Order in place

Protocol in place

Peri care documented every 12 hours

Peri care last documented

Is Foley bag not full

Where is Foley bag located

Dependent loop absent

Green sheet clip utilized

Securement device in use

Red seal intact

Reason to maintain foley
Nurse observation

Did nurse use sterile technique to place Foley.

Did Nurse use appropriate wipes for q 12 hour pericare
Pericare wipes provided. Uses pkg of 5 not large bag of comfort bath

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.