Patient Screening Medical Asst. Ask: Circle Yes or No YesNo “Do you ever leak urine/water when you don't want to? “Does it bother you enough to discuss various options?” YesYesNo URINARY INCONTINENCE 5 / 18
Patient Screening 6 / 18 RESIDENT Answer: Circle Yes or No Is urine leakage Acute or worsening?YesNo Chronic?YesNo Type of Incontinence (answer all that apply) Stress?YesNo Overflow?YesNo Urge?YesNo
MUSC - Early Catheter Discontinuation Protocol 13 / 18 Nurse-Driven Protocol Encourage early removal of foley catheters when appropriate Should be assessed every 24 hrs by nursing If no justification for a catheter exists, it can be removed by the nurse Physician should be contacted if there is any doubt
Valid Indications for Foley Catheters 14 / 18 urinary tract obstruction neurogenic bladder urologic study or surgery on contiguous structures sacral pressure ulcer (stage III or IV) with incontinence end-of-life care prolonged surgery with general or spinal anesthesia trauma fluid challenge in acute renal insufficiency intake and output monitoring AND critically ill/unable to collect urine lumbar epidural in place continuous bladder irrigation acute renal failure with anuria or oliguria
What Isn’t a Valid Indication? 15 / 18 Nonobstructive renal insufficiency Transferred from ICU Patient request Confusion Incontinence
Risks of Foley Catheters 16 / 18 3–10% daily rate of bacteriuria 10–25% of these patients will develop symptoms of UTI 3% will develop bacteremia 42% of patients report it was uncomfortable 48% said it was painful 61% said it restricted their ADLs Saint, S., Lipsky, B. A., & Goold, S. D. (2002). Indwelling urinary catheters: a one-point restraint? Annals of internal medicine, 137(2), 125–127.
Other Key Points 17 / 18 Studies show that physicians are frequently unaware whether their patients have a foley catheter in place High risks for unnecessary catheters include admission from the ED and transfer from the ICU to the floor.
Foley Tracking 18 / 18 We’re working on a workflow to notify Gen Med team attendings when their patients have foley catheters