Implementation of a Cue Card Tool to Increase Adherence to Chlorhexidine Treatments

Abstract

Problem: Hospital acquired infections (HAIs) place a significant economic burden on healthcare institutions and increase patient risk for morbidity and mortality. Daily chlorhexidine gluconate (CHG) treatments decrease the incidence of HAIs. Non-adherence to CHG treatments on a 30-bed general pediatric unit increases the risk of HAIs. Cue cards, a form of Kamishibai cards (K-cards) are utilized in the health care setting to improve adherence to protocols or as a communication tool for evidence-based practice and daily auditing processes. Purpose: The purpose of this quality improvement (QI) project is to implement CHG Cue Cards during nursing handoff to improve communication and increase adherence to CHG treatments. Methods: The QI project was implemented on a general pediatric unit from September- December 2021. A multidisciplinary team facilitated the implementation using the MAP-IT framework. A Cue Card tool was created, modeled from the concept of K-cards. Parent education material included in the unit orientation packets highlighted the benefits of CHG treatments. Cue cards were utilized during nursing handoffs to improve communication about infection control measures. Weekly electronic and paper audits tracked daily CHG treatments, presence of central lines (CL), utilization of cue cards, and occurrence of HAIs. Strategies included emails, observations, and reminder cards placed at each nurse computer. Results: In the first implementation period, initial data of all inpatients showed a 48% treatment adherence rate versus 44% post implementation, with zero percent cue card use. In the second implementation period which examined patients with CL and/or indwelling catheters, initial data revealed that 61% received treatment versus 62% post implementation; mean of seven percent cue card use. There was one HAI noted during the 15-week period.