Female foley and witness - page 2

Does anybody work at a facility that has a policy requiring you to have a witness for a foley start? I'm on a travel assignment, fairly new to my current facility. Someone (who was not a superior... Read More

  1. by   Isakolistic
    Quote from Nalon1 RN/EMT-P
    2 RN's?
    Seems a bit excessive. I understand 2 people (RN and a tech/CNA) for placement, but requiring 2 RN's seems to be a waste of resources.
    The hospital I work in requires an additional staff member to be present; doesn't require the staff member to be an RN. Ditto to the aforementioned comments that it helps to be accountable to aseptic technique (if it is an RN). This is the only procedure that 2 staff members are required to be present for in my facility to my knowledge.
    Last edit by Isakolistic on Aug 14 : Reason: Clarification
  2. by   /username
    You're a traveler. If it's the policy, it's the policy. There's no discussion to be had...

    When in Rome....
  3. by   C0SM0
    Quote from HalfBoiled
    In my unit, if a male nurse was going to insert a foley in a female patient, it is strongly encouraged to have a female witness the action. At any time a female patient can accuse the male nurse for sexual assault.
    Just curious, but why is it only "strongly encouraged" if it is a male nurse/female patient scenario?
  4. by   cyc0sys
    I think one of my old nursing instructors said it best, "If you like being a nursing, always have a witness when you're 'getting all up inside someone's business'. That way everyone knows what 'didn't' happen". I'm a male nurse so I've never really considered it to be an option anyway.
  5. by   not.done.yet
    My facility requires two nurses in the room. One to perform the task, the other to watch for a break in sterile field. If this happens, they are to quietly say to the nurse performing insertion "Let me get you another kit" as a way of stating they saw sterile break. It is intended (and is working very well) to prevent CAUTI.
  6. by   BSN16
    I don't get it. So should a male RN have a witness every time he cleans someone up, puts them on a bed pan, puts on ekg patches? where does it end?
  7. by   gonzo1
    Our new foley insertion policy requires 2 RN for foley placement. It has something to do with reducing CAUTI rates. No body likes it, but we do it.
  8. by   jive turkey
    Quote from /username
    You're a traveler. If it's the policy, it's the policy. There's no discussion to be had...

    When in Rome....
    There's always that one person that doesn't thoroughly read through a post before making a comment.
    Go back and read what I said, especially as it relates to policy then revisit the discussion. Thank you.

    I see that some facilities require witnesses to prevent CAUTI. That's great. I'm skeptical if that's the real reason or if it's a more obscure way to have a witness present to prevent accusations. Are we going to have to get a witness to start an IV to make sure we prepped the skin correctly? How about a witness for every IM and SUBQ injection? Does the PICC nurse need a witness now too? How about a hand washing witness?

    This is generally very unfortunate. As if we don't have enough challenges tending to patients in a timely fashion due to charting, patient volume, patients all being in pain, thirsty, need the restroom etc. at the same time, needing witnesses for narcotics and insulin...just like another poster said, where does it stop?

    And what about the patient? Do we ever consider how some of them may be more embarrassed at the volume of people standing over them while they're exposed?
  9. by   Orca
    Quote from C0SM0
    Just curious, but why is it only "strongly encouraged" if it is a male nurse/female patient scenario?
    Even if it wasn't required I would still do it. The potential consequences of allegations of improper conduct, even if they were totally false, is reason enough for me to do what I can to avoid them.
  10. by   Dany102
    Quote from jive turkey
    And what about the patient? Do we ever consider how some of them may be more embarrassed at the volume of people standing over them while they're exposed?
    Hello jive turkey,

    I'm glad to see some nurses are thinking of the patients in that regard. Too bad you seem to be the only one doing it in this thread so far.

    For what it's worth, thank you.

    Dany
  11. by   Accolay
    Our hospital policy is also to have a witness in an attempt to decrease CAUTI.

    As far as having a volume of people standing over a patient: I think that may be why it's important to have two RNs and not other ancillary staff doing the observing/holding of flashlight, and performing necessary education with the patient. Another reason also important to try and keep those bits covered until necessary.

    Interesting ethical discussion though- when does the hospital policy to keep down infection rates override pt's privacy in this instance? I think we would educate on the reasoning but if a patient continued to refuse the observer we probably wouldn't push the issue and document. Unfortunately for some female patients, I really did require extra hands to place a foley.

    Discuss amongst yourselves.
  12. by   Wesley Donovan
    Recently, I left my first position on an Orthopedic unit, with an average of 8-10 Foley catheters a month, not including Straight Catheters. I worked there two and half years, so I estimate I did about 200-260 Foley Catheters, and less than 300 straight catheters. In my own personal experience, I've only encountered a hand full of patients maybe around 5-7 that did not want me to place the catheter. There was no two person policy, so this was interesting to read. The CAUTI per our internal medicine physician was irrelevant, and I concluded the same result at least in my own findings. Patients will develop UTI almost always regardless of what technique you use because the bacteria enters around the catheter, there is no outer urinary flushing and the time the catheter stays in is the most important factor. For this reason, Cipro was typically prescribed by default.

    When I first started as a new grad, I was worried/nervous/unsure, however this does create a sense of uncertainty between you and the patient. It's kinda an awkward situation, where the patient is expecting you to be confident, and aware of what the hell your doing, and so when you communicate your not sure how to approach the situation, it just makes everything uneasy. Now days, I pick up retention instinctively mainly through their behavior, assess the last 24 hours and always confirm a rough estimate with a bladder scan. I explain the issue, tell them what needs to be done & how, give them the option of me or someone else, get MD order and resolve the problem.

    In patient's that are 18 years or younger, around my age, or patient's who demonstrate irrational behavior, I will ask for a witness to be present. Other than that, never had any problems. Interesting discussion though.

    Have a great day guys,

    Wes

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