Accountability of UTI

i think she's talking out her kazoo.

ask her to put this new 'policy' in writing.

she's nuts.

leslie

Our Supervisor is doing reviews and is stressing catheters and UTI's. She is telling everyone whom inserts one they will be held accountable. What type of accountability can she mean? One nurse saud that she told her; her pay would be docked:(for what the pt's whole hospital visit???). Can they do this? Are we to be written up, quit, or refuse to insert a cath?

Just Wondering?

tac50133

Went through this a few years ago. No it is not legal for them to dock your pay and your NM needs to cease with this threat.

Ask for an in-service for ALL employees that do pt. care. That way everyone is on the same page. You can't pick and choose what procedures you will or won't do. I always expect staff that I work with to be of the same caliber that I expect of myself. The "guilty" ones always weed themselves out.

This all stems from Medicare's new policy of not reimbursing hospitals for UTI's that develop during hospital admission.

We had a foley-care inservice last month.

I really cant believe your nm is threatening you with this!!! Seriously either shes nuts or your hospital is! First of all, how could there be evidence showing it was the nurses teqnique that caused the UTI. Some people are just more at risk of getting a UTI with a foley even if the nurse used super sterile teqnique. Doctors know this. Also, arent UTI's sometimes caused by poor peri care around the foley? You cant really blame that on one nurse.

I wouldnt worry about these threats. Sounds like your nm is just trying to scare the nurses on your floor.

It really is ridiculous--and while peri-care is definitely another issue with the whole Foley/UTI thing, the CNAs can't be blamed either. Sometimes a patient has a Foley and a diaper and will have BMs all day. Even being there to clean it up right away every single time isn't going to prevent a UTI in all cases.

Insurance companies are no longer going to compensate hospitals for treating patients who develop UTI while in the hospital.

I'm seeing fewer and fewer patients get indwelling catheters ordered.

I am seeing the same; fewer foley catheter orders. Of course, this means more diapers saturated with urine, which can ultimately mean more skin breakdown; and Medicare will no longer pay for skin breakdown that is hospital acquired!! Talk about a vicious circle.

amen nursemary9!

I want to place a call to Medicare about this.....lol

The Phone Call:

Nurse: Hi, this is SillyStudent, RN from ABC Hospital. I have an issue that I am not sure how to address.

Medicare: Go ahead, I will try to assist you.

N: Well, I have a patient, Mr. Smith. He is actually not alert and oriented whatsoever. He dribbles urine almost continuously, and pulls at his tubes. We removed the foley catheteter because we won't be reimbursed for his care if he gets a UTI from pulling on his tubes. Actually, we caught him rubbing feces into the end of his member

M:Well, I hope he doesn't get an infection

N:I estimate he had one within 27.2 seconds of doing it, miss.

M: Too bad. We won't pay for it, you know. Well, what can I do for you?

N: I am actually calling for advice. We put a condom cath on him, but he pulls that off as well. We are a restraint free facility. The constant urine is causing skin breakdown on his gluteal folds, perineum and coccyx. We wash him down about every 30 minutes, but it isn't quite enough.

M: We won't pay for that, either.

N: *patiently* I am aware of that. I wanted to get him a sitter, but it has come to my attention that Medicare doesn't pay enough reimbursement for a sitter to pay for said sitter's lunch. This guys complete assets are 3 gum wrappers and a wet cigar that we found in his left hip pocket upon admission. He also had some extremely old crud and feces under his fingernails, but I doubt the local antique dealers would be interested in that.

M: So, exactly what help can I offer you?

N: I wanted to know how to turn this financially ruining mess into something that we can expect payment for.

M: Oh, sorry. We don't have any answers for you. Check with your Hospital Administration.

N: My Hospital Administration? They are currently threatening to dock my pay if my patients get infections or skin breakdown.

M: Oh, you should not let them get infections, then. Silly Nurse!

I honestly do not believe that you are going to be held financially libel for any UTI's. What I believe that your supervisor was trying to instill in the unit was a sense of accountability as a nurse to your patient and the staff on the unit being held to a level of accountabilty as a collective group.

By accountability, I mean an increased sense of awareness of how you can prevent a UTI by critically thinking and applying nursing interventions.

Did you use sterile technique when it was inserted? Did you evaluate daily to ensure that the foley was still a necessary intervention? Was the care of the catheter completed and was it all documented.

Foleys can be extremely unconfortable to patients and they should be looked at as not a convenience for nursing, but as a necessary intervention for the patient. The same concept that restraints are not babysitters for patients who can't be watched closely.

Sillystudent........that was great!