1. Catheter Associated UTI Remove That Foley!

2. 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

3. 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

4. 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

5. 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

6. 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

7. Does the patient meet criteria for a Foley? YES NO YES 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__________________ Obtain Remove Foley order Is there a Foley Catheter in place?

8. Foley Catheter Checklist* DatePost 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

9. 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

10. Sticker for Chart Front to Alert MD Place on front of chart Foley Catheter in place…… See Doctor’s Order Sheet Date__________ 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.

11. Unit Flyer

12. 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?

13. 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

14. GECE Screenshot 2 Documentation Changes as of January 1, 2010: #1 Discontinue date of foley #2 Foley Catheter Criteria IF patient has a foley

15. 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.

16. Questions

17. Foley Catheters cause: A.Increased infections B.Increased length of stay C.Increased risk of falls D.Increased cost E.All of the above

18. 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

19. 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

20. 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.