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Improving Compliance With Safe Sleep Guidelines for Vulnerable Patients in a Community Safety Net Hospital Neonatal
Andrew Beverstock1, Samantha Carlton1, Hillary Lee1
1From the Division of Neonatology, Baylor College of Medicine/Texas Children's Hospital, Houston, Tex.
Insights
Safe sleep practices in the neonatal intensive care unit (NICU) were improved through targeted interventions. Compliance increased from 58% to 91%, promoting safer sleep for infants post-discharge.
Area of Science:
- Neonatal care
- Pediatric safety
- Quality improvement in healthcare
Background:
- Unsafe sleep practices are a leading cause of preventable infant mortality.
- Many infants in the neonatal intensive care unit (NICU) experience unsafe sleep conditions.
- Establishing safe sleep modeling in the NICU can improve post-discharge parental adherence.
Purpose of the Study:
- To increase compliance with safe sleep recommendations in level II and III NICUs.
- To improve adherence to national safe sleep guidelines for infants over 32 weeks gestation.
- To achieve an 85% weekly compliance rate with safe sleep standards by March 2025.
Main Methods:
- Implemented a multi-cycle Plan-Do-Study-Act (PDSA) quality improvement project.
- Included education for residents, fellows, and nurses on NICU safe sleep standards.
- Introduced non-reclined cribs and bedside reminder signs.
Main Results:
- Achieved a significant increase in mean compliance with safe sleep practices.
- Mean compliance rose from a baseline of 58% to 91% post-intervention.
- Exceeded the study aim of 85% compliance.
Conclusions:
- The interventions successfully enhanced safe sleep compliance among NICU nursing staff.
- Future efforts will focus on embedding safe sleep practices into the NICU culture for sustainability.
- Ongoing strategies include promoting "nursing safe sleep champions," regular audits, and using sleep sacks.
Introduction:
Modeling safe sleep in the neonatal intensive care unit (NICU) increases the likelihood that parents will follow these practices after discharge. Many NICU infants are put to sleep unsafely, and unsafe sleep practices are the leading cause of nonnatural death among children locally. We created safe sleep standards for infants older than 32 weeks based on national guidelines: infants should be placed supine in a flat, empty crib and should never be swaddled loosely. We aimed to increase the weekly percentage compliance with safe sleep recommendations from a baseline of 58% (0.58 compliant) to 85% (0.85 compliant) by March 2025 in our level II and III NICUs based on random crib audits.
Methods:
In plan-do-study-act cycle 1, we educated residents and fellows about safe sleep practices in the NICU and changed our daily electronic medical record smart phrase to integrate safe sleep readiness. In PSDA cycle 2, we educated nurses about safe sleep and implemented nonrecline cribs. In plan-do-study-act cycle 3, we implemented bedside signs for each crib with reminders of our standards.
Results:
We successfully achieved our aim. Our mean compliance increased from 58% (0.58 compliant) at baseline to 91% (0.91 compliant) postintervention.
Conclusions:
Our project successfully improved compliance with safe sleep practices of the current nursing staff: our interventions moving forward will focus on embedding safe sleep practices into our NICU culture so that our changes are sustainable. Our ongoing interventions will be promoting "nursing safe sleep champions," continuing to perform regular audits, and further implementing the use of sleep sacks instead of loose swaddles.
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