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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
How to correctly place a foley catheter
Rubric Code: Z2XW43B
By JenniferBullock
Ready to use
Public Rubric
Subject: Medical  
Type: Exam  
Grade Levels: Undergraduate

Powered by iRubric Sterile Field/Foley cath
  Good

(N/A)

Fair

(N/A)

Poor

(N/A)

Pt verification/ preparation

Good

Correctly identifies pt information by protocol. Selects and prepares all equipment and supplies needed per doctors order. Washes hands.
Fair

Identifies patient name or birthdate, but not both. Selects and prepares most of equipment and supplies.
Poor

Does not know pt identifiers. Selects and prepares inadequate or inappropriate equipment or no equipment.
Explanation of Procedure

Good

Explained procedure to patient/family. Able to state appropriate reason for catheter insertion.
Fair

Explained procedure and appropriate reason for catheter placement with prompts from written checklist.
Poor

Does not explain need for catheter or
answer questions.
Sterile Gloves & Field

Good

Able to apply sterile gloves without contamination. Able to set-up sterile field and maintain sterility of field throughout procedure.
Fair

Able to apply sterile gloves after 2 attempts. Able to set-up and maintain sterile field with minimual errors.
Poor

Unable to apply sterile gloves, set-up sterile field or maintain sterile field throughout procedure.
Foley Insertion

Good

Able to insert foley catheter using correct steps. Verbalizes watching for urine return; once noted, verbalizes continuation of insertion to ensure catheter is in bladder then balloon inflated.
Fair

Able to insert foley catheter with assistance from written checklist OR incorrectly/does not verbalize looking for urine return, continued insertion to ensure catheter tip is in bladder and inflation of balloon.
Poor

Unable to insert foley catheter using all steps for procedure. Does not verbalize correct steps up to and including inflation of balloon to secure placement.
Securement

Good

Instructions provided on securing device to leg and placing bag below to the bladder; attached to non-moveable part of bed.
Fair

Verbalizes securement but omit more than two necessary details (bed or leg)
Poor

Does not verbalize securement of device.
Documentation

Good

Verbalizes appropriate documentation of placement of catheter. Pt tolerance, size, securement of device, initial output amount and descriptors of urine.
Fair

Omits one or more factors important for catheter placement, such as patient tolerance, size of catheter, initial output and urine description.
Poor

Does not verbalize documentation requirements for catheter placement.
Removal of Catheter

Good

Verbalizes clean procedure of catheter removal without prompting from written checklist including removal of securement device, education of patient, verification of removal order, deflation of balloon and documentation.
Fair

Omits one or two elements for appropriate removal:
verification of order for removal
pt education
emptying of bag
removal of securement device
deflation of balloon
documentation
Poor

Omits three or more elements for appropriate removal:
verification of order for removal
pt education
emptying of bag
removal of securement device
deflation of balloon
documentation




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