PURPOSE: The purpose of this project was to identify current, actual foley practice in my facility; evaluate the findings and implement evidenced based practices; and finally, evaluate the implementation of the practice improvement.

METHODOLOGY: A data collection tool was utilized for evaluating 32 patients with foley catheters. The practices assessed included: unit inserting foley; orders written; complications; justified insertions; reasons for insertion and securement. The information was evaluated and measures were implemented and reevaluated after implementation. Measures implemented were silver catheters, catheter securement, and staff education. A second assessment of practice was done after the above were implemented for approximately 8 months.

RESULTS: Initial evaluation showed: 24 justified insertions and 8 unjustified; 5 secured catheters and 26 not secured; no complications; the ER had the highest rate of unjustified insertions (5) orders were written vaguely; and catheters were not changed prior to the collection of specimens when they came in from another facility. Post implementation showed a 75% improvement rate in unjustified insertions; ER still had the unjustified insertions; 50% of patients had catheters secured compared to 15% previously; the number of patients with any unjustified foley days decreased by 60%. Orders were not written on 25% of the catheters despite 75% being justified. Most significant was that our facility CAUTI days dropped from 12 to just over 2 after implementation of the changes in practice and products.

CONCLUSION: Practice improved at my facility but staff still needs more education. The introduction of silver catheters likely improved the CAUTI rate. Foley practices should be monitored on periodic basis to improve evidence based practice.

References: Gray, M, JWOCN Vol.31, Number 1, pg 10-11.