Device Audit - CAUTI Prevention

• Conducted on

  Date
• Location
  Address

• MRN

• Patient Name

• Room number

• Audit conducted by

Observation

• Peri/Cath care performed (no crusting/mucus noted at insertion site)

  YES

  NO

• Securement device applied and intact

  YES

  NO

• Tamper-resistant seal intact (closed system)

  Yes

  No

  N/A

• Urine flow unobstructed (no kinks or dependent loops)

  YES

  NO

• Green securement clip (sheet-clip) utilized

  YES

  NO

• Urine collection bag below level of bladder

  Select YES NO

  • YES
  • NO

• Urine collection bag not sitting on floor

  YES

  NO

• Urine collection bag not over 3/4 full

  YES

  NO

Documentation

• Order for IUC insertion documented

  YES

  NO

• Appropriate indication for catheter insertion

  YES

  NO

• Daily catheter justification reviewed & documented

  YES

  NO

• Peri/Cath care documented

  YES

  NO

• CAUTI Education-documented

  YES

  NO

• CHG bath documented

  Yes

  No

  N/A

• Yes

  No

  N/A