Do you need a doctors order for this?

RNsRWe, ASN, RN · Jul 24, 2014

The answer is found in your facility's policy manual. You might, or you might not. But you need to look to your own facility to know what you can do there. You've heard both yes and no because it varies from place to place, and situation to situation.

I've seen it happen that a nurse removes a foley to change it, only to NOT be able to get it back in (prostate issues, etc). NOT a happy urologist who gets called in the wee hours to come in for that.

Just know what your workplace allows, AND what the hx of this patient is.

Silverdragon102, BSN · Jul 24, 2014

Depends on the policy of the facility.

caliotter3 · Jul 24, 2014

Also depends on the orders in place for a particular individual.

Karou · Jul 24, 2014

Agree with other posters that it depends on your facilities policy. Some LTC facilities have orders to replace foleys monthly or on a schedule. So maybe you have a policy on changing them on a PRN basis.

When in doubt, call the doctor. I second another poster that I would be worried that were you to take it out without an order, then be unable to replace it, you could be in a very sticky situation.

nurse4ever08 · Jul 24, 2014

If urology placed it yes. If nurse placed no, catheters must be changed every 30 days for infection control

Been there,done that, ASN, RN · Jul 24, 2014

The answer is found in your facility's policy manual. You might, or you might not. But you need to look to your own facility to know what you can do there. You've heard both yes and no because it varies from place to place, and situation to situation.
I've seen it happen that a nurse removes a foley to change it, only to NOT be able to get it back in (prostate issues, etc). NOT a happy urologist who gets called in the wee hours to come in for that.
Just know what your workplace allows, AND what the hx of this patient is.

Oh well, we can't go around having unhappy urologists. :rolleyes:

In the case of a Foley not draining, it is a medical emergency. Treat the problem not the doctor.

RNsRWe, ASN, RN · Jul 24, 2014

Oh well, we can't go around having unhappy urologists.
In the case of a Foley not draining, it is a medical emergency. Treat the problem not the doctor.

Obviously! I never suggested otherwise. But if a foley is in place that can only be replaced BY the urologist, it just might change how one approaches the situation.

The OP asked a policy question, so....given the response to check her policy.

Been there,done that, ASN, RN · Jul 24, 2014

Obviously! I never suggested otherwise. But if a foley is in place that can only be replaced BY the urologist, it just might change how one approaches the situation.
The OP asked a policy question, so....given the response to check her policy.

I hear what you are saying. In this case , there is no time no check policy. The patient's condition needs immediate action. Urology and policy be damned.

As professionals, we must make this kind of call every day.That is what makes us accountable in the nursing profession.

scottaprn · Jul 25, 2014

Yes you do need an order. The only question is do you have a standing order that you can implement in place by the policy of your facility or do you have to call and get an order.

Take the time to look over the facility policies where you work. Not knowing if you have an order and doing something, no matter how well intentioned, is fine and dandy right up to the point that something goes wrong and you have practiced outside of the legal scope and you get fired and reported to the board of nursing.

ChristineN, BSN, RN · Jul 25, 2014

I work in the hospital setting where we do have protocols about replacing the foley. That being said, there has been more emphasis on getting a physician's order. With hospital acquired UTI's being something we don't get reimbursement for from Medicare, it is good to have an order just so if something happens, pt gets a UTI, at least you are covered

tyvin, BSN, RN · Jul 25, 2014

I haven't met a foley I couldn't change except in one case. Older very thin man at a SNF with indwelling foley supposedly resting in his room; I was the charge and the RN came and told me she was going to change the guys foley per order...OK. Over 30 minutes later the RN comes strolling down the hall swinging the foley like a flag, complete with tubing which was filled with a beautiful shade of FRANK BLOOD!

As she yells down the hallway "I can't get it in him, I tried several times; it keeps rolling" ... OMG; I'm surrounded by morons! I exit stage left and as I stand at the bedside of the man I found him sweating profusely with an extended abd (looked about a good 5 months if you know what I mean) and when I looked straight into his eyes they told me with a desperate plea I swear I could hear; "pleeeeease help" (and keep that nurse away from me).

Without hesitation I called 911 stat.

One hour later I called the ER to check on him and the nurse giving me report was giving me razz about how the nurses at the SNF couldn't change a foley. Found out later from a friend in the ER that the nurses at the ER couldn't do it either, that a doc finally came in and showed the nurses how to put a coude catheter in him.

Of course we all know why the doc decided on a coude...When the, hmmm, RN was trying to put in the foley, she said it rolled. The rolling indicates prostrate concerns and the coude is a special foley that is specific for that due to it's stiff nature. After that incident the facility ordered coudes to keep in stock. I've never seen a doc change a foley. Not saying there is a case where only a doc can do it; but I live on a small island ... :roflmao:

FYI, I may have had only a few years of experience at the time this happened, but the RN who attempted to change the foley had 20 years in the field...I expected a little more from her.