Urinary Catheter Orders Policy

Urinary Catheter Orders Policy

Effective Date: [Original NPP Date]
Revised Date: [Current Date]

Resident Information

Diagnosis requiring urinary catheter: ________________________________________________

Catheter Specifications

Catheter size:
____ #________________ Fr with ____ cc balloon to straight drainage and/or leg bag as indicated.

Catheter type (if indicated):

Catheter Care Orders

Q shift:

• Check foley catheter for patency and provide foley care.
• Change catheter and drainage bag PRN.
• Irrigate foley catheter with 60cc NS – may use gentle pressure PRN for blockage.

Signatures

MD Signature: ________________________________________
Date: ___________________________

Transcribed By: ______________________________________
Date: ___________________________

References:

• Centers for Medicare & Medicaid Services. State Operations Manual, Appendix PP - Guidance to Surveyors for Long-Term Care Facilities. [Link to current CMS SOM]
• CMS Requirements of Participation for Long-Term Care Facilities. [Link to current guidelines]