Date of Graduation

Summer 8-21-2026

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Program

Kaiser cohort MSN capstone

First Advisor

Cathy Coleman, DNP, RN, CPHQ, CNL

Abstract

Problem

            Despite improvements in central line-associated bloodstream infection (CLABSI) attribution, variability in Kamishibai card (K-card) observation practices and documentation limited the unit's ability to identify, learn from, and correct persistent deviations from expected practice. Baseline data showed frequent incomplete documentation and a pattern of completing K-card observations outside bedside shift report.

Context

This project took place in a 20-bed medical-surgical ICU, using the existing K-card process to support high-reliability prevention of hospital-acquired conditions (HAC). Baseline assessment revealed inconsistent observation workflows, incomplete documentation, and unclear roles and expectations.

Interventions

A standardized K-card observation workflow was developed through rapid-cycle testing. Observations were integrated into bedside shift report, and staff roles were delineated. The team established clear documentation expectations, champion modeling, and educational resources, including a training video and reference materials.

Measures

The primary measure was the percentage of K-card observation fallouts fully documented, including cause. Data were collected from Reasons Bundle NOT Met K-card documentation sheets for two nursing-sensitive indicators (NSIs): CLABSI and hospital-acquired pressure injury (HAPI).

Results

Baseline compliance was 40.7%; by June 2026, overall unit compliance was 42.2%. CLABSI documentation compliance improved from 39.4% to 62.9%, and champions achieved 100% compliance. Increased HAPI observation volume likely diluted overall compliance.

Conclusions

Standardizing the K-card observation workflow established a reproducible, high-reliability process for identifying causes of practice variation. Reliability improved most among staff who received 1:1 education, practiced the workflow, and were highly engaged. Continued dissemination and sustainment efforts are needed to sustain quality improvement gains and achieve broader HAC-prevention adoption unit-wide.

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