RESUMO
OBJECTIVE: To ensure whether spaced education, which increases long-term knowledge retention, could be integrated into auditor competency assessment. DESIGN: Quality improvement project. SETTING: Academic, freestanding children's hospital. PARTICIPANTS: Hand hygiene (HH) auditors. INTERVENTION: We enrolled trained HH auditors in an online spaced-education platform to assess mastery of knowledge, delivering 46 unique questions at spaced intervals followed by rationale; we retired questions after 3 correct answers. An e-mailed 10-item survey gauged participant satisfaction with the program. The Wilcoxon signed-rank test was used to compare change in median knowledge score from first to final attempt. RESULTS: A total of 12,120 questions were attempted by 126 auditors, and 49 (39%) completed the entire course. Median knowledge score increased significantly by 10.5 percentage points (IQR 4-15) between first and final attempts (P < 0.001). Thirty auditors (27%) responded to the survey. The majority agreed the number and complexity of questions were appropriate (57% and 67%, respectively). Eighty-seven percent reported the platform easy to navigate, and 77% agreed adequate time was provided for completion. Free-text suggestions included delivering fewer questions at a narrower spacing interval over a shorter time frame because of competing work demands. CONCLUSIONS: Auditor knowledge of HH indications and technique is critical to ensuring data validity. A spaced-education competency program improved HH auditor knowledge in the short term. Completion rate was low, and some participants expressed a desire for fewer questions over a shorter time frame. This study offers insight into ways to optimize spaced education as a potential tool for HH competency assessment.
RESUMO
BACKGROUND: We instituted Kamishibai (K-card rounding) with the goals of improving indwelling urinary catheter maintenance bundle reliability and decreasing catheter-associated urinary tract infection (CAUTI) rates. METHOD: In a free-standing children's hospital, we undertook a hospital-wide quality improvement project from January 2019 to June 2021 after developing a K-card based on our urinary catheter maintenance bundle. Auditors used K-cards to ask standardized questions during weekly rounds. Bundle reliability and CAUTI rates were analyzed prospectively. RESULTS: During the study period, 826 K-card audits were performed for 657 unique patients. While overall maintenance bundle reliability remained stable at 84%, there was a statistically significant improvement in reliability to the bundle element "medical discussion of need for the urinary catheter" from 88% to 94% (P = .01). The hospital-wide CAUTI rate significantly decreased (incidence rate ratio, 0.38; 95% CI, 0.15-0.93; P = .04). DISCUSSION: Hospital-wide urinary catheter K-card rounding facilitated standardized data collection, discussion of reliability and real-time feedback to nurses. Maintenance bundle reliability remained stable after implementation, accompanied by a significant decrease in the CAUTI rate. CONCLUSIONS: Implementation of hospital-wide urinary catheter K-card rounding was associated with reduction in CAUTI rates. The project demonstrated likelihood of reproducibility with support of a multidisciplinary team.