Improving Infant Safe Sleep Practices in the Newborn Nursery

Purpose/Objectives: While the “Back to Sleep” public health campaign has made great strides in decreasing rates of Sudden Infant Death Syndrome (SIDS), many babies still sleep in unsafe environments both in the hospital setting and at home, and sleep-related deaths still occur. Adherence to the American Academy of Pediatrics (AAP) infant safe sleep guidelines [1] in our newborn nursery was poor, especially in respect to extra items within the sleeping area. This project aimed to improve adherence to the guidelines in the newborn nursery using a QI approach. SMART Goal: Improve the percentage of infants with “Perfect Sleep” (sleeping on their backs in an empty bassinette without additional items, appropriately bundled and with the head of the bassinette flat) from baseline of 41.9% to 70% within a year. Design/Methods: An audit tool was created to record infants’ sleeping environments within the nursery. The first PDSA cycle created an educational module based on the AAP 2016 infant safe sleep guidelines. Mother-Baby nurses viewed the module and completed a pre- and post- knowledge survey. Subsequent interventions focused on 3 main areas over 6 additional PDSA cycles- continued nursing education, parent education, and providing sleep sacks (wearable blankets) for infant sleep. Results: 64.8% (35/54) nurses completed the educational module and surveys. Baseline data showed good knowledge of back to sleep, empty sleep area, no loose blankets in the crib, no bed-sharing, and room sharing recommendations. After completing the module, nurses showed increased knowledge of several other AAP recommendations. The correct answer on a question regarding elevating head of bed increased from 82% to 97%, and the correct answer to a question on prone positioning and amniotic fluid clearance increased from 65% to 94%. Nurses’ perception of their knowledge of the recommendations improved (“some” or “good” knowledge of AAP recommendations increased from 65% to 94%). Figures 1 and 2 show control charts of select results. Although we did not quite meet our SMART goal of 70%, we demonstrated an increase in our composite measure “Perfect Sleep” from a baseline of 42% to 67%. Additionally, we saw a statistically significant improvement in each of the individual components of the AAP Safe Sleep recommendations over the baseline. For example, the percentage of sleep areas containing extra items fell from 38% to 20%, and the percentage of infants inappropriately bundled fell from 15% to 4%. Conclusion/Discussion: A QI approach can be used in the newborn nursery setting to both improve adherence to individual elements of the AAP’s infant safe sleep guidelines and to improve the percentage of infants demonstrating “Perfect Sleep” in complete adherence to the guidelines. Future work will investigate whether this improved adherence within the nursery translates to improved parental adherence after discharge.