Nurse Driven Foley Removal Protocol

Purpose:
Purpose: This evidence based nurse driven protocol was developed to decrease the incidence of Hospital Acquired Urinary Tract Infections (HAUTI) at Bayhealth Medical Center.

Significance:
Hospital acquired urinary tract infections translated into poor patient outcomes, prolonged hospital days and non-reimbursable healthcare costs. Evidence supports the development of a nurse driven foley removal protocol to decrease hospital acquired urinary tract infections.

Strategy and Implementation:
A literature review of current evidence was completed utilizing websites such as; Joanna Briggs Institute for Best Practice, Centers for Disease Control and Prevention, and Peer Reviewed Journals dated from 2000 to 2008. The protocol will be implemented in all acute care areas of a 354 multi-campus community hospital. The protocol consists of two parts; the checklist and the foley removal flow diagram. The protocol guides the bedside nurse's decision making process. Nurses evaluate the need to remove a foley catheter by using the checklist. Nurses refer to the flow diagram to guide them to take appropriate actions to care for the patient without a foley catheter. Re-education of the nursing staff on appropriate indications for a foley catheter and infection control measures to prevent foley related UTI's when a foley catheter is indicated. This education was completed with on line education and post testing. Unit champions were also trained and utilized.

Evaluation:
Data from all in-patient care areas (Catheter utilization rate= indwelling catheter days/patient days) and lab reports of positive urinalysis screen is obtained by Infection Control. December 1, 2008 to June 1, 2009 we have had a 60% reduction in HAUTI's and significant reduction in foley days.

Implications for Practice:
Nurses utilizing a nurse driven foley removal protocol decreases Hospital Acquired UTI's. Patients do not experience an extended LOS and cost containment for non-reimbursible events is met.