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 or lateral to me "rank" wise) decided to suggest I get a witness after they discovered I started a foley alone, then later decided to inform me it is policy after I explained to them I rely on my judgment to decide when it is necessary.
Policy can't be argued, not looking for an angle there. Not looking for a lecture as to why it is a good idea to have one. I get it, and trust me I get a witness more times than not. I do have a gripe requiring it to happen every single time for various reasons.
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.
My facility requires that 2 RNs be in the room for a foley insertion- the gender of the nurses or the patient doesn't matter.
I think that's a good policy. It's good to have the help anyway. I don't think I've ever started a Foley on a female without someone in the room. Not sure if it was required, I just needed the assistant.
I think that's a good policy. It's good to have the help anyway. I don't think I've ever started a Foley on a female without someone in the room. Not sure if it was required, I just needed the assistant.
With a large number of older and/or obese female patients, it's nice just to have someone there to hold a leg or shine a flashlight. So I can see the logic of requiring two staff memebers when inserting a cath on a female patient. The posters who talk about necessitating both staff be RNs, well that just shows who among us work in acute care and who work in LTC.
I do not think, however, that there should be two staff just for the reason of sexual abuse allegation. I do not seek out a female witness for protection whenever I provide personal crate to a woman. As a society I think we have moved beyond that.
Policies usually come from bad experiences. So I'm sure there has been accusations from confused little old ladies that have to be taken seriously, and to prevent the headache, a witness to say hey, yup I was in the room. Is usually all that takes for it to disappear!
None of the above tasks require penetration. Invasion is a different level all together. Some female patients are fine with me conducting physical assessments, toileting, and patches/dressings. Some request a female nurse for all the aforementioned.
It always ends with the patient's comfort level. You just have to rely on good bedside judgement and trust people on some level. Covering your buttocks, when appropriate, is just being career mindful.
I'm not really clear why it would help to have a witness only during foley insertion. If the purpose of the witness is to provide for a way to dispute claims made by the patient of something that didn't occur, what's to stop them from making false accusation about any other time you went into the room?
Specializes in OR, Nursing Professional Development.
I'm not really clear why it would help to have a witness only during foley insertion. If the purpose of the witness is to provide for a way to dispute claims made by the patient of something that didn't occur, what's to stop them from making false accusation about any other time you went into the room?
In my facility, it's not about claims but about infection and having a second set of eyes for sterile technique.
I'm not really clear why it would help to have a witness only during foley insertion. If the purpose of the witness is to provide for a way to dispute claims made by the patient of something that didn't occur, what's to stop them from making false accusation about any other time you went into the room?
Door and curtain open most times I am in a room, unless I am exposing something that does not need to be shared.
Wesley Donovan
2 Posts
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