Developing foley care protocol

[Lauren Fuentes]

I am working part time as a delegation nurse and have to develop a foley care protocol, and it seems I need a little help. I work full time in a MICU, so all of my training lends itself to the acute world and doesn't always translate to the home health world. I would like to have cath care performed with foley wipes, but I am having trouble finding research that supports the use of designated wipes vs baby wipes vs soap and water w/washcloth (this last one horrifies me but all home care instructions I pull up just say clean with soap and water). I also need to be cost conscious as I can't predict what insurance will pay for. Any suggestions would be greatly appreciated!

[NRSKarenRN, BSN, RN]

There is no financial support for incontinence cleaning supplies. Most care in home health is CLEAN technique --good old soap and water on washcloth worked for 25 years I've been in homecare. WOCN link below supports this perineal care. For those with financial means, disposable wipes are an alternate. Getting patients/caregivers to realize this needs to be performed daily and PRN post incontinent BM is a challenge.

Insurance companies usually provide payment for foley cath supplies only. With diagnosis of permanent Urinary Incontinence, Urinary Retention, Fecal Incontinence Medical assistance= Medicaid programs will often pay for chux, adult briefs, and incontinence barrier creme with physician RX. In PA Medicaid HMO's also cover items. This is to prevent skin breakdown + its resulting cost of treatment. I encourage washable bedpads as better alternative to prevent skin breakdown + bed/chair soilage,.

WOCN: Care and Management of Patients with Urinary Catheters: A Clinical Resource Guide

https://c.ymcdn.com/sites/www.wocn.org/resource/resmgr/publications/Care_&_Mgmt_Pts_w_Urinary_Ca.pdf

Procedures:

https://www.drugs.com/cg/foley-catheter-placement-and-care.html

Caring for Your Urinary (Foley) Catheter | Memorial Sloan ...

https://www.mskcc.org/cancer-care/patient-education/caring-your-urinary-foley-catheter

Home Healthcare Nurse: Best Practices in Urinary Catheter Care

https://journals.lww.com/homehealthcarenurseonline/Fulltext/2010/06000/Best_Practices_in_Urinary_Catheter_Care.5.aspx

[amoLucia]

NRSKaren - when you spoke 'Medical assistance programs will often pay for ... ' I'm thinking you mean MEDICAID and not Medicare? Through my Medicare and Medigap Insurance I've tried to seek out some help for my needs. NO GO!

Seems only MEDICAID offers a$$istance. There's even those current TV infocommercial advertisements that specifically quote MEDICAID-eligibles as qualifying for incont briefs.

TO OP - Don't mean to be a downer, but, you are right to be concerned about cost containment for home health care. So you're left with what the family will be able to provide and so then fancy do-dads like foley wipes will be considered luxuries and not necessities when soap & water is avail. Even gloves can be limited item.

If something is going to cost out-of-pocket, well, GOOD LUCK! With home health, one is guided by insurance approvals and cost. Sad.

[NRSKarenRN, BSN, RN]

I clarified Medical Assistance = Medicaid. Medicaid program/ Medicaid HMO's care provided part by state and federal government so chux, incontinent supplies/briefs may not be covered. Medicaid HMO's are usually capitated to specific DME companies--can change year to year depending on contract renewal.

You are correct that Medicare, many Medicare HMO's/Medicare Advantage, Commercial/Private and Medigap insurance providers do not cover these items at this time.

[amoLucia]

NRSKAREN - I figured that was your info intent. Sometimes it's very hard for recipients to differentiate the two payors. And freq, even some HC staff don't really recognize the difference. As a fairly new nurse fresh out of the hosp 1st job setting, it took me a while to switch gears. Eye-opening to say the least!

Sadly, pay't freq is what guides the pt's course of care. So to develop any protocols like OP wishes has to account for pay't right from the start.