Related Experiment Video
Updated: Jan 19, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
The wake project: Improving safe sleep practices in a neonatal intensive care unit
S Uduwana1,2, L Garcia2, S L Nemerofsky1
1Albert Einstein College of Medicine, Montefiore Medical Center - Children's Hospital at Montefiore, Bronx, NY, USA.
Insights
New York City
Area of Science:
- Neonatal Intensive Care Unit (NICU) Quality Improvement
- Infant Safe Sleep Practices
- Public Health Initiatives
Background:
- Bronx County, NYC, has a high rate of sleep-related infant deaths (SRID), particularly among non-Hispanic Black populations.
- High preterm birth rates in the Bronx necessitate targeted interventions.
- A quality improvement project focused on improving infant safe sleep in a high-risk NICU population.
Purpose of the Study:
- To develop and implement an educational initiative on infant safe sleep (SS).
- To improve safe sleep practices (SSP) in a level III NICU.
- To address a critical public health issue in a high-risk demographic.
Main Methods:
- Utilized multiple plan-do-study-act (PDSA) cycles over 12 months.
- Employed run charts to guide interventions and track progress.
- Implemented multifactorial interventions including nurse education, visual aids, and feedback mechanisms.
Main Results:
- Over 600 crib checks were conducted during the project.
- Safe sleep (SS) positioning compliance increased from 7% at baseline to 96% post-intervention.
- Significant improvement in safe sleep practices within the NICU setting.
Conclusions:
- Multifactorial interventions effectively enhanced safe sleep compliance among NICU nurses.
- Nurse motivation, team empowerment, and a dedication to culture change were vital for project sustainability.
- The project demonstrated a successful strategy for improving infant safe sleep in a high-risk population.
Background:
Every year, about 50 babies in New York City die from a sleep-related injury. The Bronx County ranked second highest rate of sleep-related infant deaths (SRID) at 0.5 per 1000 among the other boroughs. The highest rate was among blacks and the rate of SRID cases were highest in our population at 0.97 (zip code 10466) among all other Bronx neighborhoods which comprises 77% of non-Hispanic black population. Further, Bronx has the highest preterm birth rate at 9.5%. This quality improvement (QI) project aimed to develop and implement an educational initiative on infant safe sleep (SS) to improve "Safe Sleep Practices (SSP) in a level III neonatal intensive care unit (NICU) for one of the highest risk populations in the country.
Methods:
Baseline data was collected prior to initiating the QI project. Multiple plan-do-study-act (PDSA) cycles were completed over a 12 month period. Run charts were utilized to identify improvement and guide interventions. These interventions included education for nurses, crib cards, posters, feedback forms, grand rounds and small group discussions.
Results:
Approximately 600 crib checks (CC) were performed over the duration of this project. At baseline, 7% of infants were placed in a SS position in the NICU. Following the QI project, SS position increased to 96% of infants.
Conclusion:
Multifactorial interventions significantly improved SS compliance among NICU nurses. Cultivating personal motivation among nurses, consistent empowerment and dedication to culture change by the entire team was crucial for the sustainability of the project.
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