Tips for getting SCIP measures completed on time. (Foleys)

MunoRN, RN · Jul 16, 2011

We were using an automatic pop-up in our EMR that pops 24 hours after Foley insertion, this pop-up would tell the the Nurse to put a sticker in the order section of the chart that gave the MD the options for continuing the Foley or that it would be D/C'd at 48 hours post-insertion. One problem was that the ICU, OR, and ED don't chart their foley insertions in the same EMR, and another problem was that if the MD's ignored the sticker then the Foley stayed in past 48 hours without an acceptable indication. We did add a rule that the OR,ED, and ICU need to put date stickers on the foley bags, although that's been pretty hit and miss.

So we switched to a system where all Foley orders expire at 48 hours unless re-ordered (except for foley orders written by a urologist), or unless they specify the approved indication at the time of the original order, which means even if the pop-up doesn't 'pop' because it wasn't charted or if the MD ignores the sticker then it still comes out.

Orange Tree · Jul 16, 2011

We just take them out fast. In most cases, they're taken out in PACU before a patient is even transferred to the floor.

IfnotnowWhen · Jul 16, 2011

We were using an automatic pop-up in our EMR that pops 24 hours after Foley insertion, this pop-up would tell the the Nurse to put a sticker in the order section of the chart that gave the MD the options for continuing the Foley or that it would be D/C'd at 48 hours post-insertion. One problem was that the ICU, OR, and ED don't chart their foley insertions in the same EMR, and another problem was that if the MD's ignored the sticker then the Foley stayed in past 48 hours without an acceptable indication. We did add a rule that the OR,ED, and ICU need to put date stickers on the foley bags, although that's been pretty hit and miss.
So we switched to a system where all Foley orders expire at 48 hours unless re-ordered (except for foley orders written by a urologist), or unless they specify the approved indication at the time of the original order, which means even if the pop-up doesn't 'pop' because it wasn't charted or if the MD ignores the sticker then it still comes out.

-----------Thanks Muno that is a great suggestion. It would definitely be a no-brainer if this came up in the EMAR, but I guess half the battle is getting these things charted and stickered at the source.

MunoRN, RN · Jul 16, 2011

Since the 48hr Foley duration is both a SCIP measure (JC) and a CMS rule for reimbursement that applies to all Foley's, not just those placed for surgery, I'm guessing you've combined the process for addressing both? If not, combining forces with whatever group is figuring out the CMS measures might help.

One thing that did work better was having CS put the date stickers on all the Foley insertion kits, urometers, and individual Foleys, although that didn't stop people from just throwing away the stickers, it did help, particularly with someone auditing the date stickers every day and tracking down whoever was responsible for a missing sticker.

We also implemented a Nurse initiated protocol for D/C'ing foleys so we weren't waiting on an MD order which also helped cut down on the number of Foley's close to 48 hours making it less likely that a small delay would push the time over 48 hours.

Reno1978, BSN, RN · Jul 16, 2011

We get a daily print out that shows which patients in our unit have a foley that need to be d/c'd by midnight that day, and the following day. There are order stickers that are placed in the MD orders that the MD either checks to DC the foley or selects a reason why it should stay (critically ill, immobile, whatever).

Reno1978, BSN, RN · Jul 16, 2011

We get a daily print out that shows which patients in our unit have a foley that need to be d/c'd by midnight that day, and the following day. There are order stickers that are placed in the MD orders that the MD either checks to DC the foley or selects a reason why it should stay (critically ill, immobile, whatever).

As an aside, I think this report is generated from the OR schedule, because sometimes there are patients without foleys that show up on the list.

Always_Learning, BSN, RN · Jul 16, 2011

Our surgical nurses mark directly on the Foley bag/collection chamber "remove by 01/01/01" with a sticker or permanent marker. That makes it pretty hard to miss when you're monitoring urine output or emptying it.

ckh23, BSN, RN · Jul 16, 2011

In our unit, as the charge nurse gets updates from all the nurses on patients, he/she also makes a list of patients with foleys and in restraints and then gives it to the residents for reordering.

I have also worked in a hospital that has standing orders for a foley to be d/c'd 24 hrs post op as long as urine output had been over 50ml/hr.

You can also replace foley's with texas caths for males.

Editorial Team / Admin · Jul 16, 2011

Our foley kits actually have a sheet of stickers in them that have spots for date/time inserted and the initials of the nurse inserting it. There are several of them, but we don't use them all. One is for the chart, one is for the tube itself. The ones we don't use have checkoff boxes for why (covered in the nurses notes, so duplicate documentation) or temperature records for the thermaster foleys (documented by anesthesia). I'd say 99.9% of the time, the nurses in my specialty get the sticker on the front of the chart- it's bright orange, so it can't be missed. More like 80% for the sticker getting on the tube itself, but it doesn't stick well and I'd bet by POD #1 it's already off the tube.

OC_An Khe · Jul 16, 2011

We are inserting fewer foleys to begin with as a result of SCIP. For those patients who have a foley, the order calling for its insertion also has a dc time added.

Haven't run into problems with the decreased use of foleys, other then some spinal anesthesia patients, if its a long case or patient received a lot of fluids then patient is straight cathed in OR.

Flo., BSN, RN · Jul 16, 2011

We have the Foley police which consists of a few RNs that monitor Foley's and central lines. They will hunt you and the MD down until that Foley comes out. That is their whole job.

I work ortho and we have standardized orders for joints that include dc'd Foley early am post op day 1. If you don't have standardized orders I highly recommend them. We have a few different sets depending on the surgeon.