Implementation of safe sleep practices in Massachusetts NICUs: a state-wide QI collaborative

To increase the use of safe sleep practices (SSP) among high-risk infants discharged from Massachusetts (MA) NICUs to 90% in 2 years.

The Neonatal Quality Improvement Collaborative of MA (NeoQIC) is a consortium of neonatal providers that provides infrastructure to lead and manage state-wide quality improvement initiatives. The safe sleep initiative was started in July 2015 with participation of all 10 MA level III NICUs. Based upon the project algorithm, infants are eligible for two sleep practices: SSP or NICU therapeutic positioning (NTP) depending on their gestational age, weight, and clinical illness. Compliance with SSP is defined as: (1) supine positioning, (2) in a flat crib with no incline, (3) without positioning devices, and (4) without soft objects. NTP comprised usual NICU care. Local improvement teams devise intervention strategies, perform weekly crib audits for all NICU infants, and submit data on overall compliance and compliance with each SSP component on a monthly basis to NeoQIC.

From July 2015 to June 2017, 7261 cribs were audited. Statistical process control charts showed significant improvement in the primary outcome of interest, overall compliance with SSP, for all participating NICUs. Compliance increased from 47.7% at the start of the project to 75.5% by the end of year 1 and to 81.0% by June 2017.

This state-wide collaborative has improved SSP compliance in all level III MA NICUs and demonstrated that on a state-wide level, SSPs can be routinely integrated into the care of high-risk infants.