Daily Assessment for the appropriate use of Foley Catheter
For Reduction of Urinary Tract Infection
Daily Assessment for Urinary Catheter
Date: _____________________ Name: __________________________
Floor: _____________________ Room #:________________________
Which criteria for appropriate use of foley catheter does your patient meet?
|□ Abdominal/ Pelvic or Colorectal Surgery (questionable after 48 Hours) |
|□ Renal/ Urology or Gastric Bypass surgery |
|□ Accurate I&O |
|o Hemodynamically unstable |
|o Hourly/ strict |
|□ Skin breakdown |
|□ Hip Fracture |
|□ 24 hour urine collection |
|□ Chemically paralyzed and sedated |
|□ Epidural Catheter |
|□ Inability to void/ urinary retention |
|□ Pelvic fracture / Crush injury |
|□ Head injury |
If none of the above criteria are met, obtain an order to DC foley catheter.
□ Yes - Order Obtained □ Foley discontinued
□ No - Order not obtained
Comments:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Directions for use:
As part of the shift assessment the R.N. on the morning shift will assess the need for the foley catheter by reviewing the criteria on the Daily Assessment of foley catheter form.
If the patient meets one of the criteria the foley catheter can remain in place.
If the patient does not meet the criteria listed on the form the RN will contact the physician by phone or on daily rounds with the physician and ask for an order to remove the foley catheter.
The form can be sent to Infection Prevention Department to assess effectiveness and collate data for future standing orders.
The form is intended as a work sheet to collect data, and use that data to develop a nurse driven order set to remove unnecessary foley catheters without a physician order.
This form can also be used a guideline to add to the shift assessment in the electronic medical record.
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