The EASE Quality Improvement Project: Improving Safe Sleep Practices in Ohio Children’s Hospitals

Macklin, Jamie R.; Gittelman, Michael A.; Denny, Sarah; Southworth, Hayley; Arnold, Melissa Wervey

doi:10.1542/peds.2015-4267

Cited by 26 publications

(20 citation statements)

References 12 publications

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“…21–23 As in the current study, use of safe sleep toolkits that include education tools for nurses to deliver to families have also been successfully used in the neonatal intensive care unit 24,25 Recent studies in maternity units have demonstrated that bundled interventions using nurse modeling, parents viewing a DVD, and either nurses or parents signing a commitment or acknowledgment of education improved adherence to safe sleep practices at time of discharge and at 4 months. 26,27 …”

Section: Discussionmentioning

confidence: 77%

TodaysBaby Quality Improvement: Safe Sleep Teaching and Role Modeling in 8 US Maternity Units

Kellams¹,

Parker²,

Geller

et al. 2017

Pediatrics

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Background and Objectives Nursing education and role modeling can increase adherence to safe sleep practices. Eight US hospital maternity units with variable baseline approaches to education participated in a national multicenter nursing quality improvement (QI) intervention to promote safe sleep practices. The goals at participating maternity units were to (1) increase the rate of mothers who reported receiving safe sleep information from nurses to greater than 90%, and (2) increase the rates of infants observed sleeping supine in a safe environment to greater than 90%. Methods A safe sleep QI toolkit, designed and provided to all sites, included an educational curriculum and tools to use for staff and parent education. Local teams implemented safe sleep education using the tools as Plan-Do-Study-Act (PDSA) cycles. Following each cycle, audits assessing maternal report of nursing staff education on safe sleep and inpatient infant sleep position and environment were performed. Results The QI interventions lasted a median of 160 days (range 101–273). Mothers reported receiving information on four primary safe sleep topics 72% to 95% of the time (a 24% to 57% increase over baseline). Additionally 93% of infants were observed in a supine sleep position and 88% of infants were observed in a safe sleep environment (a 24% and 33% increase over baseline, respectively). These rates were sustained up to 12 months later. Conclusion Implementation of a multi-site QI intervention for safe sleep parenting education and role modeling led to increased knowledge of and compliance with safe sleep practices during postpartum hospitalization.

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Section: Discussionmentioning

confidence: 77%

TodaysBaby Quality Improvement: Safe Sleep Teaching and Role Modeling in 8 US Maternity Units

Kellams¹,

Parker²,

Geller

et al. 2017

Pediatrics

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“…It is clear more education and positive examples are needed. (Shadman et al 2016;Macklin et al 2016;Kuhlmann et al 2016) Past studies suggest placing storage bins next to or at the end of cribs may be useful in encouraging the removal of nonessential items from the infant's crib. (Kuhlmann et al 2016;McMullen et al 2016;Zachritz et al 2016) Despite significant decreases in certain items in cribs, an increase in items such as bottles, electronics, and bumpers were noted.…”

Section: Discussionmentioning

confidence: 99%

“…(Mason et al 2013;Leong et al 2019) Multiple studies have utilized crib audits to collect information such as patient age, sleep position/location and environment, followed by a quality improvement (QI) program in children's hospitals and birthing centers; they found that safe sleep practices could be greatly improved. (Mason et al 2013;Leong et al 2019;Macklin et al 2019;Shadman et al 2016;Macklin et al 2016;Moon 2011) In response to Georgia's high infant mortality rate, the Georgia Safe to Sleep campaign was initiated in 2016 to model and educate both parents and caregivers on safe sleep practices in mother-baby units at birthing hospitals. (Georgia Department of Public Health 2016) In 2017, we performed a study at a freestanding tertiary care children's hospital to study the effectiveness of a quality initiative aimed at safe sleep compliance before and after QI interventions.…”

Section: Introductionmentioning

confidence: 99%

Expansion of a multi-pronged safe sleep quality improvement initiative to three children’s hospital campuses

et al. 2020

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Background: The American Academy of Pediatrics (AAP) recommends infants should be Alone, on their Back, and in a clear Crib to combat relatively stagnant rates of sudden unexpected infant death (SUID). These are referred to as the ABCs of safe sleep. Studies have shown these recommendations are not consistently followed in the hospital setting, but further investigation would determine how to improve the rate of adherence. The objective of this study was to evaluate the impact of an expanded safe sleep initiative at three Georgia free-standing children's hospital campuses before and after a multipronged safe sleep initiative. Methods: A quality improvement program with a pre/post analysis was performed using a convenience method of sampling. Infants < 12 months old in three inpatient pediatric campuses were analyzed pre-and post-interventions. The intervention included: 1) nursing education, 2) identification of nurse "safe sleep" champions, 3) crib cards, 4) crib audits, and 5) weekly reporting of data showing nursing unit ABC compliance via tracking boards. The goal was ABC compliance of ≥25% for the post-intervention period. A standardized crib audit tool evaluated sleep position/location, sleep environment, and ABC compliance (both safe position/location and environment). Chi square analysis, Fisher's exact test, and logistic regression were used to compare safe sleep behaviors before and after the interventions. Results: There were 204 cribs included pre-intervention and 274 cribs post-intervention. Overall, there was not a significant change in sleep position/location (78.4 to 76.6%, p = 0.64). There was a significant increase in the percent of infants sleeping in a safe sleep environment following the intervention (5.9 to 39.8%, p < 0.01). Overall ABC compliance, including both sleep position/location and environment, improved from 4.4% pre-intervention to 32.5% postintervention (p < 0.01). There was no significant variability between the hospitals (p = 0.71, p = 1.00). Conclusions: The AAP's safe sleep recommendations are currently not upheld in children's hospitals, but safer sleep was achieved across three children's campuses in this study. Significant improvements were made in sleep environment and overall safe sleep compliance with this multi-pronged initiative.

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“…36 Several HRSAfunded initiatives 37,38 and the National Institutes of Health-funded Safe to Sleep campaign 7 include provider training modules that integrate effective behavior change methods, such as motivational interviewing. New mobile health message interventions, 39 clinical decision support tools, [40][41][42] and quality improvement initiatives, [43][44][45][46] including CDC-funded perinatal quality collaborative initiatives, 47 also show promise to improve safe sleep practices.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Factors Associated With Safe Infant Sleep Practices

et al. 2019

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OBJECTIVES: To examine prevalence of safe infant sleep practices and variation by sociodemographic, behavioral, and health care characteristics, including provider advice. METHODS: Using 2016 Pregnancy Risk Assessment Monitoring System data from 29 states, we examined maternal report of 4 safe sleep practices indicating how their infant usually slept: (1) back sleep position, (2) separate approved sleep surface, (3) room-sharing without bedsharing, and (4) no soft objects or loose bedding as well as receipt of health care provider advice corresponding to each sleep practice. RESULTS: Most mothers reported usually placing their infants to sleep on their backs (78.0%), followed by room-sharing without bed-sharing (57.1%). Fewer reported avoiding soft bedding (42.4%) and using a separate approved sleep surface (31.8%). Reported receipt of provider advice ranged from 48.8% (room-sharing without bed-sharing) to 92.6% (back sleep position). Differences by sociodemographic, behavioral, and health care characteristics were larger for safe sleep practices (∼10-20 percentage points) than receipt of advice (∼5-10 percentage points). Receipt of provider advice was associated with increased use of safe sleep practices, ranging from 12% for room-sharing without bed-sharing (adjusted prevalence ratio: 1.12; 95% confidence interval: 1.09-1.16) to 28% for back sleep position (adjusted prevalence ratio: 1.28; 95% confidence interval: 1.21-1.35). State-level differences in safe sleep practices spanned 20 to 25 percentage points and did not change substantially after adjustment for available characteristics. CONCLUSIONS: Safe infant sleep practices, especially those other than back sleep position, are suboptimal, with demographic and state-level differences indicating improvement opportunities. Receipt of provider advice is an important modifiable factor to improve infant sleep practices. WHAT'S KNOWN ON THIS SUBJECT: Approximately 3500 infants die annually in the United States from sleep-related sudden unexpected causes. Previous studies have indicated suboptimal adherence to safe infant sleep recommendations and highlighted various sociodemographic disparities and connections with provider advice. WHAT THIS STUDY ADDS: We update previous estimates of safe infant sleep and include a new composite measure assessing the use of separate approved sleep surfaces. We also explore state variation and examine associations between provider advice and each of 4 corresponding sleep-related practices.

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The EASE Quality Improvement Project: Improving Safe Sleep Practices in Ohio Children’s Hospitals

Cited by 26 publications

References 12 publications

TodaysBaby Quality Improvement: Safe Sleep Teaching and Role Modeling in 8 US Maternity Units

TodaysBaby Quality Improvement: Safe Sleep Teaching and Role Modeling in 8 US Maternity Units

Expansion of a multi-pronged safe sleep quality improvement initiative to three children’s hospital campuses

Prevalence and Factors Associated With Safe Infant Sleep Practices

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