Can Managers Override Policy and Drs Orders?!?

Because cauti are high, our manager said that now we can't get orders from the provider. It has to go through him and he has to approve a foley. Does a manager trump Drs orders and policies?!?!? He said we have to straight cath patients q4-6 and there's no harm doing this daily. 

Manager only cares about decreasing  Cautis. It's a medicare reimbursement issue. If the manager wants intermittent catheterization , by all means notify him of the foley order. Then you have  to call the physician that prescribed the foley... and explain the issues.   Get a UA C&S  order with the first straight cath.

56 minutes ago, Been there,done that said:

Manager only cares about decreasing  Cautis. It's a medicare reimbursement issue. If the manager wants intermittent catheterization , by all means notify him of the foley order. Then you have  to call the physician that prescribed the foley... and explain the issues.   Get a UA C&S  order with the first straight cath.

There's a reason why C&S are limited. You don't want to get them on every UTI because then there is unnecessary treatment/overuse of antibiotics. You certainly don't get one just because you're doing a straight cath.

I'm not saying that sometimes C&S is avoided because of the "numbers" but protocols have been created so that it isn't done for every UTI. They're probably should be more reflex cultures done, but that's not always appropriate either

Specializes in NICU, PICU, Transport, L&D, Hospice.
27 minutes ago, Aloe_sky said:

Now that he has removed the foleys from the unit, it has to go through him since they will be kept in his office only.  Nothing is in an email or writing, everything is verbal. 

If the manager is requiring something that is not written policy/ procedure or covered by provider orders you should consider your risk and liability should something unexpected occur. 

Specializes in Travel, Home Health, Med-Surg.

I don’t understand how the NM is being allowed to override the provider order. This needs to be cleared up STAT. What are the Docs saying when you tell them that the manager won’t allow a foley, do they then change the order to straight cath? You say they have removed the foleys from units (so all of the units in the hospital?). Either way a a new policy is in order (for what ever units are affected). This needs to be addressed by Upper management of both nursing and physicians. I would refuse to do anything without a proper MD order, period! 

6 hours ago, mtmkjr said:

There's a reason why C&S are limited. You don't want to get them on every UTI because then there is unnecessary treatment/overuse of antibiotics.

A point of clarification: What you are trying to avoid treating is asymptomatic bacteriuria.

Simple, symptomatic cystitis and UTI are both treated with antibiotics.

I think what you are talking about is avoiding doing a bunch of UAs and cultures on asymptomatic patients.

Specializes in Critical Care.

I feel like there is more to this, since CAUTI protocols are so common everywhere. Wish the OP would come back to provide more details/clarification. My facility implemented the need for the bedside nurse to notify the charge nurses when there is a need for a Foley; since being in the frontline, is common for nurses to often request for Foley placements. Initially we hated it, however, I have to admit...it has tremendously decreased the amount of Foleys placed in, since some nurses were requesting Foleys just for incontinence. 

Specializes in Med-Surg.

If the manager is saying straight cath without an order then no that's not legal.  

If the manager is saying, "let's talk about this before you call the doctor to get an order for a foley" that's totally appropriate.   

I am confused that you say he says to straight cath q4-6h and it's it's okay to do this daily.  That doesn't make sense.  

Many people with urologic problems do indeed get straight cathed on a regular basis.  Otherwise it is common practice to straight cath first rather than insert a foley.  For example a post op patient that can't void, we would straight cath twice before inserting a foley.  But often we straight cath once and after anesthesia wears off they can void after that.

Over the years we've dramatically decreased the amount of foley's we put in patients and we have to chart the justification as well as get an MD order of course.  Thankfully for our pre-op hip fracture patients and other bed pound patients we've gone to using external female catheters like Purewick instead of indwelling.  

(Disclaimer, I didn't read every single response in this thread so I hope I'm not being repetitive.)

Specializes in Med-Surg.
16 hours ago, JKL33 said:

And let's not overlook the elephant in the room, which is that any UTIs associated with multiple straight caths by (often inexperienced) extremely harried staff members is not something that is being measured and it doesn't have an acronym-turned-word for people to crow about. It's good that we have been able to decrease inappropriate use of indwelling catheters and infections associated with them, but for now we have replaced that with an intervention/outcomes we aren't vigorously measuring. If that straight cath patient develops a UTI, at least it won't be a CAUTI!! Whew! ?

You could also decrease CAUTI rate by telling nurses that they must report to the nurse manager if they think their patient needs a urine culture. ?

Your right, but still I think 75% of UTI in the hospital acquired UTI's are associated with indwelling.  But I don't suppose you measure hospital acquired UTIs and go back and see if they've been straight cathed. Best not do that.

Kind of like C-Diff protocol.  Test everyone with diarrhea in the first 3 days so the hospital doesn't take a hit, but after that there is a whole algorithm set up designed to really not test the patient for c-diff.  

Specializes in Former NP now Internal medicine PGY-3.

Somehow I doubt what was said in the OP post is what happened or what the manager meant in real life. 

Most hospitals have a protocol anyway that we all follow and we have to have a good reason to place a foley or provide one and it’s probably docked against us if we have higher foley counts than other providers. 

Specializes in Occupational Health.
44 minutes ago, Tegridy said:

Somehow I doubt what was said in the OP post is what happened or what the manager meant in real life. 

I'm thinking the same thing. I'm finding it hard to believe that any provider would tolerate a NM ignoring an order (not questioning...that is a different issue). A couple of well placed phone calls by one or two providers would have quickly resolved this issue. 

That being said I have had a run-in with a couple of NM's that routinely overstepped their boundaries and tried to make medical decisions which contradicted or overrode an order I'd written....it didn't go well for the NM's. 

Inappropriate an uneccessary foleys can lead to cauti, sepsis and death. Regulatory agencies are watching hospitals and nursing homes like hawks where prolonged foley use is concerned.

Hospitals in turn are doing so too to avoid consequences. Maybe your manager has been asked to monitor foley use.

It seems to be communication failure above all.

Specializes in Critical Care, ER and Administration.

Many years ago, when I was a new manager, my director explained policy to me. Policies are like a hospital law. There is a process using best practice to create policy. The manager, doctor, director or CEO can not change a policy without going through the proper procedure. If you go to court, your actions will be judged by your hospital policy. A manager also cannot cancel or change an MD order. I would recommend going up your chain of command.

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