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iRubric: Sterile Field/Foley Cath Insertion rubric

iRubric: Sterile Field/Foley Cath Insertion rubric

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Sterile Field/Foley Cath Insertion Sterile Field/Foley Cath Insertion Foley insertion Rubric Code: ZXAA974 By Annhahnb Ready to use Public Rubric Subject: Nursing Type: Exam Grade Levels: (none)

Sterile Field/Foley cath Enter rubric description
	Excellent 3 pts	Average 2 pts	Needs Improvement 1 pts	Comments (N/A)
Pt verification/ preparation	Excellent Correctly identifies pt information by protocol. Selects and prepares all equipment and supplies Check physicians orders. ID patient ID Care provider Explain procedure	Average Identifes patient name or birthdate, but not both. Selects and prepares most of equipment and supplies. Missed 1 of the below: ID patient ID Care provider Explain procedure	Needs Improvement Does not know pt identifiers. Selects and prepares inadequate or inappropriate equipment. Missed 2 or more of the below: ID patient ID Care provider Explain procedure	Comments
Pre procedure performance	Excellent Performs hand hygiene Provides for patient privacy	Average Missed 1 of the below Performs hand hygiene Provides for patient privacy	Needs Improvement Missed both peerformance procedures Performs hand hygiene Provides for patient privacy	Comments
Patient Preparation	Excellent Drape the patient for privacy	Average Patient partially exposed	Needs Improvement Patient completely exposed	Comments
Prior to sterile field set up	Excellent Apply clean gloves Wash perineal area Examine meatus****	Average Missed 1 of the below Apply clean gloves Wash perineal area Examine meatus****	Needs Improvement Missed 2 or more of the below: Apply clean gloves Wash perineal area Examine meatus****	Comments
Sterile Gloves & Field	Excellent Able to open sterile packet without contamination Able to apply sterile gloves with out contamination. Able to set-up sterile field and maintain sterility of field throughout procedure.	Average Able to open sterile packet without contamination Able to apply sterile gloves after 2 attempts. Able to set-up and maintain sterile field with minimual errors.	Needs Improvement Unable to open sterile packet without contamination Unable to apply sterile gloves, set-up sterile field or maintain sterile field throughout procedure.	Comments
Preping Site for catheter insertion	Excellent Lubricate the catheter Separate the labias with nondominant hand Use one clean cotton ball or wipe for each area Clean the far labia fold Clean the near labia fold Clean directly over the center of the urethral	Average Missed 1 step Lubricate the catheter Separate the labias with nondominant hand Use one clean cotton ball or wipe for each area Clean the far labia fold Clean the near labia fold Clean directly over the center of the urethral	Needs Improvement Missed 2 or more steps Lubricate the catheter Separate the labias with nondominant hand Use one clean cotton ball or wipe for each area Clean the far labia fold Clean the near labia fold Clean directly over the center of the urethral	Comments
Foley Insertion	Excellent Able to insert foley catheter using correct steps. Continue to hold labia until insertion completed Inflate balloon Secure foley bag to patient and to bed frame	Average Able to insert foley catheter with 2 incorrect steps. Continue to hold labia until insertion completed Inflate balloon Secure foley bag to patient and to bed frame	Needs Improvement Unable to insert foley catheter using all steps for procedure. Let go of labia during insertion. Inflate balloon Foley bag not secure to patient and to site other than bed frame	Comments
Post skills	Excellent Dispose of supplies Remove gloves Perform hand hygiene Provide patient safety Call Bell Bed to lowest position Leave room tidy	Average Missed 1 step Dispose of supplies Remove gloves Perform hand hygiene Provide patient safety Call Bell Bed to lowest position Leave room tidy	Needs Improvement Missed 2 or more steps Dispose of supplies Remove gloves Perform hand hygiene Did not provide patient safety Call Bell Bed to lowest position Leave room tidy	Comments
Documentation	Excellent Document the procedure Amount of urine Urine color Catheter size Patient tolerance of procedure Time and date	Average Missed 1-2 items in procedure	Needs Improvement Missed 2 or more items in procedure	Comments

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