Sample Urinary Catheter Protocol/Order Set - eQHealth Solutions

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Dec 14, 2013 (3 years and 9 months ago)

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Sample Urinary Catheter Protocol/Order Set

• Prevent Catheter Associated Urinary Tract Infections •


INTERVENTION



Insert _______ fr
.

catheter under sterile technique and document in medical record. Change urinary catheter every


28 days. If
p
a
tient arrives to facility with catheter
,

obtain UA C&S from sampling port and change out catheter.


Reason for Insertion
:



___

Obstruction of the urinary

tract distal to the bladder
.


___

Alteration in BP or volume status requiring accurate volum
e measure.


___ Pre
O
p catheter insertion for patient going to OR or procedure.


___

Continuous bladder irrigation for urinary tract hemorrhage/TURP
.


___

Urinary incontinence posing a risk to the patient stage 3
-
4 perineal ulcer
.


___

Neurogenic bl
adder dysfunction and urinary retention
.


___

Comfort Care.


___

Other: _______________________________________________


Document Insertion in medical record.


Obtain
u
rine
s
pecimen within 48 hours of admission and send for culture and sensitivity.


Write insertion date, time, unit placed, and initials on urine bag and urinary catheter with permanent marker.



Ensure system remains closed and verify seal at junction of catheter to bag (this will be exception if using a



specialty catheter or urometer bag) Document seal intact or not intact daily.


Engage in proper hand hygiene and use of gloves when ha
ndling catheter.


Use catheter
-
securing device.


Empty Foley bag <

2/3 full
,
and empty prior to any transport
.


Label the emptying device with the patient’s name and date
,

and keep in patient’s room.


Ensure perineum was cleansed with soap and

water or bath cloths during hygiene q day and
PRN

as needed for soiling.


Properly place collection bag on bed using dependent drainage. Drainage
BAG

attached to side of bed and


BELOW

the level of the
BLADDER
.


Obtain any urinary specimen fro
m the Catheter port with syringe and sterile needle. (Do Not Use from Bag)


Complete daily assessment of need and document in medical record.


Enter
r
eminder “
s
ticker” to
p
hysician
p
rogress
n
ote and/or
o
rder
s
heet requesting review and removal of ur
inary catheter


every 7 days and/
o
r when patient no longer meets criteria for urin
ary

catheter
. D
ocument
notification of the physician
in


the medical record.


Urinary Catheter Removal Protocol



Obtain
m
edical
o
rder
f
rom Licensed Ind
epend
ent

Practitioner to remove catheter
.


Document
r
emoval of the
c
atheter

-

date and t
ime.


Document
p
ost
-
c
atheter
v
oid.


Bladder
s
can if no voiding within 6 hours of removal and notify physician of urine > 250ml identified.




____________________
___________


____________________________________________

Date






Licensed Independent Practitioner Signature



This material was produced by
Oklahoma Foundation for Medical Quality, the Medicare Quality Improvement Organization for Oklahoma

and has bee
n adapted for use by
eQHealth Solutions, the Medicare Quality Improvement Organization for Louisiana, under contract with the Centers for Medicare

& Medicaid Services (CMS), an agency of the
U.S. Department of Health and Human Services. The contents presen
ted do not necessarily reflect CMS policy.
LA10SoW2B11
-
2503