WHATS NEW UCAT UCAT REVIEW What is UCAT

WHAT’S NEW, UCAT?

UCAT REVIEW What is UCAT? Urinary Catheter Assessment Tool RN Assessment 1) Initial UCAT assessment - upon indwelling catheter insertion/order 2) Daily UCAT assessment (required by PA ACT 52 for patients with indwelling catheters) 3) Components: Mental status. Alert & oriented (0) Able to follow commands (0) Responds to verbal stimuli (1) Unable to follow commands (1) Unresponsive (2) Mobility. Mobile (0) Needs assistance (1) Immobile (2) Skin Assessment – No breakdown (0) Stage I or II Pressure ulcer - on sacrum or back (1) *Stage III or IV Pressure ulcer - on sacrum or back (2)

Nurse Driven Protocol • Not New • When physician orders an indwelling urinary catheter, an order to follow/not follow the Nurse Driven Protocol is also REQUIRED • Nurse Driven Protocol (NDP)? • Empowers the RN to remove Foley based on UCAT score of 0 – 2 and no “Indications” present Indications: clinical situations where Foley removal may not be appropriate • NO separate order is needed to remove a Foley when there is an order for Nurse Driven Protocol , the patient scores 0 -2, and there are no “Indications” present – so TAKE IT OUT!

Nurse Driven Protocol Highlight… If the Indwelling Urinary Catheter is removed and the patient has difficulty voiding, assess the patient’s bladder using the bladder scanner. Contact the physician if the bladder urine volume is greater than 300 cc or if the patient has not voided in 8 hours.

Scoring UCAT • Add total score: ______ (Score ranges from 0 – 6) • Document • RN Actions (if NDP ordered) Score 0, 1, or 2 – Remove Foley (unless Indication present) Score 3 or 4 – Consider alternatives (condom catheter, straight cath) Collaborate with physician; obtain order to remove Foley & begin alternate strategy Score: 5 or 6 – Maintain catheter; complete RN portion of Daily Device Order Form

Indications* for Maintaining Indwelling Urinary Catheters * Formerly known as “Exceptions” • OR in 24 hours; check with surgeon • Aggressive diuresis/strict I & O (ONLY if unresponsive, history of urinary retention, or unable to void in urinal/specimen hat) • Urology/Nephrology requirement • Uncleared spine or pelvic injury • Unresponsive, sedated, or intubated • Persistent urinary retention (ONLY if failed voiding trial) • Epidural; check with physician

New Documentation Screens Coming

Implementation • The changes to the Nurse Driven Protocol will be announced later this month when the UCAT policy is revised. • Look for the policy release memo.

VOIDING TRIAL Physician Order Needed The information included below is an example of a Voiding Trial. Individual practitioners may order their own Voiding Trial parameters. A physician order for Voiding Trial may read something like this example: • For symptoms of Urinary Retention, use a bladder scanner to assess residual bladder volume after an attempted void. • If post void residual volume (PVR) > 300 m. L, perform straight cath. • Repeat assessment of bladder volume after an attempted void every 8 hours as necessary. • If urinary retention (as defined by PVR > 300 m. L) persists after 3 straight caths, insert a Foley catheter. • Consult with physician - who may consider the addition of an alpha blocker if clinically appropriate. • After 48 hours, remove the Foley catheter and repeat voiding trial as described above. • If urinary retention persists (as defined by a PVR > 300 m. L) after a second voiding trial, reinsert urinary catheter. • Consult with physician – who may consider a Urology consult.

Remember If your patient’s UCAT score is 0 -2, and you have an order to follow the Nurse Driven Protocol, and there are no “Indications” present – what do you need to do? TAKE the FOLEY OUT!

General Reminders for Preventing CAUTI Use sterile technique when inserting an indwelling catheter WASH YOUR HANDS Use a securement device

General Reminders for Preventing CAUTI Specimen Collection Reminder… Use sterile technique and obtain the specimen from the catheter port. The drainage bag of the indwelling catheter should: • ALWAYS be below the level of the patient’s bladder. • NEVER touch the floor or be on the bed with the patient. Use the sheet clip to secure the tubing to prevent kinking and dependent looping. Cleanse the spigot with alcohol before and after empting the drainage bag.

Additional education for preventing UTIs can be found on Tracker Trainer. Please look for the program called: Preventing UTI: Review of Patient Care Requirements

The last word… Take Test to acknowledge your completion of this program.