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Improving Safe Sleep Practices for Hospitalized Infants
Kristin A Shadman1, Ellen R Wald2, Windy Smith3
1Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; and kshadman@pediatrics.wisc.edu.
Insights
Implementing safe sleep practices (SSPs) in hospitals significantly improved infant care, increasing adherence from 0% to 26.9%. While nurse knowledge rose, home practice changes were not significant.
Area of Science:
- Pediatrics
- Quality Improvement Science
- Healthcare Policy
Background:
- Adherence to American Academy of Pediatrics safe sleep practice (SSP) recommendations in hospitalized infants is largely unknown, with assumed low compliance.
- A quality improvement initiative was launched to enhance SSP adherence for infants in a children's hospital general care unit.
Purpose of the Study:
- To implement and evaluate interventions aimed at increasing adherence to safe sleep practices for hospitalized infants.
- To assess the impact of these interventions on nurse knowledge and infant sleep environments.
Main Methods:
- A multidisciplinary team developed and implemented interventions using Plan-Do-Study-Act cycles after policy development and room setup redesign.
- Nurse knowledge was assessed pre- and post-education, and safe sleep practices were monitored via room audits during infant sleep episodes.
- Statistical process control and run charts were used to track improvements and sustainability; caregiver home practices were assessed post-discharge.
Main Results:
- Nursing knowledge of SSPs significantly increased, excluding avoidance of bed-sharing.
- Simultaneous adherence to all SSP recommendations improved from 0% to 26.9% (P < .001).
- Significant improvements were observed in individual practices, notably the proportion of empty cribs (3.4% to 60.3%, P < .001).
Conclusions:
- The quality improvement initiative successfully achieved sustained improvements in hospital safe sleep practices.
- Nurse knowledge regarding SSPs improved, but the impact on caregiver home practices post-discharge remains uncertain.
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.
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