Nurses just want everyone to have a foley!

[MrsWampthang]

At the LTAC that I work at, it has become the trend to DC foleys on everyone, including those patients that should always have foleys. Their reasoning for this is that it has something to do with preventing UTIs. I questioned the reasoning behind taking a foley out of a patient that, because of an unfortunate accident, doesn't have a normal urethra and has no way to ask for a bedpan. This patient is a feed, so really can't hit the call lite nor even feel the urge to urinate so utimately is wet a lot. I had the UTI statement thrown at me, and I made the statement that I thought it was undignified to expect this patient to lay in a wet bed, and reiterrated that both nurses and CNAs are extremely busy and can't possibly keep this patient constantly dry. Course, their reply was "yes you can." Whatever. I would like to see the ones that made that statement work the twelve hour shift that I just put in and see if they had time to change someone in a timely manner. I was so busy running up and down the hall for PRN pain meds that I hardly had time for anything else, let alone fluffing and puffing my patients. I guess I'm whining but the last two days were so tiresome both physically and mentally. So what are the policies in other places and does anyone know the statistics of UTIs vs foleys. (I know, I could look it up, but I'm too tired.) Thanks for letting me vent.

Wishing our facility had our own Narcotics Anonymous,

Pam

[RN34TX]

However, my facility's (and my own personally) policy is that a foley does not need to be in place for your own convenience.

I've had that rhetoric thrown in my face by MD's and supervisors alike as a former LTC and med/surg nurse.

For my own convenience?

As if I'd normally be reading a book or talking on the phone during my shift had that foley been in place but darn, it's not, so now I have to get off my butt and go change the bed linens.

The UTI excuse is weak and gets weaker by the year. It's long worn out.

It goes up there with not placing a central line in a patient due to the risk of infection.........

Yet the MD goes on to order Vanc and other potentially harmful drugs if a peripheral line becomes infiltrated/extravasated and in addition orders labs every 4-6 hours like for patients on heparin gtt's.

He/she somehow thinks that IV's and labs will somehow magically get done on their blown up elderly renal patients who's veins are long worn out by getting stuck over and over again.

Just like they think that a nurse is standing over their incontinent patients 24/7 with nothing else to do, eagerly awaiting the next flow of urine to clean up and that their patients would never sit in a puddle of urine for more than 5 seconds.

No skin breakdown potential here, right?

And if there is skin breakdown, it must be because the nurses are negligent and/or lazy spending their time filing their nails or talking on the phone throughout their shift.

That all works fine in "Dreamland Perfect World Hospital" but few, if any of us work there.

Let's pull all the foleys, then start pointing fingers of blame if the patients start to experience skin breakdown and/or other problems.

Now that makes perfect sense.

[MrsWampthang, BSN, RN]

I've had that rhetoric thrown in my face by MD's and supervisors alike as a former LTC and med/surg nurse.

For my own convenience?

As if I'd normally be reading a book or talking on the phone during my shift had that foley been in place but darn, it's not, so now I have to get off my butt and go change the bed linens.

The UTI excuse is weak and gets weaker by the year. It's long worn out.

It goes up there with not placing a central line in a patient due to the risk of infection.........

Yet the MD goes on to order Vanc and other potentially harmful drugs if a peripheral line becomes infiltrated/extravasated and in addition orders labs every 4-6 hours like for patients on heparin gtt's.

He/she somehow thinks that IV's and labs will somehow magically get done on their blown up elderly renal patients who's veins are long worn out by getting stuck over and over again.

Just like they think that a nurse is standing over their incontinent patients 24/7 with nothing else to do, eagerly awaiting the next flow of urine to clean up and that their patients would never sit in a puddle of urine for more than 5 seconds.

No skin breakdown potential here, right?

And if there is skin breakdown, it must be because the nurses are negligent and/or lazy spending their time filing their nails or talking on the phone throughout their shift.

That all works fine in "Dreamland Perfect World Hospital" but few, if any of us work there.

Let's pull all the foleys, then start pointing fingers of blame if the patients start to experience skin breakdown and/or other problems.

Now that makes perfect sense.

Wow! Now that's a good post. I totally agree with you there. I don't mind in the least cleaning up a patient of poo or urine or changing bed linens, however, if I have 6-7 patients myself, the aid has responsibility for 15 which includes feeding at least one patient three meals that shift, as well as setting up or bathing 5 or 6 patients, of my 6 patients 3 are on a narcotic clock and call for their prn narcs on the nose when they know they are due (one such patient had prn morphine q 30 minutes-yeah, like that happened.), then how am I supposed to be able to check the incontinent patient, on a regular basis, that has no awareness of the need to urinate to make sure they are not sitting in a puddle of urine? I guess I'm not super nurse, but I DO believe in foleys for patients who need them, i.e. paraplegics who have no sensation below the waist or are so senile that they have no sense of when they need to urinate, so they pee all over everything, (the bed, the wall, the floor, you, their roommate, etc.) Ok, I'm done venting, but that's my humble opinion and I'm sticking to it.

Pam

[jimthorp]

There are only two reasons that we will leave in a foley in our facility:

1. Structural abnormality that prevents bladder emptying (e.g. enlarged prostate, or urinary retention problems)

2. Excoriation or wound in the area that would be worsened by urine

Where I work there are very few reasons why someone would have a Foley. There must be an acceptable medical diagnosis but I'm not sure what they are. We have one that has had a Foley since I've been there (over a year) and has had maybe two UTI's in that time. When this directive came down we had one resident that had to be straight cathed q8°. This went on for several months and no UTI. Eventually, PVR was

Proponents of this directive say that the briefs are designed absorb and keep fluids away form the skin. Ideally they must be changed q2° but we all know the realiy of this.

I had an obese male who developed what looked like a pressure ulcer on the back of his scrotum, later determine to be from scratching. I tried to get a Foley ordered and the Doc agreed but the facility would not let me put one in. True, the brief absorbs the urine but until it makes it to the brief it rolls down over the dressing. Still no Foley. Talk about a tough place to get a dressing to stick.

[Sisukas]

i'm sorry, i have to vote against the foley in long term care. i work for float team and have been at all 6 med/surg units....i've seen more urosepsis than infected decubiti. and of the urosepsis cases, the majority of them have been e. coli urosepsis. we have one patient who's currently in her third hospitalization for this in the past 10 months. i know i don't have to give all of you the details of the difficulty caring for these poor ladies.

we get a lot of nursing home patients who have great skin; both incontinent and with foley catheters. i often tell the staff at the nursing homes that their cna's are going a great job with that. (i was a cna for 5 years in long term care). but it seems that they need to remember which way to wipe their patients with foleys. i shouldn't see crusted stool on the catheters.

[Marie_LPN, RN, LPN, RN]

When we have patients like this I often bring up the issue of skin breakdown. Sometimes it works, other times it falls on deaf ears. The times where it falls on deaf ears, it takes the pt's skin actually breaking down (unnecessarily, I might add :angryfire: ) before they agree to having one placed.[/quote']

Yep. That's one reason why i don't always miss med-surg.

[MarySunshine]

It is easier to provide foley/peri care every 6 hours than to clean an incontinent patient every 1 hour. I'm with RN34TX on this one. As a patient in that situation, I would rather have a foley.

Or they could, you know, have adequate staff.

[nursetim, NP]

Nurses just want everyone to have a foley! You say this like it's a bad thing.

[Marie_LPN, RN, LPN, RN]

The more i read the title, the more i see it going to the tune of Cyndi Laupers "Girls Just Wanna Have Fun"

(Heeeeeeeyeeee Ted, think we got a song for ya.....)

[MrsWampthang, BSN, RN]

Nurses just want everyone to have a foley! You say this like it's a bad thing.

Yeah, that's kind of what I thought when I heard that someone had actually made this statement.

Pam

[DizzyLizard]

The facility I used to work at had a low UTI rate because the patients who had foleys regularly received proper foley and peri care. If the pt needs a foley, the pt should get the foley....especially if urine is going to saturate dressings or the person is at very high risk for skin breakdown.

[jimthorp]

The facility I used to work at had a low UTI rate because the patients who had foleys regularly received proper foley and peri care. If the pt needs a foley, the pt should get the foley....especially if urine is going to saturate dressings or the person is at very high risk for skin breakdown.

I agree, but try telling that to the suits.

[MrsWampthang, BSN, RN]

There are only two reasons that we will leave in a foley in our facility:

1. Structural abnormality that prevents bladder emptying (e.g. enlarged prostate, or urinary retention problems)

2. Excoriation or wound in the area that would be worsened by urine

Other than that, they come out. Yes, it means a lot of wiping butt, but it's what we do, and it's what is usually best for the patient. Our patients that do have foleys because of one of the above reasons (almost always #1) they have the most horrific chronic UTIs. We have several different versions of a bladder training program. However, my facility's (and my own personally) policy is that a foley does not need to be in place for your own convenience.

Sorry, but I have to disagree with you. If patients are getting proper foley/peri care, then they shouldn't be getting horrific, chronic UTIs. I advocate for foleys, not for my own convenience, but for the patient's dignity. It is just cruel to let the have to sit in their own urine if there is no reason too. It's bad enough that they have to poo themselves. Foleys shouldn't be DCd to make the numbers at the facility look good. Unless the facilty has an over abundance of staff, which never happens in the real world, then patients should be given every chance for dignity and safety and to heck with what looks good on stats for the facility. Just my opinion though.

Pam