Impact of Kamishibai Card Process on Compliance With the Central Venous Line Maintenance Bundle

Background: The Kamishibai Card (K-Card) process is a storytelling methodology designed to help identify barriers and remove or redesign them. Purpose: The purpose of this study was to evaluate the effectiveness of the K-Card process for central venous line (CVL) maintenance bundle compliance in a pediatric intensive care unit. Methods: A retrospective evaluation of the implementation of the K-Card process was performed using a pretest and posttest design. Results: A total of 1003 central venous catheter maintenance observations were completed during the study period. A statistically significant change was noted in one element of the CVL maintenance bundle, tubing timed and dated. The most frequent cause for noncompliance with the CVL maintenance bundle was incomplete communication during handoff, followed by device associated factors (failure of device, use of device, and availability of device). Conclusions: The K-Card process had a positive impact on CVL maintenance bundle compliance in the study setting.