| New Partners in Safety
The Children's Center looks to parents for help in keeping little patients safe
In an isolation room on CMSC 6, 21-month-old Arlen Garcia plays "throw
the blankie out of the crib" with his mother, Arlene. To make him
feel at home during his seven-week recovery from bladder surgery, Arlene
has taped pictures of the boy's two brothers to his crib, a note from
his auntie, plus an "Arlen- speak"-to-English "dictionary"
to help make him better understood.
Parents are often the only clear line of communication between hospitalized
young children and the myriad of health care workers. And communication
is critical when it comes to patient safety. With that in mind, the
Children's Center now is developing programs that encourage parents
to become more proactive in their child's safety.
The new strategy is part and parcel of the Josie King Safety Program,
named for a little girl who died at Hopkins as a result of a medical
error. Josie's mother, Sorrel King, took the unprecedented step of funding
her daughter's namesake program on the pediatric intensive care unit
(PICU) and the infant and toddler floor of the Children's Center (CMSC
6) in an effort to identify the systems most vulnerable to human mistakes.
"I want the doctors and nurses to slow down, look at the patient,
communicate with each other," she says. "I want them to listen
to a concerned parent."
Marlene Miller, brought in last December as the new director of Quality
and Safety Initiatives at the Children's Center, feels compelled to
create a safety net around all of the Center's specialties so nothing
falls through the cracks. But because some patients are moved around
the hospital, then home, then back again, she says it's crucial to have
parents involved "because they're the only ones who are there with
the child through every transition. They have the power of direct observation,
and we need their voice."
Hand-washing is the focus of a safety effort on Arlen's unit. It may
seem like a no-brainer, but nurse manager Cathy Garger says that nosocomial,
or hospital-acquired, infections are a leading cause of death in the
United States, and good hand hygiene is the first line of defense. And
so, the first Josie King Safety Team meeting last fall (chaired by Garger)
gave birth to a hand-washing campaign that protects patients like Arlen
from infection and puts parents in the driver's seat.
Up went the Purell hand-disinfecting-gel dispensers in the hallways
and the colorful, kid-friendly signs reminding people to wash their
hands. Parents and staff are given purple buttons that say "Have
you washed your hands?" (Garger says the buttons "are a kind
of permission slip to let parents know it's OK to ask.") Staff
model the behavior for parents by using Purell every time they come
into the child's room, and parents start using it themselves. The trend
continues to spread: Now all Children's Center units have Purell dispensers
strategically positioned, from patients' rooms to utility rooms.
But hand-washing is just the tip of the iceberg. Last summer, the Children's
Center Safety Team surveyed physicians, nurses and pharmacists. Results
revealed that "medication processes are the number-one concern,"
says Lisa Phifer, director of pediatric nursing.
The pediatric clinical research unit (PCRU) is already one step ahead
of the game. Nurse clinician Suzanne Marvin devised a way to involve
parents by giving them a copy of their child's medication administration
record and educating them about each medication. "That way, they'll
be watching us, not just trusting us blindly," she says. (There
are now plans to roll out the unit's program to other areas of the Children's
As for the future of pediatric safety, Miller, a pediatrician who was
acting director of the Center for Quality Improvements and Patient Safety
at the U.S. Department of Health and Human Services, says she has great
visions. "I hope that our future holds ad hoc meetings of parents
and patients throughout the Children's Center so they can talk directly
to physicians and nurses about what they're seeing that concerns them,"
she says. "Involving parents in their child's health care takes
the fear out. Having the parents just sit back passively-well, that
model is now archaic."
Children's Center Director George Dover agrees: "No one knows a
child better than the parents. They are essential in helping us provide
a safe environment for our patients. And that's a top priority for all
those who care for children at Hopkins."