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Decreasing CAUTI

Posted on: August 29, 2017

Medical Executive Committee supports and approved the evidence based practice of decreasing CAUTI through the approval of a nurse driven protocol to remove foley catheters based on the following:

Criteria for Continuing Indwelling Urinary Catheter

  1. Known or suspected urinary tract obstruction
  2. Neurogenic bladder dysfunction/urinary retention
  3. Recent urological surgery, bladder surgery, pelvis surgery or recent surgery involving structures contiguous with the bladder or urinary tract after pelvis surgery (GYN & Colorectal surgeries)
  4. Other surgical patients: Postoperative day 0 or 1
  5. Urinary incontinence in a patient with Stage III or IV pressure ulcers on the trunk, perineal wounds, necrotizing infections
  6. Need for accurate measurement of urinary output in a patient in Critical Care
  7. Gross hematuria in patients with potential clots
  8. Epidural catheter still in place
  9. Palliative care for the terminally ill
  10. Immobility (complete bedrest) with the inability to empty bladder without mechanical means
  11. Patients with indwelling urinary catheters in place on admission. Investigate reason and promote catheter removal when appropriate.
  12. Suprapubic catheters

Post-Catheter Removal Assessment and Care

RN will assess the patient for:

  1. Spontaneously voiding
  2. NOT voiding, however patient is comfortable and expresses no urge to void
  3. Uncomfortable and has urge to void

Bladder scan should be done for any of the following reasons:

  1. Patient is uncomfortable at any time, whether voiding or not
  2. Patient has urge to void, but is unable to do so
  3. Patient is incontinent at any time
  4. Patient has not voided in over 6 hours

If the patient is uncomfortable or has the urge to void and bladder scan >400 ml

  1. Straight cath patient x1 then notify physician if unable to void adequately
  2. Notify physician if patient has a history of enlarge prostate or urinary problems necessitating prolonged indwelling urinary catheter for an indwelling urinary catheter order instead of straight cath

If bladder scanner volume is >600 ml, contact physician:

  1. Record intake and output volume

If a patient has to keep the foley, the physician only has to sign once. Appropriate changes to the EHR were made to align with this protocol and quality monitoring will be conducted to measure the performance improvement.

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