Modeling Safe Infant Sleep in the Hospital

Despite reductions in the rate of sudden infant death syndrome (SIDS) over the last 25 years, over 3000 infant deaths annually in the US are attributable to sleep-related causes. We aimed to improve safe sleep practice (SSP) adherence by healthcare providers working with infants admitted to an inpatient pediatric unit in an urban academic center specifically increasing compliance on five core SSP (supine, alone in the crib, no objects in crib, appropriate bundling, and flat crib).

This Quality Improvement project evaluated a staff education intervention using a pre- and post-design. Surveys of providers determined baseline SSP knowledge. Adherence to SSP in the hospital was audited before and after education. One hundred pre-intervention infant sleep placement observations were recorded and 123 were collected post-intervention.

Surveyed providers had appropriate knowledge of SSP; however, baseline audits indicated that no patients met all SSP practices in the hospital. Post-intervention adherence to SSP showed significant (p < .05) improvements in keeping the crib flat, removing objects from the crib, and avoiding over-bundling. Overall, SSP adherence increased by 12.5% post-intervention.

This quality improvement project suggests that the inpatient setting provides opportunities for providers to demonstrate SSP but that healthcare providers often do not follow SSP in practice. Continued education can lead to improvements in SSP adherence ensuring that hospitals are modeling SSP for the families of infants.

Limited improvements to SSP adherence illustrate the complexities of modifying provider behaviors in the absence of formal policy.