Urinary Catheter Maintenance

• Location

  Select MRHO R1 MRHO R2 MRHO R3 MRHO R4 MRSHO L1 MRSHO L2 MRSHO L3

  • MRHO R1
  • MRHO R2
  • MRHO R3
  • MRHO R4
  • MRSHO L1
  • MRSHO L2
  • MRSHO L3

• Patient Name

• Visit Number

• Audit Date

  Date

• Personnel

General Information

• Urinary Catheter Present on admission?

  Yes

  No

  N/A

• Date of Insertion?

  Date

• Is there a Physician Order?

  Yes

  No

  N/A

• SCIP - Has this catheter been in place 2 days or longer? (If 2 days please request documentation to continue from physician.)

  Yes

  No

Today's Indication for Foley

• Today's Indication for Foley

  Select Acute spinal cord lesion higher than S2-S4 or history of MS, Spina Bifida, that causes urinary retention. Comfort for end of life or Hospice Urologist or Surgeon order for condition of urinary tract, example enlarged prostate oredema of scrotum/penis Bariatric patient not able to use bedpan or commode Chronic use prior to hospitalization Ordered by Urologist to stay in place Assist in healing of open sacral wounds in the incontinent patient Order to Discontinue

  • Acute spinal cord lesion higher than S2-S4 or history of MS, Spina Bifida, that causes urinary retention.
  • Comfort for end of life or Hospice
  • Urologist or Surgeon order for condition of urinary tract, example enlarged prostate oredema of scrotum/penis
  • Bariatric patient not able to use bedpan or commode
  • Chronic use prior to hospitalization
  • Ordered by Urologist to stay in place
  • Assist in healing of open sacral wounds in the incontinent patient
  • Order to Discontinue

Maintenance Practices

• Peri care completed once per shift (if possible ask patient)

  Yes

  No

  N/A

• Bag cover on if not in patient room?

  Yes

  No

  N/A

• Is the Foley bag equal or less than half full? (If greater than half full - please Empty)

  Yes

  No

  N/A

• Orange sticker on tubing present?

  Yes

  No

  N/A

• Initials on the sticker

• Date on Sticker

  Date

• Securement (Statlock) in place?

  Yes

  No

  N/A

• Tamper Evident Seal (TES) Intact?

  Yes

  No

  N/A

• No Dependent Loops

  Appropriate

  Inappropriate

• Tubing and bag below bladder

  Yes

  No

  N/A

• Bag is above floor (not touching floor)?

  Yes

  No

  N/A

Reminders/Notes

• Education Provided and Documented

  Yes

  No

  N/A

• Clean port with alcohol when emptying the bag or accessing port for any reason.

• Notes:

Signatures

• Auditor Signature

  Sign