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Other protections are far less complex. Keeping the head of the bed elevated at least 30 degrees and good oral hygiene are among the steps that help fend off the pneumonia that kills 36,000 people a year while they’re on ventilators. That’s something family members can watch for _ or they even can be trained to brush a loved one’s teeth around the breathing tube.

Already, Hopkins has introduced a “family involvement menu” of care items. “We believe that you know the person that we are caring for far better than we do,” the menu reads.

Ultimately, Pronovost envisions an iPad-like device that allows both health workers and family members to see at a glance which of dozens of required daily care steps have been performed and which still need to be.

“The beauty of checklists is it gives you that constant visual reminder,” and an electronic, automated version is the next logical evolution, said Ann Marie Pettis, director of infection prevention at the University of Rochester Medical Center, who called the project intriguing.

Engaging the patient and family in some ways is tougher. Hospitals have had a hard time encouraging people to ask doctors and nurses if they’ve washed their hands, said Gina Pugliese of the Premier Safety Institute, a hospital improvement alliance.

“So many patients and families are hesitant to ever question the doctor,” she said. “It’s so important they get involved.”

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EDITOR’S NOTE _ Lauran Neergaard covers health and medical issues for The Associated Press in Washington.