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Using Kamishibai Cards to Identify Barriers and Display Adherence to the Central Line-Associated Bloodstream
Shelly L Brown1, Dori L Klemanski, Joni Tornwall
1Author Affiliations: Clinical Nurse Specialist, Leukemia (Dr Brown), Chief of Advanced Practice Providers (Dr Klemanski), and Associate Chief Nursing Officer for Inpatient (Dr Ross), The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute; Associate Clinical Professor (Dr Tornwall), and Clinical Professor (Dr Browning), The Ohio State University College of Nursing; and Nurse practitioner, Cancer Supportive Care (Dr Browning) The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus.
Insights
This study improved adherence to central line-associated bloodstream infection (CLABSI) prevention practices in nurses through targeted interventions. Kamishibai cards enhanced compliance and awareness of key CLABSI prevention elements.
Area of Science:
- Infection Control
- Nursing Practice
- Patient Safety
Background:
- High rates of central line-associated bloodstream infections (CLABSI) persist in academic comprehensive cancer hospitals.
- Nursing practices are crucial for CLABSI prevention bundles, yet barriers to adherence are often unaddressed.
- Sustainable programs are needed to enhance nurses' skills and documentation of CLABSI prevention.
Purpose of the Study:
- To increase adherence to nursing practices for CLABSI prevention.
- To implement a sustainable program for improving nurses' skills and documentation of CLABSI prevention bundle components.
- To identify and address barriers affecting compliance with CLABSI prevention protocols.
Main Methods:
- A 9-week project involving pre- and post-implementation chart reviews and visual audits.
- Nurse surveys were conducted post-project to gather feedback on barriers and interventions.
- Kamishibai cards (K-cards) were utilized as evidence-based visual audit tools to monitor compliance.
Main Results:
- Compliant documentation of daily chlorhexidine gluconate (CHG) bathing increased to 75%.
- Inconsistent communication and knowledge gaps were identified as significant barriers to compliance.
- 75% of nurses reported that the K-card display positively influenced their CLABSI prevention practices.
Conclusions:
- The project successfully enhanced nurses' knowledge and adherence to CLABSI prevention practices.
- Awareness of commonly missed CLABSI prevention bundle components was significantly improved.
- The intervention demonstrated potential for creating a sustainable program to reduce CLABSI rates.
Purpose:
Central line-associated bloodstream infection (CLABSI) rates have been consistently high at an academic comprehensive cancer hospital. CLABSI prevention bundles can mitigate central line infections, and many components focus on nursing practice. Identification of barriers to maintaining adherence to these elements is not always assessed or addressed. The purpose of this project was to increase adherence to CLABSI prevention nursing practices and to implement a sustainable program to elevate nurses' skills and documentation of CLABSI prevention bundle components.
Description:
Pre-implementation/post-implementation chart reviews, post-implementation visual audits, and a survey for nurses post project were completed over a 9-week period. This project identified and addressed barriers to CLABSI prevention bundle compliance. Audits assessed nursing practice elements of the CLABSI prevention bundle. Evidence-based Kamishibai cards (K-cards) were used as a visual audit tool to display compliance of CLABSI bundle elements.
Outcomes:
Compliant documentation of daily chlorhexidine gluconate (CHG) bathing increased to 75%. Inconsistent communication practices and knowledge gaps were frequent barriers to compliance. Seventy-five percent of nurses reported the K-card display changed their own CLABSI prevention practices.
Conclusion:
This project increased knowledge, adherence to CLABSI prevention practices, and awareness of components most often missed.
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