and the list of 66 low-value care practices by the Dutch Nursing Association. The next step after developing lists to reduce low-value care should be to create awareness amongst nurses, stimulate the dialogue on de-implementation in practice and facilitate learning how to imitate evidence based quality improvement projects to quantify and reduce nursing low-value care.


Relevance and goal

Several studies show that healthcare professionals around the world provide care that is of low-value. It wastes limited resources and may cause physical, psychological and financial harm to clients. In addition, it wastes time that the healthcare professional can spend on more effective practices or care that is left undone. This is especially important in the light of the global nursing shortage and the fact that cure and care is increasingly shifting to the home situation. Care facilities are closed, and elderly people stay at home with multiple and complex problems and small social networks. With this pressure on community nurses, reducing low-value care is especially an important step towards safer and more sustainable care.


This project is a next step, building on the ZonMw project "Beter Laten lijst" en “Slim zorgen” of Vilans. This project aims to contribute to evidence based practice in nursing community care and to empower nurses to pick up the bat. Specifically, we will provide them with evidence for low-value care and learn with them to build on influencing factors for providing low-value care and to develop appropriate strategies for the community. We will enable them to de-implement these nursing care activities and guide them use evidence-based care in an independently manner in the future. This will learn them and us about efficient de-implementation strategies for community care in general. Based on this we will develop practical and attractive easy to use tools that can be used for large scale dissemination.



This project will elaborate on existing knowledge on de-implementing low-value care. For this project we will use an existing de-implementation model consisting of 6 steps. Knowledge and experiences from existing models and used toolkits, (e.g. Vilans Toolkits), earlier research will be included in the six phases of the de-implementation model.


In the preparation phase (6 months) the first three steps will be taken: 1) identification of potential areas of low-value nursing care and recruitment of teams, 2) identification of local priorities for de-implementation and the magnitude of the problem by baseline measurements and a survey, and 3) the development of the strategy by designing the toolkits, de-implementation strategy, including team leadership- and communication strategy.

In the second phase (12 months) step 4 and 5 will be performed: 4) execution of the strategy by 12 teams working with the toolkits, supported by project managers (members of the nursing teams), and 5) evaluation of the strategy by both qualitative and quantitative methods.

The final phase (3) is about dissemination. The practical toolkits will be definitively developed, the de-implementation strategy will be refined and experiences and results will be described en communicated by channels of V&VN (the Dutch Nursing Association) and Vilans.



The RENEW project will be carried out in a unique partnership of IQ healthcare, Vilans and V&VN. These organizations jointly ensure the scientific validation and the practicality and usability of the tool. Furthermore this collaboration makes enrichment and dissemination of information about reducing unnecessary care activities in nursing care possible.


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