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Published on: January 26, 2019
Improving Adherence to Safe Sleep Guidelines for Hospitalized Infants at a Children's Hospital
Adolfo L Molina1, Meghan Harrison2, Candice Dye3
1Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Alabama at Birmingham, Birmingham, Ala.
Insights
Implementing targeted interventions significantly improved infant safe sleep adherence in hospitals, creating a safer sleep culture. This study highlights the success of quality improvement methods in pediatric care settings.
Area of Science:
- Pediatric patient safety
- Healthcare quality improvement
- Infant sleep medicine
Background:
- Sudden unexpected infant deaths pose a national health challenge.
- Local adherence to safe sleep recommendations was suboptimal.
- A tertiary children's hospital initiated a multidisciplinary effort to enhance infant sleep environments.
Purpose of the Study:
- To improve adherence to safe sleep recommendations for hospitalized infants.
- To achieve a 95% weekly average adherence rate within 12 months.
- To address specific areas of nonadherence identified through hospital data.
Main Methods:
- Utilized the American Academy of Pediatrics policy statement as a guideline.
- Implemented targeted interventions based on hospital-specific data.
- Tracked adherence using a proportions process control chart (p-chart) over 52 weeks.
- Employed Student's t-testing to analyze adherence changes.
Main Results:
- Overall safe sleep adherence significantly increased from 70.8% to 94.7%.
- 100% crib adherence rates rose from 0% to 70.4%.
- The p-chart indicated two significant trend shifts, demonstrating sustained improvement.
Conclusions:
- Quality improvement (QI) methodology effectively enhanced adherence to safe sleep guidelines.
- Observed behavioral changes signify a positive shift in safe sleep culture.
- Sustained adherence in follow-up audits confirms the long-term impact of interventions.
Introduction:
Sudden unexpected infant deaths are a major problem nationally. We had poor adherence to safe sleep recommendations locally at our institution. Given the significance of this problem, hospital administration at a tertiary children's hospital tasked a multidisciplinary group of faculty and staff with improving sleep environments for hospitalized infants.
Methods:
Our safe sleep task force implemented targeted interventions using the American Academy of Pediatrics policy statement as the gold standard and based on hospital data to address areas of greatest nonadherence to recommendations. We aimed to improve weekly average adherence to 95% over 12 months. A proportions process control chart (p-chart) tracked average weekly adherence over a 52-week time frame. In addition, we performed Student's t-testing to evaluate differences in adherence over time.
Results:
There was a significant improvement in overall adherence to safe sleep recommendations from baseline (M = 70.8%, SD 21.6) to end of study period (M = 94.7%, SD 10.0) [t(427) = -15.1, P ≤ 0.001]. Crib audits with 100% adherence increased from a baseline (M = 0%, SD 0) to the end of the study period M = 70.4%, SD = 46) [t(381)= -21.4, P ≤ 0.001]. This resulted in two trend shifts on the p-chart using Institute for Healthcare Improvement control chart rules.
Conclusions:
Targeted interventions using QI methodology led to significant increases in adherence to safe sleep guidelines. Notable improvements in behavior indicated significant changes in safe sleep culture. We also noted continued adherence in follow-up audits reflecting sustainability.
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