Urinary Catheter: Observation 2

Instructions: Observe patients with urinary catheters in place. Observe each practice and record the observation. In the column on the right, sum (across)
the total number of “Yes” and the total number of observations (“Yes” + “No”). Sum all categories (down) for overall performance.

Patient Patient Patient Patient Summary of Observations

Urinary catheter: Observation Categories
1 2 3 4
Yes Total Observed

Is the catheter properly q Yes q Yes q Yes q Yes

1 secured to the patient? q No q No q No q No

Is there unobstructed flow q Yes q Yes q Yes q Yes

2 from the catheter into the bag? q No q No q No q No

Is the collection bag below the q Yes q Yes q Yes q Yes

3 level of the bladder? q No q No q No q No

Are the bag and tubing off of q Yes q Yes q Yes q Yes
4 the floor? q No q No q No q No

Total YES and TOTAL OBSERVED

 Urinary Catheter: Observation 2

Date:______________

Observer Role: o Nurse o Tech o Other__________ Initials:______

Location/Unit:____________

Notes and comments: