Revised Skill Checklist Inserting a Foley Catheter PDF

Preview

Summary

Notes...

Description

Florida SouthWestern State College NUR 1214L Health to Illness Practicum

Inserting a Foley Catheter Skills Checklist Name: _______________________________ Date: _______________ Proficient (Total Points=100) Preliminary Activities

Objectives Not Met (Total Points=0)

Total Points = 24

Pts

Total Points= 16

Pts

Total Points=0

Pts

Checked physician’s order

3

Checked physician’s order with prompting

2

Did not check for physician order

0

3

Gathered equipment and supplies with difficulty/prompting

Gathered equipment and supplies

2

Did not gather all necessary equipment and supplies

3

Introduced self with prompting

2

Did not introduce self

0

Verified client identity x2

3

Verified client identity x1

2

Did not verify client identity

0

Completed Hand Hygiene

3

Hand Hygiene after touching patient

2

No hand hygiene

Provided for privacy with prompting

2

Assessed pain level with difficulty or required prompting

2

Explained procedure to patient/client with difficulty

2

Assessed pain level

Explained procedure to patient/client Total Points=16 Adjusted bed to working height. Applied clean gloves.

Assisted client as needed to perform routine perineal care to cleanse the meatus from gross contamination

3

3

3

Pts

Total Points= 10

Points Earned

0

Introduced self

Provided for privacy

Prior to Procedure

Needs Improvement (Total Points = 62 )

0

Pts

Did not provide privacy

Did not assess pain level Did not explain procedure to patient/client Total Points= 0

0

0

0 Pts

2

Adjusted bed, but not to appropriate height

1

Did not adjust bed to working height

0

3

Applied clean gloves with prompting

2

Did not apply clean gloves

0

3

Assisted client as needed to perform routine perineal care to cleanse the meatus from gross contamination with difficulty or prompting

2

Did not client as needed to perform routine perineal care to cleanse the meatus from gross contamination

0

Points Earned

1 Revised 4/13/19

Florida SouthWestern State College NUR 1214L Health to Illness Practicum

Inserting a Foley Catheter Skills Checklist Name: _______________________________ Date: _______________ Removed gloves and performed hand hygiene Placed client in appropriate position and draped all areas except perineum. Female: supine with knees flexed, feet about 2 feet apart, and hips slightly externally rotated. Male: supine, thighs slightly abducted or apart Established adequate lighting Procedure

Total Points = 54

Stood on client’s right if nurse was right-handed and on left if nurse was left-handed. If agency policy permitted, applied clean gloves and injected 1015 mL Xylocaine gel or water-soluble lubricant into the urethra of the male client. Wiped the underside of penile shaft to distribute the gel up the urethra. Waited at least 5 minutes for the gel to take effect before inserting the catheter. Removed and discarded gloves. Performed hand hygiene

3

Removed gloves and performed hand hygiene with prompting

3

Placed client in appropriate position and draped all areas except perineum with difficulty or prompting

2

Did not place client in appropriate position and drape all areas except perineum

Established adequate lighting with prompting

1

Did not establish adequate lighting

2 Pts

2

3

Total Points= 32

Stood on client’s right if nurse was right-handed and on left if nurse was lefthanded with prompting

Injected xylocaine gel or water-soluble lubricant into the urethra of the male client with difficulty or prompting.

2

Did not remove gloves or did not perform hand hygiene

0

0

0

Pts

1

2

Total Points= 0

Pts

Did not stand on client’s right if nurse was righthanded and on left if nurse was left-handed.

0

Did not appropriately inject xylocaine gel or water-soluble lubricant into the urethra of the male client. Did not remove and discard gloves or perform hand hygiene.

0

Points Earned

2 Revised 4/13/19

Florida SouthWestern State College NUR 1214L Health to Illness Practicum

Inserting a Foley Catheter Skills Checklist Name: _______________________________ Date: _______________ Opened the catheterization kit. Placed a waterproof drape under the buttocks (female) or penis (male) without contaminating the center of the drape.

Applied sterile gloves.

Organized the remaining supplies on sterile field: a. Saturated cleansing balls with antiseptic solution. b. Opened lubricant package. c. Removed specimen container and placed it nearby with lid loosely on top. d. Attached the prefilled syringe to the indwelling catheter inflation hub e. Lubricated the catheter 2.5 to 5 cm (1 to 2 in.) for females, 15 to 17.5 cm (6 to 7 in.) for males and placed it with the drainage end inside the collection container

3

Opened the catheterization kit. Placed a waterproof drape under the buttocks (female) or penis (male) without contaminating the center of the drape with difficulty or prompting.

5

Applied sterile gloves with difficulty

4

Organized the remaining supplies on sterile field with difficulty.

2

Inappropriately opened the catheterization kit breaking the sterile field.

0

3

Broke sterile field while applying the sterile gloves (without acknowledging it and correctly applying another pair)

0

Incorrectly organized the remaining supplies on sterile field, breaking sterility.

0

2

3 Revised 4/13/19

Florida SouthWestern State College NUR 1214L Health to Illness Practicum

Inserting a Foley Catheter Skills Checklist Name: _______________________________ Date: _______________ Cleansed the meatus. a. For women: Spread the labia with nondominant hand to visualize meatus. Did not allow the labia to close over cleaned meatus. Cleansed in anteroposterior direction using one cleansing ball for each wipe downward. Cleansed from lateral to center with last wipe over the meatus. b. For men: Grasped penis just below glans with nondominant hand. Retracted foreskin if necessary. Cleansed in circular motion from meatus around glans to the base. Used a new ball each time for three more wipes. Inserted the catheter. a. Grasped catheter firmly 5 to 7.5 cm (2 to 3 in.) from tip. Asked client to take a slow deep breath and inserted catheter as client exhaled. b. If catheter became contaminated by touching labia on the female, foreskin on the male, or any other body part before entering the meatus, performed catheterization with a new sterile catheter. c. Advanced catheter 5 cm (2 in.) farther after

4

7

Cleansed the meatus with difficulty

Inserted the catheter with difficulty

2

4

Incorrectly cleansed the meatus

0

Incorrectly inserted the catheter and/or broke sterility while inserting the catheter without replacing catheter.

0

4 Revised 4/13/19

Florida SouthWestern State College NUR 1214L Health to Illness Practicum

Inserting a Foley Catheter Skills Checklist Name: _______________________________ Date: _______________ urine begins to flow through it.

Held catheter with nondominant hand. For an indwelling catheter, inflated retention balloon with designated volume: a. Without releasing catheter, held inflation valve between two fingers of nondominant hand while attaching syringe and inflating with dominant hand. b. Pulled gently on catheter until resistance was felt. Collected a urine specimen if needed.

Examined and measured urine. Check agency policy for further instructions if more than 750 mL - 1,000 mL of urine drained from the bladder at one time.

a. Secured indwelling catheter leaving enough slack for usual movement to client’s thigh.

2

Did not hold catheter with nondominant hand.

0

0

3

Inflated retention balloon with designated volume with difficulty

2

Incorrectly inflated retention balloon with designated volume or did not inflate balloon.

3

Collected a urine specimen with difficulty or prompting.

2

Did not collect a urine specimen when needed.

0

2

Did not examine and measured urine or did not check agency policy for further instructions if more than 750 mL - 1,000 mL of urine drained from the bladder at one time.

0

2

Inappropriately secured indwelling catheter.

0

3

3

Examined and measured urine with difficulty or prompting.

Secured indwelling catheter with difficulty or prompting

5 Revised 4/13/19

Florida SouthWestern State College NUR 1214L Health to Illness Practicum

Inserting a Foley Catheter Skills Checklist Name: _______________________________ Date: _______________ b. Secured collecting tubing to bed linens and hung bag below bladder level Wiped the perineal area of any remaining antiseptic or lubricant. Replaced foreskin if retracted earlier.

Returned client to comfortable position. Instructed client on positioning and moving with catheter in place.

Discarded all used supplies in appropriate receptacles.

Removed and discarded gloves. Performed hand hygiene

Other Considerati ons

3

3

3

3

Total Points = 6

Pts

Documented procedure, including catheter size and results in client’s record

3

Communicated appropriately with patient/client

3

Wiped the perineal area of any remaining antiseptic or lubricant, replaced foreskin if retracted earlier with difficulty or prompting Returned client to comfortable position and instructed client on positioning and moving with catheter in place with difficulty or prompting. Discarded all used supplies in appropriate receptacles with prompting. Removed and discarded gloves. Performed hand hygiene with prompting.

Total Points = 4

Documentation was not clear, but included all necessary elements. Communicated appropriately with prompting

2

2

Did not wipe the perineal area of any remaining antiseptic or lubricant. Did not replace foreskin if retracted earlier.

Did not return client to comfortable position and/or instruct client on positioning and moving with catheter in place.

0

0

2

Did not discard all used supplies in appropriate receptacles.

0

2

Did not remove discarded gloves and/or did not perform hand hygiene.

0

Pts

Total Points =0

Pts

Documentation was not clear or complete, many errors were present

0

2

2

Did not communicate appropriately (see comments)

Points Earned

0

6 Revised 4/13/19

Florida SouthWestern State College NUR 1214L Health to Illness Practicum

Inserting a Foley Catheter Skills Checklist Name: _______________________________ Date: _______________

Instructor Signature: _____________________

TOTAL POINTS = _______

Documentation: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

COMMENTS: _____________________________________________________________________________________________ _____________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________________________

7 Revised 4/13/19...