Center for Advanced Practice


From Auditor to Coach: Implementation of Kamishibai-Card Rounding for Compliance Monitoring...46th Annual Conference, APIC 2019, Philadelphia, PA.

Publication Title

American Journal of Infection Control

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Standardized care bundles are a critical component in preventing healthcare-associated conditions (HAC) in hospitalized patients. Adherence to prevention practice bundles ensures that staff follow highly reliable practices to reduce patient harm. At a large academic children's hospital, compliance with standard care bundles was historically monitored using manual audits comprised of chart and direct observations. This process lacked opportunities to engage staff directly. In response, a Lean improvement tool called Kamishibai Cards (K-Cards) were implemented to promote meaningful bedside discussions. In August 2016, the initial K-Card pilot was implemented in the Cardiac Intensive Care Unit (CICU) and focused on the bundle for?Central Line-Associated Bloodstream Infections (CLABSI). A Plan-Do-Study-Act model of improvement was utilized. After four weeks, a post survey was distributed to staff to assess knowledge, effectiveness and satisfaction with the rounding process. With continued positive responses, K-Card use quickly expanded to other units across all nine HAC work streams and in September 2017 replaced traditional audits hospital-wide. A systematic communication and conversion plan was developed, including educational toolkits and strategies to ensure inter-rater reliability. Post-pilot survey results showed that K-Cards increased understanding of bundle practices for 60% of respondents, improved the ability to care for patients with central lines for 50%, and enhanced educational experience for 90%. Since conversion, preliminary feedback has indicated richer, meaningful teaching moments and understanding of the bundles. CLABSI provides one example: following the transition, compliance took a dip as conversation revealed gaps in understanding. K-Card coaching allowed teams to immediately address gaps, and compliance increased back above 90%. The implementation of K-card rounding has allowed structured just-in-time feedback and changed the audit process to one that is valuable for staff. By promoting more meaningful discussions at the bedside, K-cards are an important tool in influencing organizational culture around prevention practices.


Congresses and Conferences -- Pennsylvania, Cross Infection -- Prevention and Control, Guideline Adherence, Infection Control - Methods, Patient Safety, Pennsylvania



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