Improving Safe Sleep Practices for Hospitalized Infants

Abstract

BACKGROUND AND OBJECTIVES: Adherence to the American Academy of Pediatrics safe sleep practice (SSP) recommendations among hospitalized infants is unknown, but is assumed to be low. This quality improvement study aimed to increase adherence to SSPs for infants admitted to a children’s hospital general care unit between October 2013 and December 2014. METHODS: After development of a hospital policy and redesign of room setup processes, a multidisciplinary team developed intervention strategies based on root cause analysis and implemented changes using iterative Plan–Do–Study–Act cycles. Nurse knowledge was assessed before and after education. SSPs were measured continuously with room audits during sleeping episodes. Statistical process control and run charts identified improvements and sustainability in hospital SSPs. Caregiver home practices after discharge were assessed via structured questionnaires before and after intervention. RESULTS: Nursing knowledge of SSPs increased significantly for each item (P ≤ .001) except avoidance of bed sharing. Audits were completed for 316 sleep episodes. Simultaneous adherence to all SSP recommendations improved significantly from 0% to 26.9% after intervention. Significant improvements were noted in individual practices, including maintaining a flat, empty crib, with an appropriately bundled infant. The largest gains were noted in the proportion of empty cribs (from 3.4% to 60.3% after intervention, P < .001). Improvements in caregiver home practices after discharge were not statistically significant. CONCLUSIONS: Sustained improvements in hospital SSPs were achieved through this quality improvement initiative, with opportunity for continued improvement. Nurse knowledge increased during the intervention. It is uncertain whether these findings translate to changes in caregiver home practices after discharge.

Modeling Safe Infant Sleep in the Hospital

“…The Back to Sleep campaign was launched in 1994 in an effort to reduce the rates of sudden infant death syndrome (SIDS) in the United States. The initial campaign, encouraging parents to put their infants to sleep in a non-prone position after research demonstrated an association between the prone sleep position and an increased risk of SIDS, reached a wide audience and was incredibly successful (AAP Task Force, 2016;Moon, 2016;Shadman, Walk, Smith, & Coller, 2016). Between 1994 and2001, rates of SIDS declined dramatically (Moon, 2016;Shadman et al, 2016).…”

“…The initial campaign, encouraging parents to put their infants to sleep in a non-prone position after research demonstrated an association between the prone sleep position and an increased risk of SIDS, reached a wide audience and was incredibly successful (AAP Task Force, 2016;Moon, 2016;Shadman, Walk, Smith, & Coller, 2016). Between 1994 and2001, rates of SIDS declined dramatically (Moon, 2016;Shadman et al, 2016). Ongoing research over the last thirty years has expanded our understanding of SIDS risk factors and, in response, the American Academy of Pediatrics (AAP) continually updates the recommended safe sleep practices (SSP) for infants (Moon, 2016).…”

“…Thus, in the most up to date safe infant sleep recommendations released in 2016, the AAP states that, "Health care professionals, staff in newborn nurseries and neonatal intensive care units, and child care providers should endorse and model recommendations to reduce SIDS risk," (AAP Task Force, 2016). Unfortunately, data indicates that healthcare providers often model unsafe practices or simply fail to discuss safe sleep (Ajao et al, 2011;Eisenberg et al, 2015;Goodstein et al, 2015;Hauck et al, 2002;Hauck et al, 2003;Mason et al, 2013;Shadman et al, 2016;Smith et al, 2010). These failures can both further confuse parents and implicitly suggest that unsafe practices are acceptable.…”

A Hospital-Based Initiative to Reduce Postdischarge Sudden Unexpected Infant Deaths

“…In recent publications, multiple authors have described QI interventions in the nursery that demonstrated improvements in nurse' s knowledge and practice around safe sleep practices. [4][5][6] Although improvements were demonstrated in in-hospital process measures, Shadman et al 5 found no change in parent home practices after discharge. In other studies, it has been demonstrated that health care providers are a significant source of education for safe sleep and that information given at the time of delivery translates to improved compliance with safe sleep recommendations.…”

“…In previous studies, it has been demonstrated that hospital safe sleep education using quality improvement (QI) methodology may improve the modeling of safe sleep practices in hospitals [4][5][6] but fails to impact postdischarge outcomes. 5 It is not surprising that a generic single-dose educational strategy such as discharge counseling would not impact outcomes given that authors of previous health and safety-related behavior change research demonstrate little impact on postdischarge practices of adults with diverse backgrounds, lifestyles, and parenting experience. 7 Additionally, there is evidence that parents recall little of the anticipatory guidance delivered in the newborn nursery.…”