Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Elise Schaller


Elise Schaller

Roxanne Reid

Abigail Kleinschmidt



Problem: The transition process from a hospital setting to home is critical for pediatric patients and their families. However, there is no standardized process to ensure asthma discharge orders and asthma action plans are printed at the time of discharge

Methods: This observational quality improvement project utilized a pre-and-postimplementation of the Kamishibai Card (K-Card) process for pediatric discharge checklist compliance in an inpatient pediatric general medicine unit. This project used a sample of all children aged 2 years to 21 years with an asthma diagnosis admitted to the inpatient general medicine pediatric unit. This project included an education phase and an implementation phase. The QI project was performed using a plan-do-act study method to assess barriers during the implementation phase.

Results: A total of 58 patients were included in the quality improvement project (40) patients pre-implementation phase and 18 patients- post-implementation. During the pre-implementation phase, there was a home management plan of care compliance rate of 95% with November 2022 having the lowest rate of compliance at 83%. After the implementation of the K-card tool, there was an overall home management plan of care compliance rate of 89%. The result of the two-tailed paired samples t-test was not significant based on an alpha value of .05, t (3) = -0.29, p = .790.

Implications for Practice: K-cards may help in enhancing home management plan of care in the pediatric population with asthma by auditing the necessary discharge components set in place by the Joint Commissions Childhood Asthma Care Measure -3 (CAC-3). K-Card audit reports may be used to identify barriers to proper discharge and develop new standardized workflow strategies.