Head of the hospital bed raised? Check. Patient's teeth brushed? Check.
Those simple but often overlooked steps can help protect some of the most critically ill patients - those on ventilators - from developing deadly pneumonia. And if they knew about them, family members could ensure the steps weren't forgotten.
Hospitals are rife with infections and opportunities for medical mistakes. Now, a nearly $9 million project at Johns Hopkins University aims to combine engineering with the power of patients and their families to prevent some of the most common threats.
The idea: Design patient safety to be more like a car's dashboard, which automatically signals drivers when the oil needs changing or if a passenger forgot to buckle up, or like the countdown systems that make sure no step is missed when a satellite is launched.
Today, safe, quality care largely depends on individual health workers remembering hundreds of steps without good ways to tell if they forget one, said Hopkins' patient safety expert Dr. Peter Pronovost. Getting it right takes what he calls "almost heroic efforts."
And too often, the people best able to spot early warning signs - patients and their families - are treated as passive bystanders rather than encouraged to participate in their care, he said.
"Who knows better than the family?" asked Dr. George Bo-Linn of the Gordon and Betty Moore Foundation's new Patient Care Program.
The foundation, created by Intel co-founder Gordon Moore, is funding the Hopkins work as the first step in a planned 10-year, $500 million effort to improve patient safety and family engagement in hospitals around the country. Separately, the Institute of Medicine has signed on to help, partnering with the National Academy of Engineering, to bring together top experts on how to design safety systems.
Sometimes the failure to merely discuss treatment with patients or their families causes the harm. Consider Nicole D. James of Elkridge, Md., who undergoes frequent overnight hospital stays to treat the intense pain of sickle cell anemia. One such visit turned into a miserable two-week stay when the ER doctor added a powerful antibiotic to James' usual pain treatment without telling her first - a drug that worsened her sickle cell crisis. It turned out the doctor had spotted a shadow on James' lung X-ray that he thought was pneumonia but that she could have told him, and her regular physician confirmed, really was old scar tissue.
Numerous programs are under way to improve patient safety. Among them is the government's Partnership for Patients, funded by $1 billion from the new health care law, that is helping hospitals adopt proven safety strategies.
Hopkins' Pronovost led the creation of one of the most well-known: a simple checklist that ensures hospital workers follow steps that lower the risk of deadly bloodstream infections from common IV catheters. That checklist now is being used in ICUs nationwide, and the government reported last year that those infections have plummeted by 60 percent as a result.
Pronovost's new project will target multiple ICU threats simultaneously. It will require linking medical devices that today don't talk to each other, he said.
Simpler protections to help fend off pneumonia in people on ventilators include keeping the head of the bed elevated at least 30 degrees and good oral hygiene.