A Successful Quality Improvement Project to Improve Infant Safe Sleep Practice

Abstract

Objective To prevent sleep‐related infant deaths by updating the current standard of practice in a hospital to endorse the safe sleep recommendations of the American Academy of Pediatrics (AAP) Task Force on Sudden Infant Death. Georgia's rate of sleep‐related infant deaths is consistently greater than national averages. Design Crib observations and chart audits were done before and after the educational intervention. Prior to the educational intervention, newborn sleep practices, unit guidelines for safe sleep, and parent education were evaluated and updated to meet the 2011 AAP standards. Medical and nursing staff participated in an educational session on safe sleep. Sample Convenience sample of crib observations (116) and chart audits (82) before and after educational sessions. One hundred fifty registered nurses, techs, clerks and obstetric, pediatric, and family medicine physicians participated. Methods Crib observations, chart audits (pre‐ and postimplementation), and educational sessions (pretest, posttest). Implementation Strategies A Safe Sleep protocol was implemented after completion of educational sessions. This protocol included distribution of educational materials to mothers at delivery and 24 hours postpartum. Changes were made in the electronic chart to enable staff to better document a safe sleep environment and education. Results A statistically significant change in the crib observations and chart audit data pre‐ and postimplementation of Safe Sleep guidelines and educational sessions was found. In the postimplementation crib observations, 18% of the cribs had objects in them compared to 92% preimplementation. Comparison data regarding education pre‐ and postimplementation were statistically significant for all topics, including an increase in back to sleep education (19%), avoiding smoke (182%), and avoiding cosleeping (380%). Safe sleep educational topics that had not previously been documented (pacifiers, no objects in crib, no overbundling, firm sleep surface) are being documented more than 95% of the time. The posttest scores increased from 6.9% to 32% among all groups of providers. Conclusion/Implications for Nursing Practice Through implementation of Safe Sleep protocols on a nursing unit and education of medical and nursing staff, safe sleep education can easily be delivered in the hospital prior to discharge and modeling of safe sleep environments can occur. Comprehensive education and role modeling for all parents of newborns has the potential to reduce the number of sleep‐related deaths that occur. To prevent sleep‐related infant deaths by updating the current standard of practice in a hospital to endorse the safe sleep recommendations of the American Academy of Pediatrics (AAP) Task Force on Sudden Infant Death. Georgia's rate of sleep‐related infant deaths is consistently greater than national averages. Crib observations and chart audits were done before and after the educational intervention. Prior to the educational intervention, newborn sleep practices, unit guidelines for safe sleep, and parent education were evaluated and updated to meet the 2011 AAP standards. Medical and nursing staff participated in an educational session on safe sleep. Convenience sample of crib observations (116) and chart audits (82) before and after educational sessions. One hundred fifty registered nurses, techs, clerks and obstetric, pediatric, and family medicine physicians participated. Crib observations, chart audits (pre‐ and postimplementation), and educational sessions (pretest, posttest). A Safe Sleep protocol was implemented after completion of educational sessions. This protocol included distribution of educational materials to mothers at delivery and 24 hours postpartum. Changes were made in the electronic chart to enable staff to better document a safe sleep environment and education. A statistically significant change in the crib observations and chart audit data pre‐ and postimplementation of Safe Sleep guidelines and educational sessions was found. In the postimplementation crib observations, 18% of the cribs had objects in them compared to 92% preimplementation. Comparison data regarding education pre‐ and postimplementation were statistically significant for all topics, including an increase in back to sleep education (19%), avoiding smoke (182%), and avoiding cosleeping (380%). Safe sleep educational topics that had not previously been documented (pacifiers, no objects in crib, no overbundling, firm sleep surface) are being documented more than 95% of the time. The posttest scores increased from 6.9% to 32% among all groups of providers. Through implementation of Safe Sleep protocols on a nursing unit and education of medical and nursing staff, safe sleep education can easily be delivered in the hospital prior to discharge and modeling of safe sleep environments can occur. Comprehensive education and role modeling for all parents of newborns has the potential to reduce the number of sleep‐related deaths that occur.