Partnering to Reduce Unnecessary Foley Catheter Use

By Erin Macsay, DNP, APRN-CNS, ACCNS-AG

Appropriate urinary catheter use remains one of the most effective strategies for preventing catheter-associated urinary tract infections (CAUTIs) and improving patient outcomes. Providers play a critical role in ensuring Foley catheters are used only when clinically indicated and removed as soon as they are no longer needed.

In August, the System Medical Executive Committee approved updates to the Nurse-Driven Foley Removal Protocol. The revised protocol includes a new appendix outlining the appropriate use of external urinary collection devices, including indications, contraindications, and maintenance considerations. It also expands the bladder scan and intermittent straight-catheterization pathway to support patients experiencing urinary retention, regardless of whether they previously had an indwelling urinary catheter removed.

Appropriate Indications for Foley Catheter Use

As a reminder, Foley catheters should remain in place only when one of the following indications exists:

A provider has documented a specific clinical reason for continued use.

The catheter was placed by, or management is directed by, Urology, Gynecologic Oncology, Urogynecology or Oncology, and the care plan supports continued catheterization.

Hourly urine output monitoring is required.

The patient is experiencing acute urinary retention.

Catheterization is needed to promote healing of select pressure injuries, wounds or surgical incisions.

Importantly, accurate intake and output monitoring alone is not an indication for Foley catheter placement. Depending on a patient's clinical condition and functional status, urine output can often be measured effectively using less invasive options such as urinals, bedpans, collection hats, commodes, assisted toileting, or external urinary collection devices.

A Daily Opportunity to Improve Care

During daily rounds, consider asking a simple question:

"Does this patient still need a Foley catheter today?"

Timely removal of unnecessary catheters and consideration of appropriate alternatives can reduce catheter-associated complications, improve patient comfort and mobility, and strengthen our CAUTI prevention efforts.

Working together to minimize unnecessary catheter days helps us provide safer, higher-quality care for our patients.

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