ࡱ > | ~ { " bjbjqq 4Z e e ` - I I m m m 8 4 t] ( ' ' ' ] ] ] ] ] ] ] _ a v ] m ) & " ' ) ) ] I I .] + + + ) I m ] + ) ] + + CY D ;\ 9v) J* v Z & ] D] 0 t] Z 6c * 6c L ;\ 6c m ;\ ' h x' J + ' < ' ' ' ' ] ] + ^ ' ' ' t] ) ) ) ) 6c ' ' ' ' ' ' ' ' ' : Department Generating PolicyInfection Control Affected DepartmentsAll Nursing Care UnitsAuthor (if applicable)Sharyl BergerudDept/Title9/2011
Infection Control DirectorDept / Committee Approval Med/Surg Subcommittee
Angelika Titus, RNDate/Title11/2011
Chairperson/Clinical EducatorDept / Committee Approval Date/TitleExecutive Approval Shelley PetersonDate/Title11/2011 CNOMedical Staff Approval Surgery IDT
Executive CommitteeDate/Title9/13/11
9/27/11
PURPOSE:
Purpose of this policy is to help the nurse determine when a Foley catheter should be discontinued. Catheter-Associated Urinary Tract Infection (CAUTI) is the highest occurring Healthcare Acquired Infection (HAI) in the United States. Foley catheter usage contributes to an increase in infections, increase in length of stay, increased cost of care, increased patient discomfort and increased antibiotic use. Foley catheters are used for specific patient conditions which should be assessed on a daily basis to determine if the catheter can be removed. Orders to continue a catheter are necessary and should reflect the indication for use. Catheters may be removed from patients that do not meet criteria for catheter and who do not have orders to continue the catheter.
Interventions CAUTI Reduction Bundle:
Insert Foley catheters only when necessary must have an order
To relieve urinary tract obstruction
To permit urinary drainage in patients with neurogenic bladder dysfunction and urinary retention
To aid in urologic surgery or other surgery on contiguous structures
To promote healing in Stage III and IV pressure ulcers affected by continual urine leakage
To obtain accurate measurements of urinary output in critically ill patients
For Comfort Care/Palliative Care patients
Required immobilization for trauma or surgery (eg. Hip fracture)
Patients with epidural catheters used for pain management
Engage in proper hand hygiene when handling catheter
Insert catheter using aseptic technique and sterile equipment
Use catheter sizes of 16FR or 18FR with a 10ml balloon when appropriate
Use a generous amount of sterile lubricant for catheter insertion.
Interventions CAUTI Reduction Bundle (Cont):
Maintain system properly
Use catheter-securing device
Properly place Foley bag on the bed, below the level of the patient at all times, including during transport, avoiding contact with the floor.
Ensure Foley tubing is free of obstructions and kink free.
Maintain closed sterile drainage. (Avoid hand-irrigating the catheter).
Empty the urinary drainage bag frequently enough to prevent reflux.
Use a separate, clean container for each patient, label with the patients name and date, and discard it after 24 hours.
Avoid contact between the urinary drainage tap and the container.
Obtain urine samples from a sampling port using aseptic technique.
Ensure perineum was cleansed with soap and water during morning care/ADLs, and after bowel movement, ensuring external catheter is also cleansed.
Write insertion date, time, unit placed and initials on the tube sticker and place on the drainage tubing.
Document insertion in patients record, including nurses notes and Assessment screen. (Use aseptic technique for insertion)
Observe and document the clarity of urine every shift; report changes immediately.
Complete daily assessment of need for Foley Catheter, and remove as soon as possible.
Nurse-Driven Foley Removal Protocol:
See Foley Catheter Removal Protocol algorhythm on page 3.
Determine if patient meets criteria to continue Foley catheter
If the patient does not meet criteria for Foley catheter and if there is no order to continue Foley catheter, write an order Foley removed per protocol.
Remove Foley catheter.
Documentation:
Foley catheter status documented every shift in Shift Assessment Screen. Change Y to N for Foley Catheter in place and document removal time in nurses notes.
Document any applicable signs and symptoms of UTI: fever(>38C, 100.4F), suprapubic tenderness, or costovertebral angle pain or tenderness, frequency, burning or pain with urination.
Nurse Driven Foley Removal Protocol
SHAPE \* MERGEFORMAT
Foley Catheter should be continued if any of the following criteria are met:
To provide relief of urinary tract obstruction not manageable by other means.
To permit drainage in patients with neurogenic bladder dysfunction and urinary retention not manageable by other means (i.e., with clean intermittent catheterization)
Perioperative use in selected surgeries (Gynecologic, Genitourinary or surgery on contiguous structures (colorectal surgery or abdominal/pelvic surgery) *Order must be written at Post Op Day 1 or 2 to continue catheter beyond Post Op Day 2.
Assist in healing of perineal and sacral wounds in incontinent patients
Patients who are Hospice/Comfort/Palliative Care
Required immobilization for trauma or surgery (i.e., Hip Fractures)
Chronic indwelling urinary catheter on admission
Accurate measurement of urinary output in the critically ill patients (Intensive Care)
Patients with epidural catheters in place. *Order must be written if surgical patient at Post Op Day 1 or 2 to continue catheter until epidural removed.
The following are not indications for Foley catheters:
Urine output monitoring outside of Intensive Care
Incontinence with no skin breakdown
Prolonged perioperative use (unless indicated above, removal by Post Op Day 2)
Patients transferred from intensive care to general units
Morbid obesity
Immobility
Confusion or dementia
Patient request
G: pcs files/Housewide Nursing Policy Manual/MSCC Policies/
Key Search Words: CAUTI, Foley, foley, catheter, Foley Protocol,
DEACONESS HOSPITAL SPOKANE, WAPolicy/Procedure TitleNurse Directed Protocol for Determination of Foley Catheter RemovalManual LocationMed/Surg/CC Manual
P & P IntranetPolicy #C-3a
(Addendum to C-3)Original9/2011PagesPage PAGE 1 of NUMPAGES 4Current11/2011
Foley Catheter In place?
No
No action necessary. Continue to assess urinary output. Avoid catheter placement
Yes
Does patient meet criteria to leave Foley in? (see Criteria list below)
Continue to assess on a DAILY basis
Yes
Yes
Remove Foley Catheter
No
Yes
Written order to continue Foley Catheter?
Acute urinary retention/obstruction
Urologic or GYN surgery
Assist healing of perineal/sacral wounds in incontinent pt
Hospice/Comfort/Palliative Care
Required immobilization
Chronic indwelling catheter on admission
Accurate measurement of urinary output in Critical Care
Presence of Epidural catheter for pain management
No
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