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  1. Salinas, Brianna MSN, RN, CNL
  2. Villamin, Colleen MSN, RN, OCN, CNL
  3. Gallardo, Luisa Dee MSN, RN, NE-BC


Background: Lean management tools have proven effective in achieving high reliability in health care.


Local Problem: Unstructured leader rounds, decentralized prevention bundle repositories, and unfavorable patient experience outcomes prompted leaders on a thoracic and cardiovascular surgery unit to find other methods to address these issues and positively impact outcomes.


Methods: Nurse sensitive indicator prevention bundles, root cause analysis tools, and best practices were used to develop Kamishibai Cards (K-Cards) for each measure targeted.


Interventions: K-Cards were implemented to standardize processes, engage patients in their care, and promote staff identification of barriers and solutions.


Results: Nurse-sensitive indicators and patient experience metrics were positively impacted by Kamishibai Rounding. K-Cards promote a state of continuous improvement, which supports sustainability of evidence-based practice and best practices that were implemented.


Conclusions: K-Cards use high-reliability principles to standardize nursing practice to promote quality outcomes.