IP and Quality Foley rounding report
Learning from frontline staff
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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Providence St Peter Hospital
Oncology 3rd
Med Renal 4th
Med Tele 5th
IMCU 11th
PCU 10th
Neuro Trauma CCU1
Cardiac CCU1
Ortho 6th
Surgical 7th
COU
Emergency Dept
Pediatric 8th
Neuro 9th
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How long has the foley been in place
Uncertain
less than 24 hours
three days or less
longer than 72 hours
Prior to admit
Chronic with replacement
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What is the indication for the Foley Catheter?
Please Select
Urinary Retention
Surgery
Incontinence
Strict I&Os
Emergent/deterioration
Nephrology following
Pain mgmt /mobility
Comfort Care/End of LIfe
Other
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Have you discussed the Foley catheter with anyone today?
Please Select
YES
NO
MD
CNA
Patient
Charge RN
Beginning RN Shift report
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What are the current BARRIERS to removing foley today?
Moisture, skin breakdown
Strict I&Os related to decision making
Mobility issues
Chronic placement
Urinary retention this admission. Attempted straight cath already
Removed today
Surgery
Comfort Care/End of Life
Max assist
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Additional comments about Foley Catheters to help in our CAUTI prevention work?
Please Select
Yes
No
morning rounding preferred
afternoon rounding preferred
Why are you asking, you can check EPIC
Other
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Free texted additional comments for CAUTI work:
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