Kamishibai cards are best known for identifying errors and abnormalities in the Toyota Motor Corp.’s manufacturing processes but have since been adapted to other industries, including health care.

Amanda Bettencourt, M.S.N., R.N., a pediatric clinical nurse specialist, heard about the “K cards” at a conference and brought the idea back to work. By February, bulletin boards with K cards had been posted in the Pediatric Cardiac Intensive Care and pediatric hematology/oncology units.

The idea is as simple as it is effective: Stimulate real-time, peer-to-peer conversations about the steps involved in safety compliance. When the program was rolled out, its initial focus was on preventing falls and central-line-associated bloodstream infections.

The K cards stimulate a spontaneous, organic discussion that drills down into the minutiae of a safety issue. Among them: When did you last do a dressing and insertion site assessment? Are all dressing, cap, tubing and medications/fluids within date?

The K card for central line infection prevention contains more than a dozen items that need to be discussed and checked off. The goal is to assure that all of the infection-prevention actions listed on the card are completed at least 90 percent of the time.

“This is a tool to help measure our safety compliance and figure out what we need to do to get better. It’s a very engaging activity,” Bettencourt said.

K cards also can have an immediate effect: Getting 90 percent compliance on central-line infection prevention practices can reduce infections up to 40 percent, according to Stephanie Oliveria, B.S.N., R.N., a nursing clinical leader in the UF Health Shands Hospital Pediatric Cardiac ICU. In Oliveria’s unit, the staff of more than 80 nurses does at least 10 K cards a month. Safety compliance rose steadily from 70 percent to more than 90 percent in her unit after the K cards were implemented, she said.

Ozzie Hunter, M.S.N., R.N., a nurse manager in UF Health Shands Hospital’s Pediatric Hematology/Oncology Unit and the Pediatric Infusion Center and Outpatient Clinic, said almost all of the K card sessions in recent months have been done among staff members.

“What the staff likes is that it’s not management looking at them and what they’re doing. It’s them interacting with each other and discussing how we can better our practices on the floor,” he said.

Next, the K card program will be expanded throughout the hospital by September to help prevent falls, central-line infections and catheter-associated urinary tract infections.

Bettencourt said the K cards have been especially helpful in fostering candid discussions. Colleagues are more honest with each other about what they could have done better than if a manager was doing a traditional audit of a patient safety process.

“This is a tool to help measure our safety compliance and figure out what we need to do to get better. It’s a very engaging activity.” — Amanda Bettencourt, M.S.N, R.N., pediatric clinical nurse specialist.