InfxPrev

@dawdlingsquid the other, less descriptive term for the bacterial matrix/slime that forms on Foleys is biofilm--in particular there is crystalline biofilm. Do a search on that stuff and you will never want to put a Foley in anyone again! I started working at my present hospital 8 months ago, and you are sooo right--I had to mount an intense blitz to the ED physicians and RNs---they were passing out Foleys on elderly women with unfortunate predictability. Even when a straight cath for a specimen was ordered, they'd pop a Foley in whether or not she was going to be admitted and whether or not the thing was even indicated. Oddly enough, this was not done near as often to elderly men who often do have some retention issues. Elderly women tend to be the opposite--incontinence issues which was the actual reason their Foleys were being placed. It stopped when I clarified that per policy the only actual accepted reasons to place a Foley in our ED was retention/obstruction or pelvic trauma and that any other reason would be individually addressed by the ED doctor and admitting hospitalist. Also that under no circumstances ever is an RN to place a Foley without an order--if you get a verbal order in the heat of an emergency, it is both the physicians' and the nurses' responsibility to get that order entered/documented before the end of the shift. (We had two CAUTIs at that time, both had no physician's order nor even an indication both were even needed). We also use condom caths for males who cannot use urinals and are incontinent (its an art form to attach them but they do work) and a device called Purewick for women. Both protect the patient's skin and avoid bed changes which is pretty much the number one reason staff was so intent on placing the Foleys. There was additional education needed for ED to Inpatient admissions for both doctors and nurses that unless the admitting hospitalist wrote orders for a Foley, any of those things that were placed in the ED needed to come out before transfer to inpatient beds---if a nurse was in doubt, ask to clarify and get an order if you and the doctor feel the thing really is needed). We instituted 24 hour checks by Inpatient units noc shift to catch Foleys present without orders or indications in inpatients and we do daily huddle/rounding where we discuss each inpatient, check if they have a Foley and as the hospitalist is present, ask if the thing can be DC'd and replaced, if even needed, by a noninvasive device or strategy. We place Foleys only when absolutely needed, write a review daily if they are still needed and get rid of the things as fast as possible when they aren't. Our use of Foleys has dropped by two thirds. When placed we do Foley care, documented, at least once a shift---Foley care is a competency now for C.N.A.s and RNs. RNs have the additional competency for insertion and indications for Foleys, and placement of condom caths and the Purewick.

Nope, you are not a "crusty old bat"---give hubby a box of crayons for your anniversary and then tell him its hilarious. Actually, maybe not a good idea!

Placing a Foley for retention/obstruction is addressed in the sentence before your bolded quote, "Placing a Foley in the first place when there are no indications warranting that invasive procedure,". Obstruction/retention is a universal reason for placing a Foley. ...as to no contraindications of placing Foleys in someone who has a UTI , you are mistaken, it is not best practice. I am an Infection Preventionist/Epidemiologist, CIC. When the bladder is not its usual sterile self, bacterial slime forms on areas of the urinary catheter (such as the tip where the os is located) and because of this protective matrix many individual organisms may not be affected by antibiotics or only partially so and become resistant. Patient is treated, then returns with a worse infection that may or may not respond as well to antimicrobial treatment. If a Foley has to be inserted into a patient with a UTI, it should be done just as you would for any other time you insert one of these things--for good reason and get it out as soon as you can (before the end of the antimicrobial treatment if at all possible) because removing the catheter can loosen up the matrix and turn organisms loose in the bladder again. (And infection potential aside, from a general comfort standpoint as you said, the urethra tends to be irritated anyways with a UTI, the presence of a Foley doesn't help unless its absolutely needed.

Consider this: hospice RNs. I am serious, here. I did this about midway through my career--was looking for "something" but wasn't seeing it in the usual acute hospital rush. First thing that a hospice RN does when onboarding a new patient is a detailed physical exam and a review of all medications--to see if there are conflicting meds, duplicated medications or meds that could be delivered in a better way (inhaler vs nebulizer is an example). Then there is education about the patient's condition based on the exam, home nutrition, management of symptoms. I found back then that unless the patient had an invasive cancer AND the referring physician waited till the last minute to tell them "sorry, can't help you anymore, here is hospice's card--call them" I could make such an enormous difference in the patient's life that easily 20-25% of them "graduated" from hospice and we were no longer needed because they became healthier--sometimes for months, sometimes for years before their chronic conditions started impairing their lives again. This wasn't just me, across the board hospice care nationwide has the same percentages. How was this accomplished when a physician had deemed them with less than 6 months to live? Because hospice RNs take the time to do the the things that needed to be done--med reconciliation, diets specific to conditions, pain management (not just opiates or NSAIDs but taking in the whole picture and the interactions of body/mind and spirit) exercise (yes exercise for those patients who would benefit and/or wanted to do that) education of the caregivers and families--all of these things are aimed not only to ease suffering like most people think, but to give BACK to the patient their lives and allow them to live fully for the time that they have. You are in a rut now--stuck on the hamster wheel of acute care hospitals that give you so many patients, so little time to take with your patients. You can do for your patients NOW what hospice RNs do at end of life. You have to somehow find that time--it will be hard at first but remember that there are others on your team who would likely faint dead away in delight if you asked for their help if you found concerns (dietitians and pharmacists are cute that way). The attending physician is a great resource though often they are rushed too. Physical therapy, respiratory therapy, occ therapy, case managers, all have specific areas they are experts on (again, big picture of the patient and how all systems interact). You are starting up in your career as a nurse, utilize the rest of your team--learn from them so the next time you see similar in another patient, you will recognize something that they or you might be able to help. Go to your interdisciplinary meetings or team rounds! The whole idea of a hospital is to bring back health, not for patients to keep going in/out of our doors as seems to be the case nowadays. If you are in a hospital that you do not learn at least one new thing regularly about conditions, medications or therapies from physicians and other team members and you aren't making any headway getting involved with them---find a new hospital. They are out there, sometimes though you bounce a couple times till you find one. Acute care should be the drive to address conditions before they become chronic--otherwise what are we doing for our patients?

If you had a "huge problem with CAUTIs" and hired an outside Infection Prevention consultant who said the problem could be fixed with CUROs, it is no wonder he/she is no longer there. Far more likely cause is improper/nonsterile insertion of the Foley, leaving it in past when it is needed, placing a Foley in the first place when there are no indications warranting that invasive procedure, placing Foley's in patients with existing UTI (good way to give them a kidney infection/sepsis), improper or no Foley and peri-care or no Foley awareness (e.g. keep below the level of the patient), breaking the system routinely to irrigate, unnecessary Foley changes, unnecessary UAs (seriously!)--there are many reasons that there are unit problems with CAUTIs and they come down to misinformation, lack of evidence based practice policy and lack of adherence to that policy and accountability (and using those things way more than they should be).