430 Table 3. Nurses Responses to Online Survey Regarding Their Experience with the CATH TAGa
All Included Wards/Units
Question
How likely is it that you would recommend the CATH TAG to be used in all Australian hospitals?
My general experience with the CATH TAG was :::
Note. SE, standard error; ICU, intensive care unit. aRespondents were asked to respond on a scale of 0–100.
ICU
Overall, how satisfied or dissatisfied are you with the CATH TAG? 82 55.1 2.728 19 37.6 82 55.5 3.252 19 33.0
Non ICU
N Mean SE N Mean SE N Mean SE 5.967 63 60.30 2.760 7.477 63 62.25 3.144
82 55.2 2.405 19 40.42 6.159 63 59.70 2.264 I believe my patients’ general experience with the CATH TAG was 82 54.4 1.898 19 46.32 3.895 63 56.63 2.098
P Value <.001 <.001
.001 .021
Brett G. Mitchell et al
Table 4. Experience with the CATH TAG: Summary of Findings From Focus-Group Participants Theme
Summary Practical use
Most comments that were categorized as related to the practical use of the CATH TAG focused on barriers to use, applicability to different clinical settings and human-related factors.
Sample of participant comments
‘ ::: it was a reminder to people to check.’ ‘To me it’s easy just to see.’ ‘I believe they are a good idea, that if implemented they will or should decrease UTIs.’
‘[ ::: ] I think that they’re a very very good idea of having CATH TAG.’
Patient care and patient
perceptions Future use
Although a subtheme suggested that patients did not notice the CATH TAG, participants also discussed times patient involvement with catheter care and indicated that there was no negativity from patients.
Numerous comments were made about incorporating the CATH TAG into the catheter itself. Suggestions were largely based on the assumption that the CATH TAG, or some form of it, would be used in the future.
‘Well the one lady that we had it [CATH TAG] with, she’s very involved with all her care, and she thought it was a great idea.’
‘Nobody [patients] was negative, no.’ —
‘But they certainly would be wonderful in nursing homes as well.’
‘[ ::: ] That’s what we need we need them for cannulas because we’ve got such a problem with cannulas.’
‘Yeah, I can see the future; this is just the beginning of what this could do for other devices and systems.’
4.9–6.2) and 5.08 days (95% CI, 4.6–5.6), respectively (Figure 1). Similar results were obtained after adjusting for sex, age, and infec- tious diagnoses (HR, 0.98; 95% CI, 0.87–1.10; P=.74). A nonsig- nificant reduction in catheter-associated asymptomatic bacteriuria was observed (odds ratio [OR], 0.90; 95% CI, 0.52–1.53; P=.69). For patients who were not transferred or transferred to a ward in the same phase of the study, there was no effect (HR, 1.09; 95% CI, 0.97–1.24; P=.15). Excluding patients from the ICU, the duration of catheteriza-
tion was significantly lower in patients for whom the CATH TAG was used (HR, 1.20; 95% CI, 1.06–1.37; P < .01). The mean duration of catheterization decreased by 23% from 5.00 days (95% CI, 4.44–5.56) to 3.84 days (95% CI, 3.47–4.21).
Perceptions of use
Online survey There was a positive response to the CATH TAG, as demonstrated by participant answers to a range of questions (Table 2 and Supplementary Table S4 online). When comparing responses between ICU and non-ICU staff, non-ICU staff indicated a signifi- cantly higher level of agreement to several questions. For example, they indicated that the CATH TAG was helpful in daily routines (P=.003) and as a reminder to check the ongoing need for cath- eterization (P < .001). In the ICU, patients were less likely to ask about the CATH TAG (P < .001) or to notify nurses of a change in the CATH TAG light (P=.002). Non-ICU nurses were more
satisfied (P < .001), were more likely to recommend the CATH TAG (P < .001), and had a more positive experience than ICU nurses (Table 3).
Focus group Three main themes emerged in the focus group: (1) issues related to the practical use of the CATH TAG during the project; (2) patient care and patient perceptions; and (3) future use of the CATH TAG (Table 4). Detailed results are provided in the supple- mentary material online.
Discussion
We identified a reduction in urinary catheter duration after an intervention in which a novel electronic reminder system was attached to urinary catheter bags. A significant reduction in cath- eterization duration (23%) was identified outside the ICU. The use of the device was received positively by nursing staff and could be implemented easily into clinical practice. The study was enhanced by a mixed-methods approach, which helped us further under- stand the findings. Interventions, such as a reminder system, to reduce the dura-
tion of catheterization have been shown to be effective in other studies.6–9 However, our study is distinct due to the use of ran- domization in the study design.6–8 In our subanalysis exploring non-ICU patients, we identified a significant reduction in cath- eterization duration. This result is consistent with a French study
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