Foley Phobia??

[MQ Edna]

I'm really starting to wonder if some nurses have "foley phobia". I'm finding more and more patients coming into the unit I work (ICU) soaked in urine d/t incontinence after being in ER, post-op etc. I've also had patients come to our unit after being on other non-ICU floors for days, incontinent, with saturated depends/incontinent pads and sheets/gown wet with urine. Last week I had a new-admit floor patient thank me for putting in a foley because they were sick of laying in urine all the time.

Worse than that, recently a relative of mine was hospitalized for end stage COPD, with a history of several falls, and bouts of dementia/confusion. She was being diuresed and when I visited her she had on a leaking depends and sheets wet up to the shoulders. She fell and broke her hip while trying to use a bedside commode without nurse assistance. If that wasn't bad enough, while in traction for the fracture she was still in a depends and had to endure the pain of having brief and bedding changed several times a day until I questioned the doctor about putting in a foley, which he ordered to be done.

Maybe I just don't get it?? I consider a foley a nurses "friend" for incontinent patients. Now, I know that a foley is an infection risk, but what about lying in a wet brief for several hours, and skin breakdown risks etc. In ICU we have standing orders for foley placement per nurse's discretion. Maybe this is different on other floors of the hospital. Do you have to get an order for a foley? Do doctor's discourage it . . .I just don't get it!

[TazziRN, RN]

Yes, we need an order for a foley, but in my ER if we put one in, the docs will cover us later. Speaking as an ER nurse, if a pt is sick enough to be admitted to ICU, it's not uncommon that a foley just isn't thought of unless the problem is CHF or something else where output would be a concern. Not saying that we don't care or don't want to do it, but it may not be high on the priority list if there's other things we need to worry about.

Also, if the pt is alert and oriented and doesn't say anything, we oftentimes assume the pt doesn't have to go.

Not excuses, just explanations.

[wooh, BSN, RN]

Yep, have to get an order, and doctors discourage it. (sarcasm on) Because of course the floor nurses have unlimited time to change incontinent patients (end sarcasm) and (jaded attitude on) doctors are more worried about infection with the foley they ordered, than they are about skin breakdown that can be blamed on nursing (end jaded attitude).

[Katnip, RN]

A lot of facilities are trying to reduce the uses of Foleys because of infection issues. Yes, I realize incontinence causes greater risk of skin breakdown, but then I don't make policy.

In our ER it used to be we could just place Foley's at nurse's discretion then the docs would back it up but it changed because a few of the docs didn't like Foley's at all. We did learn who would back you when you placed it and who wouldn't allow them at all without what they considered to be a good reason.

[RGN1]

Here in the UK they are also phasing out the "mis-use" of foley catheters. They think it's better to have to change wet patients countless times & use inco pads (of course we have ALL the hours in the world!!) but then again it's not them who have to deal with it!!

With the relationship between being wet & pressure sores I just don't get it! Especially in end of life care!

[Noryn]

Accrediting agencies and doctors are discouraging routine use of indwellings because the risk of infection is so high. Even the CDC has statements on the use of indwelling catheters and incontinence is not a reason. It may be hitting hospitals now but this started in nursing homes a few years back.

I have worked in the trenches and I do know how much time it can take when pts are almost constantly incontinent but I also saw quite a few patients have VRE and MRSA in their urine which required IV antibiotics. I also understand the risks of incontinence in regards to breakdown but at this point it seems the risks of an indwelling catheter for incontinence outweigh the benefits.

I think a major factor is accountability. If a patient does develop a horrible UTI, the doctor and hospital better have a good reason why that catheter was placed. It is sad though that with the cost of healthcare patients have to lie hours in a soaked bed but that is the reality.

[ortess1971]

At my hospital, you need an order from a doctor. I think the fear of infection is somewhat valid and I've also seen elderly or bedridden men that actually had the skin around the meatus worn away from foleys that had been in long term. One of the general surgeons in my OR won't let just anyone catheterize pts. because not everyone uses proper sterile technique, she will often just do it herself unless she trusts you. I myself have no fear of foleys unless it's a large female, LOL.

[XB9S, BSN, MSN, EdD, RN, APN]

Here in the UK they are also phasing out the "mis-use" of foley catheters. They think it's better to have to change wet patients countless times & use inco pads (of course we have ALL the hours in the world!!) but then again it's not them who have to deal with it!!

With the relationship between being wet & pressure sores I just don't get it! Especially in end of life care!

But in the UK it is still a nursing decision to catheterise a patient - I would never ask the permission of a doctor to catheterise my patients I would assess the need and go ahead if I felt it was justified as would most of the nurses I know. Yes there is an increased risk of infection but both continence and pressure area care is also a priority within the essence of care isn't it????? Where I work we also have access to continence nurses who are a great source of advice and help with these issues.

[NYCRN16]

I dont know about the UK, but in the US you DO need an order. That is standard no matter where you work. Most of us in ER have standing orders that we can put a foley into anyone we feel needs it. The only thing is, some patients should not get a foley such as patients with cancer or HIV who are suseptible to infection, or if they have had very recent prostate/bladder surgery. In that case they either do not get a foley, or they get one placed by urology.

[nuangel1, BSN, RN]

i agree with imagine in or ed we can place a foley at our descretion getting a md order usually our ed drs agree with th decision but in the above cases i would question md 1st ? need for urolgy.

[neneRN, BSN, RN]

In our ER, the nurse is the one who decides if a pt needs a foley, and just goes ahead and puts it in; rarely do you see an ER doc write an order for one- they just assume we'll do it if its needed...BUT, technically speaking, we are not supposed to be doing it without a doctor's order, so I'm sure there are nurses who don't put them in unless an order is written.

Gotta say though, I don't think I've ever sent a pt to ICU without a foley; if they're sick enough to go to the unit, then they're sick enough for a foley.

[leslie :-D]

Gotta say though, I don't think I've ever sent a pt to ICU without a foley; if they're sick enough to go to the unit, then they're sick enough for a foley.

these are my sentiments also.

leslie