Nurse Directed Protocol for Determination of Foley ...



|Department Generating Policy |Infection Control |

|Affected Departments |All Nursing Care Units |

|Author (if applicable) |Sharyl Bergerud |Dept/Title |9/2011 |

| | | |Infection Control Director |

|Dept / Committee Approval |Med/Surg Subcommittee |Date/Title |11/2011 |

| |Angelika Titus, RN | |Chairperson/Clinical Educator |

|Dept / Committee Approval | |Date/Title | |

|Executive Approval |Shelley Peterson |Date/Title |11/2011 CNO |

|Medical Staff Approval |Surgery IDT |Date/Title |9/13/11 |

| |Executive Committee | |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:

1. 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

2. 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

3. Use a generous amount of sterile lubricant for catheter insertion.

Interventions – CAUTI Reduction Bundle (Cont):

4. 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 patient’s 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.

5. Ensure perineum was cleansed with soap and water during morning care/ADL’s, and after bowel movement, ensuring external catheter is also cleansed.

6. Write insertion date, time, unit placed and initials on the tube sticker and place on the drainage tubing.

7. Document insertion in patient’s record, including nurse’s notes and Assessment screen. (Use aseptic technique for insertion)

▪ Observe and document the clarity of urine every shift; report changes immediately.

8. Complete daily assessment of need for Foley Catheter, and remove as soon as possible.

Nurse-Driven Foley Removal Protocol:

1. See “Foley Catheter Removal Protocol” algorhythm on page 3.

2. Determine if patient meets criteria to continue Foley catheter

3. 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.”

4. Remove Foley catheter.

Documentation:

1. Foley catheter status documented every shift in Shift Assessment Screen. Change “Y” to “N” for Foley Catheter in place and document removal time in nurse’s notes.

2. Document any applicable signs and symptoms of UTI: fever(>38ºC, 100.4ºF), suprapubic tenderness, or costovertebral angle pain or tenderness, frequency, burning or pain with urination.

Nurse Driven Foley Removal Protocol

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Foley Catheter should be continued if any of the following criteria are met:

1. To provide relief of urinary tract obstruction not manageable by other means.

2. To permit drainage in patients with neurogenic bladder dysfunction and urinary retention not manageable by other means (i.e., with clean intermittent catheterization)

3. 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.

4. Assist in healing of perineal and sacral wounds in incontinent patients

5. Patients who are Hospice/Comfort/Palliative Care

6. Required immobilization for trauma or surgery (i.e., Hip Fractures)

7. Chronic indwelling urinary catheter on admission

8. Accurate measurement of urinary output in the critically ill patients (Intensive Care)

9. 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:

1. Urine output monitoring outside of Intensive Care

2. Incontinence with no skin breakdown

3. Prolonged perioperative use (unless indicated above, removal by Post Op Day 2)

4. Patients transferred from intensive care to general units

5. Morbid obesity

6. Immobility

7. Confusion or dementia

8. Patient request

G: pcs files/Housewide Nursing Policy Manual/MSCC Policies/

Key Search Words: CAUTI, Foley, foley, catheter, Foley Protocol,

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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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