Intervention to reduce unnecessary urinary catheter use in a large academic health science centre: A one-group, pretest, posttest study with a theory-based process evaluation.
Chantal Backman, Krista R Wooller, Delvina Hasimja-Saraqini and 6 others
PMID 33988900WHAT IT FOUND
CAUTI prevalence was 18.2% before and 14.1% after, with no clear reduction.
Staff interviews identified competing priorities, protocol availability and overlap with other orders as barriers.
Key findings
01The CAUTI protocol did not significantly reduce CAUTI prevalence: 18.2% before implementation and 14.1% after.
02Staff interviews identified competing priorities or time constraints (11 participants, 61.1%), patient characteristics or preferences (10 participants, 55.6%), protocol availability (8 participants, 44.4%), and overlap with other catheter orders (8 participants, 44.4%) as main barriers.
03Staff interviews produced more enablers than barriers (19 vs 13), with knowing benefits (16 participants, 88.9%), education and training (13 participants, 72.2%), protocol ease and access (13 participants, 72.2%), and agreement with evidence (12 participants, 66.7%) most common.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was a one-group pretest-posttest design with no control group, so changes cannot be clearly attributed to the protocol. Only four units with the highest catheter rates were audited, so results may not represent other units. The audit included patients who already had an indwelling catheter, so it did not directly measure how many unnecessary catheters were avoided. Uptake was low: a protocol form was completed in the chart for 12.1% of postintervention patients. The apparent drop in CAUTI prevalence was based on 18 cases before and 14 after among 99 audited patients per period, and it was not statistically significant. Patient characteristics differed between periods, including service mix and acute length of stay, which may confound comparisons. The process evaluation included 18 staff participants, and discipline-specific themes were few, possibly reflecting the small sample.
Declared interests
The authors have no relevant financial or non-financial interests to disclose.
The easy way to misread this
Do not read the lower CAUTI prevalence (18.2% before, 14.1% after) as proof the protocol worked. The difference was not statistically significant (p = .563), and the authors state the implementation did not work across the four audit units.