catheter associated uti remove that foley!. objectives review evidence that foley catheters cause...
Post on 21-Dec-2015
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Catheter Associated UTI
Remove That Foley!
Objectives
Review evidence that foley catheters cause infection
Employ algorithm to determine if foley catheter is appropriate
Apply guidelines for when to remove foley catheter
Foley Catheters Cause
Infections Length of stay Cost $$$ Patient Discomfort Antibiotic Usage Risk of falls (tethered to bed/1 point
restraint) Risk of skin breakdown, DVT and
pneumonia due to immobility
Urinary Tract Infection (UTI) and Indwelling Catheters
UTIs: THE most common Hospital Acquired Infection (HAI) and are directly associated with the use of indwelling foley catheters
40% of all HAI are caused by UTI 80% are secondary to foley catheters Risk of infection
5% each day 25% at 1 week 100% at one month
Duration
SCIP INF-9* recommends that post-operative foley catheters are removed by the end of post op day 2
Use urinary catheter in operative patients only as long as necessary
SCIP INF-9 requires physician documentation for foley catheter continuation
*SCIP = SURGICAL CARE IMPROVEMENT PROJECT *INF-9 = Infection Module # 9
When to Discontinue Foley Catheters?
Decreasing the duration of an indwelling urinary catheter will reduce the risk of a catheter-associated UTI
The time frame for foley catheter removal is dependant on clinical judgment and findings
Indwelling catheters should not be changed at arbitrary intervals
No action necessary. Avoid catheter
placement.
Does the patient meet
criteria for a Foley?
Continue to monitor
Foley need on a daily basis
YES
YES
NO
NOYES
Foley Catheter Decision-Making Algorithm
Foley Indicators Obstruction relief Neurogenic bladder Strict I&O GU related Surgery/Procedure Stage III/IV decubitus Diuresis / Mass hydration Comfort Care/Palliative Care Other__________________
ObtainRemove Foley
order
Is there a Foley Catheter
in place?
Foley Catheter Checklist*Date Post Op Day #_____________
Foley Day #_______________
Room #
Does your patient have a foley catheter? Y N
Is there an order for the catheter? Y N
Which service is your patient on? Medical Surgical Trauma
Which criteria for appropriate use of foley catheter does your patient meet:
Obstruction relief Neurogenic bladder Strict I&O GU related Surgery/Procedure Stage III/IV decubitus Diuresis / Mass hydration Comfort Care Other
If none of the above criteria are met, was a D/C foley order obtained? Y N
*Used in ICUs that do not document nursing assessment in IDX/GECE
Foley Catheter Sticker*: Doctor’s Order Documentation of catheter criteria FOLEY CATHETER ORDER
Date/Time Doctor__________
This patient has a Foley Catheter, inserted __________(date)
Please indicate criteria for continuation of foley catheter:
IF NO CRITERIA APPLY PLEASE CONSIDER DISCONTINUATION OF FOLEY CATHETER
□ Continue Foley Catheter □ D/C Foley Catheter Physician/NP/PA Signature __________________#________Date/Time__________ Cat # 86604
Obstruction relief Neurogenic bladder Strict I&O GU related Surgery/Procedure Stage III/IV decubitus
Diuresis / Mass hydration Comfort Care/Palliative Care Other_____________________________________________
*Place dated sticker on physician order sheet
Sticker for Chart Front to Alert MD
Place on front of chartFoley Catheter in place…… See Doctor’s Order SheetDate__________ Cat # 86605
Date and place this sticker on the front of the chart to alert MD that the foley catheter order sticker has been placed on the physician order sheet.
Unit Flyer
Nurses must advocate for the removal of unnecessary indwelling catheters.
Use the criteria-based guidelines to determine need for foley catheter.
Document foley criteria, insertion date, and discontinuation date.
How does this apply to nursing?
Use the decision-making algorithm Use the Criteria-Based Foley Catheter Checklist
daily for areas that do not chart in GECE/IDX If no criteria on the checklist are met, obtain a
physician’s order to discontinue the foley catheter Foley Catheter Days will be collected on each unit,
every day There is no evidence to support a set time of day
that foley catheters are to be discontinued.
Nursing Guidelines
GECE Screenshot
2 Documentation Changes as of January 1, 2010:#1 Discontinue date of foley#2 Foley Catheter Criteria IF patient has a foley
Maintain catheters based on recommended guidelines Maintain a sterile, continuously closed drainage system. Keep catheter properly secured to prevent movement
and urethral traction. Keep collection bag below the level of the bladder at all
times (even during transport). Maintain unobstructed urine flow. Empty collection bag regularly, using a separate
collecting container for each patient, and avoid allowing the draining spigot to touch the collecting container.
Maintain meatal care with routine hygiene (bathing) using soap and water.
Questions
Foley Catheters cause:
A. Increased infections
B. Increased length of stay
C. Increased risk of falls
D. Increased cost
E. All of the above
Criteria for Foley Catheter includes:A. Neurogenic bladder
B. Strict I&O
C. GU related Surgery/Procedure
D. Stage III/IV decubitus
E. Comfort Care/ Palliative Care
F. All of the above
Discontinuation of foley catheters is based on all of the below except:A. Physician Order-sets
B. Research based criteria
C. Gut feeling
D. Pathways
E. MD/PA/NP order
Maintaining foley catheters includes all of the following except:A. Maintain a sterile, continuously closed drainage
system.
B. Keep catheter properly secured to prevent movement and urethral traction.
C. Keep collection bag on top of the bed covers at all times.
D. Maintain unobstructed urine flow.
E. Maintain meatal care with routine hygiene (bathing) using soap and water.