<<QUOTE
Examples of clinical conditions demonstrating that catheterization may be unavoidable include:
1 Urinary retention that:
(a) Is causing persistent overflow incontinence, symptomatic infections, and/or renal dysfunction;
(b) Cannot be corrected surgically; or
(c) Cannot be managed practically with intermittent catheter use.
2 Skin wounds, pressure sores, or irritations that are being contaminated by urine;
3 Terminal illness or severe impairment, which makes bed and clothing changes uncomfortable or disruptive (i.e., as in the case of intractable pain).
>>END QUOTE
This is what the surveyors are instructed by the Guidance to Surveyors to look at:
<<QUOTE
" Was the resident continent upon admission?
" If continent at admission, was the resident identified as having risk factors of incontinence (e.g., frequency of urination, with limited mobility)?
" What care did the resident receive to promote maintenance of continence?
" Did the facility attempt to manage the incontinence and increase bladder function without the use of an indwelling catheter (e.g., a bladder training program, prompted voiding schedule, external catheter)?
" Identify if resident triggers RAPs for urinary incontinence, ADL functional/rehabilitation potential, and cognitive loss/dementia and the RAPs were used to assess causal factors for decline, potential for decline or lack of improvement.
" If the resident has an indwelling catheter:
o Is the staff following the facility's protocol and/or written procedures for catheterization?
o Do all personnel wash their hands before and after caring for the catheter/tubing/collecting bag?
o Does the facility assess for continued need for use of the catheter, as appropriate, utilizing the evaluative data as described and implemented in the care plan?
>>END QUOTE
The RAPs provide an excellent assessment tool for dealing with incontinence and indwelling catheters.
Rena
Rena R. Shephard, MHA, RN, FACDONA, RAC-C
Chair, American Association of Nurse Assessment Coordinators
[EMAIL PROTECTED]
Subj: Foleys
Date: 1/20/04 6:20:15 AM Pacific Standard Time
From: [EMAIL PROTECTED]
Reply-to: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the Internet
I need clarification on what constitutes a legitimate use of a foley cath.
So many of our new admits come with foleys from the hospitalâthe first thing I want to do is get rid of the foley (unless they have Stage 3s or 4 etc - page C-37) and then evaluate to see if they have the ability to be continent. I am getting resistance from the nurses (especially one nurse that believes she knows more about the MDS process than I do â thatâs another subject I wonât get into here)
Currently we have a resident (300 pounds) admitted for pain management (back pain) with history of chronic renal insufficiency and IBS â has several thick liquid stools a day (occasionally incontinent probably related to inability to toilet quick enough) with small areas of excoriation on bottom. UTI developed after admission. Nurses are saying chronic renal insufficiency is enough to justify a foleyââââ..any comments?
Should the RAPS be the area I try and explain the reason for the use of a foley?
