Parents like Arlene Garcia, here with son Adrien, now are playing a role in safety. Marlene Miller meets with her safety team. Nurse Cathy Garger washes up.

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 Center.)

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."

-Lindsay Roylance