Do nurses provide a safe sleep environment for infants in the hospital setting? An integrative review.

Sudden Infant Death Syndrome: An Update

Sleep-related deaths were the fourth leading cause of infant death in Tennessee between 2014 and 2018. In response, the Tennessee Initiative for Perinatal Quality Care developed a statewide quality improvement project, which focused on the demonstration and enforcement of a safe sleep environment in participating birthing hospitals to help families learn and practice the same at home. The project's aim was to improve the percent of infants audited for safe sleep practices (0-12 mo of age, cared for in participating newborn nurseries or neonatal intensive care units) that were compliant with the practices recommended by the 2016 American Academy of Pediatrics (AAP) Task Force on Sudden Infant Death Syndrome. Participating teams were required to develop and implement safe sleep policies in compliance with the AAP recommendations, provide safe sleep education to staff and families, and complete monthly safe sleep audits. A tool was provided to assess whether each audited infant was compliant with safe sleep recommendations and any reason(s) the infant was not compliant. Teams met virtually for monthly huddles and semiannual learning sessions to discuss the development and testing of change ideas. The project teams were able to improve the percent of infants audited that were compliant with safe sleep recommendations by 22% over the course of the project. Audits revealed the main reasons for noncompliance were additional objects in the crib (49%, 329/671), unsafe bedding (27%, 181/671), and head of bed elevation (24%, 164/671). This project demonstrates the positive impact that a statewide quality improvement initiative can have on identifying and addressing barriers, sharing resources and education, and monitoring local and statewide data, which led to increased compliance with safe sleep recommendations in the hospital. Safe sleep education and monitoring should be ongoing as new parents and staff always need to be educated on safe sleep principles. · In 2020, 25% of all infant deaths in Tennessee were due to an unsafe sleep environment.. · Sleep-related deaths in infants are frequently preventable.. · State quality improvement projects are effective in increasing safe sleep compliance.. · State perinatal quality collaboratives can partner with their State Department of Health, local hospitals, and providers, to increase awareness, educate parents, and model a safe sleep environment..

A Successful Quality Improvement Project to Improve Infant Safe Sleep Practice

Endorsing Safe Sleep: Helping Nurses Turn Recommendations Into Reality

BackgroundIn the United States, sudden infant death syndrome (SIDS) is the leading cause of death in infants aged 1 month to 1 year. Approximately 3500 infants die from SIDS and sleep-related reasons on a yearly basis. Unintentional sleep-related deaths and bed sharing, a known risk factor for SIDS, are on the rise. Furthermore, ethnic disparities exist among those most affected by SIDS. Despite public health campaigns, infant mortality persists. Given the popularity of social media, understanding social media conversations around SIDS and safe sleep may assist the medical and public health communities with information needed to spread, reinforce, or counteract false information regarding SIDS and safe sleep.ObjectiveThe objective of our study was to investigate the social media conversation around SIDS and safe sleep to understand the possible influences and guide health promotion efforts and public health research as well as enable health professionals to engage in directed communication regarding this topic.MethodsWe used textual analytics to identify topics and extract meanings contained in unstructured textual data. Twitter messages were captured during September, October, and November in 2017. Tweets and retweets were collected using NUVI software in conjunction with Twitter’s search API using the keywords: “sids,” “infant death syndrome,” “sudden infant death syndrome,” and “safe sleep.” This returned a total of 41,358 messages, which were analyzed using text mining and social media monitoring software.ResultsMultiple themes were identified, including recommendations for safe sleep to prevent SIDS, safe sleep devices, the potential causes of SIDS, and how breastfeeding reduces SIDS. Compared with September and November, more personal and specific stories of infant loss were demonstrated in October (Pregnancy and Infant Loss Awareness Month). The top influencers were news organizations, universities, and health-related organizations.ConclusionsWe identified valuable topics discussed and shared on Twitter regarding SIDS and safe sleep. The study results highlight the contradicting information a subset of the population is exposed to regarding SIDS and the continued controversy over vaccines. In addition, this analysis emphasizes the lack of public health organizations’ presence on Twitter compared with the influence of universities and news media organizations. The results also demonstrate the prevalence of safe sleep products that are embedded in safe sleep messaging. These findings can assist providers in speaking about relevant topics when engaging in conversations about the prevention of SIDS and the promotion of safe sleep. Furthermore, public health agencies and advocates should utilize social media and Twitter to better communicate accurate health information as well as continue to combat the spread of false information.

Creating a Safe Sleep Environment for the Infant: What the Pediatric Nurse Needs to Know

Introduction: Sudden Infant Death Syndrome (SIDS) is one of the leading causes of infant deaths in the post neonatal period.A safe sleep environment should be created to reduce SIDS risk factors.The aim of this study is to determine the knowledge levels of Turkish family health nurses regarding SIDS and safe sleep.Methods: This descriptive study was conducted with 115 nurses working in family health centers in a province in Trkiye between March and July 2021.Data were collected using a form developed by the researcher.Results: It was found that the nurses' average score on SIDS and safe sleep was 19.59 (3.36) out of 30 and that nobody correctly responded to every question on the information form.The average knowledge level score of married nurses was higher than that of single ones, and nurses with one or two children outperformed those who had no or more than three kids (p<0.05).The average knowledge level score rose in tandem with the nurses' educational attainment (p<0.05). Discussion and Conclusion:The knowledge of nurses regarding SIDS and safe sleep was found to be above average, while it was found that their knowledge was incomplete.It was concluded that nurses' knowledge concerning SIDS and safe sleep practices needed to be strengthened.The inclusion of SIDS and safe sleep-in undergraduate nursing curricula, along with in-service training, is projected to help nurses become more knowledgeable and aware of the concern.

Objective: Sudden infant death syndrome (SIDS) remains the leading cause of death in the postnatal period. Accidental suffocation and strangulation in bed deaths have quadrupled. The American Academy of Pediatrics (AAP) expanded its back to sleep recommendations to include a safe sleep environment. The AAP makes recommendations to healthcare professionals to model safe sleep practices and educate families on SIDS reduction strategies. The dual aims of this project were to develop a safe sleep educational model for our neonatal intensive care unit (NICU), and to increase the percentage of eligible infants in a safe sleep environment.Method: The NICU Safe Sleep policy was revised to include AAP updated recommendations. Educational updates were provided to staff. A safe sleep packet with a video was created for and shared with families. Wearable blankets were implemented. A safe sleep observation checklist was created. Baseline data and post-education random observations data were collected and shared with staff.Results: At baseline, 21% of eligible infants were in a safe sleep environment. After education and reported observation, safe sleep compliance increased to 88%.Conclusions: With formal staff and family education, optional wearable blanket, and data sharing, safe sleep compliance increased and patient safety improved.

BackgroundThe American Academy of Pediatrics (AAP) recommends the ABCs of safe infant sleep (alone, back, clear crib) to combat the increasing rates of Sudden Unexplained Infant Death (SUID). It is unclear if these recommendations are followed for infants hospitalized in pediatric facilities after the newborn period. The objectives of this study were to assess baseline infant sleep behaviors at a tertiary care freestanding pediatric hospital and to evaluate the effectiveness of a hospital-based infant safe sleep program in improving adherence to safe sleep recommendations.MethodsA quality improvement program with pre- and post- analyses was performed on a convenience sample of infants < 12-months old utilizing a crib audit tool on two general pediatric inpatient units. The crib audit tool was used before and after the safe sleep program intervention. It recorded the infant’s sleep position, location during sleep, and sleep environment. Interventions included: 1) nursing education, 2) crib cards with a checklist of the ABC’s of safe sleep provided for the cribs of hospitalized infants, and 3) tracking boards to report weekly measured compliance with the ABCs. Chi square analysis was used to compare adherence to recommendations before and after program implementation.ResultsThere were 62 cribs included pre-intervention and 90 cribs post-intervention. Overall, there was no significant change in safe sleep positioning (81% to 82%, p = 0.97). There was a significant increase in adherence to the safe sleep environment recommendation (3% to 38%, p < 0.01). Overall safe sleep, including both position and environment, referred to as ABC compliance, improved from 3% pre-intervention to 34% post-intervention (p < 0.01). Only 18% of cribs audited displayed a crib card, demonstrating poor compliance on placement of the cards. There was no significant difference in compliance with safe sleep recommendations between infants with a crib card compared to those without (25% vs. 37%, p = 0.51).ConclusionsSignificant improvements were made in sleep environments and overall safe sleep compliance after introduction of crib cards and tracking boards. Most likely the crib auditing process itself and the tracking boards had a larger impact than the crib cards.

BackgroundThe American Academy of Pediatrics (AAP) recommends infants should be Alone, on their Back, and in a clear Crib to combat relatively stagnant rates of sudden unexpected infant death (SUID). These are referred to as the ABCs of safe sleep. Studies have shown these recommendations are not consistently followed in the hospital setting, but further investigation would determine how to improve the rate of adherence. The objective of this study was to evaluate the impact of an expanded safe sleep initiative at three Georgia free-standing children’s hospital campuses before and after a multipronged safe sleep initiative.MethodsA quality improvement program with a pre/post analysis was performed using a convenience method of sampling. Infants < 12 months old in three inpatient pediatric campuses were analyzed pre- and post- interventions. The intervention included: 1) nursing education, 2) identification of nurse “safe sleep” champions, 3) crib cards, 4) crib audits, and 5) weekly reporting of data showing nursing unit ABC compliance via tracking boards. The goal was ABC compliance of ≥25% for the post-intervention period. A standardized crib audit tool evaluated sleep position/location, sleep environment, and ABC compliance (both safe position/location and environment). Chi square analysis, Fisher’s exact test, and logistic regression were used to compare safe sleep behaviors before and after the interventions.ResultsThere were 204 cribs included pre-intervention and 274 cribs post-intervention. Overall, there was not a significant change in sleep position/location (78.4 to 76.6%, p = 0.64). There was a significant increase in the percent of infants sleeping in a safe sleep environment following the intervention (5.9 to 39.8%, p < 0.01). Overall ABC compliance, including both sleep position/location and environment, improved from 4.4% pre-intervention to 32.5% post-intervention (p < 0.01). There was no significant variability between the hospitals (p = 0.71, p = 1.00).ConclusionsThe AAP’s safe sleep recommendations are currently not upheld in children’s hospitals, but safer sleep was achieved across three children’s campuses in this study. Significant improvements were made in sleep environment and overall safe sleep compliance with this multi-pronged initiative.

Sudden infant death syndrome (SIDS) remains the third leading cause of infant death in the United States and the leading cause of death beyond 1 month of age. In 2011, the American Academy of Pediatrics (AAP) released the newest SIDS risk-reduction recommendations, which address healthcare providers in neonatal intensive care units (NICUs). Little is known about neonatal nurses' SIDS prevention strategies since the release of these newest recommendations. To assess neonatal nurses' beliefs, knowledge, and practices regarding SIDS prevention in both the NICU and step-down transitional care unit (TCU). A prospective-descriptive design was used. The 33-item SIDS Risk-Reduction Questionnaire was distributed to a convenience sample of nurses in a level III NICU/TCU in the Midwest. Two hundred questionnaires were distributed; 96 (48%) were returned completed. Fifty-three percent of nurses strongly agreed that SIDS recommendations make a difference in preventing SIDS and 20% strongly believed that parents model SIDS prevention practices employed by staff. A majority of nurses correctly identified 2011 recommendations. Sixty-three percent of nurses often or always gave parents verbal information and 28% often or always gave parents written information regarding SIDS. Differences were seen between NICU and TCU nurses concerning beliefs and practices, suggesting that TCU nurses more consistently follow SIDS recommendations. Increased neonatal nursing and parental education regarding SIDS prevention and updated hospital policies promoting safe sleep are paramount. Larger multicenter studies in level II/III NICUs are needed to provide further data on SIDS attitudes and practices.

The American Academy of Pediatrics (AAP) published Recommendations for a Safe Infant Sleeping Environment; however, parents still report frequent use of dangerous infant sleep practices. An online computer program was developed and piloted to investigate whether parents could be taught to create safe sleep environments using online training. Computerized safe sleep environments created by parents of children 0 to 23 months were assessed for compliance with the AAP Sleep Recommendations. Using a pre- and posttest design, the present study investigated the effectiveness of online instructions (adapted standard of care) and a computerized behavioral skills training package, which included instructions, modeling, rehearsal, and feedback. Additional pre- and posttests assessed parents’ ability to identify sleep risks in 3 pictures to assess generalization of skills learned. Overall, participants demonstrated significant improvements from pre- to posttest across both treatment conditions on the creation of a safe sleep environment and on the free response identification of risks in 3 sleep environments. Performance did not significantly differ between the treatment groups. Results suggest considerable promise for technology-aided approaches in training parents to create a safe sleep environment. Implications for Impact Statement Creating safe infant sleep environments is important and necessary in reducing sudden and unexpected infant deaths. In this online study, caregivers created safer infant sleep environments and identified more sleep environment risks after computer-based training and when using a sleep safety checklist. Providing access to this computer-based training and/or sleep safety checklist can teach caregivers about infant sleep safety and may result in safer infant sleep environments.

Integration of safe sleep and sudden infant death syndrome (SIDS) education among parents of preterm infants in the Neonatal Intensive Care Unit (NICU)

Despite American Academy of Pediatrics (AAP) recommendations, many hospitalized infants are not observed in the appropriate safe sleep environment. Caregivers tend to model sleep patterns observed in a hospital setting. This project assessed the change in infant safe sleep practices within 6 children's hospitals after the implementation of a statewide quality improvement program. The AAP recruited hospitalists from each of the state's children's hospitals and asked them to form "safe sleep teams" within their institutions. Teams used a standardized data tool to collect information on the infant's age and sleep position/environment. They collected baseline data and then weekly for the duration of the 12-month project. Teams were required to implement at least 3 Plan-Do-Study-Act cycles. We calculated changes in safe sleep practices over time. Providers received Maintenance of Certification Part IV credit for participation. Teams collected 5343 audits at all participating sites. At baseline, only 279 (32.6%) of 856 of the sleeping infants were observed to follow AAP recommendations, compared with 110 (58.2%) of 189 (P < .001) at the project's conclusion. The presence of empty cribs was the greatest improvement (38.1% to 67.2%) (P < .001). Removing loose blankets (77.8% to 50.0%) (P < .001) was the most common change made. Audits also showed an increase in education of families about safe sleep practices from 48.2% to 75.4% (P < .001). Multifactorial interventions by hospitalist teams in a multi-institutional program within 1 state's children's hospitals improved observed infant safe sleep behaviors and family report of safe sleep education. These behavior changes may lead to more appropriate safe sleep practices at home.

Dear Editor: Dr. Lawrence's editorial, “Solomon's Wisdom,”1 describes her account of a May 19, 2014 meeting at the National Institutes of Health, to which breastfeeding and infant safe sleep experts were invited. She describes the program as being planned by the American Academy of Pediatrics' (AAP's) Task Force on SIDS [Sudden Infant Death Syndrome] and recalls that no breastfeeding advocates were invited to speak. She relates that the Task Force was unaware of the critical congenital heart disease campaign, with the implication that many deaths attributed to SIDS may be undiagnosed heart disease and could be averted with neonatal pulse oximetry screening. She advocates for full neonatal metabolic screening nationally, again implying that many SIDS cases are undiagnosed cases of metabolic disease. Finally, Dr. Lawrence describes an upcoming “final report” of the Task Force, in which there would be “vigorous” support against co-sleeping and no support of breastfeeding. As members of the Task Force on SIDS, we must respectfully point out the inaccuracies in Dr. Lawrence's statements. Several Task Force members attended the meeting, convened by the National Institutes of Health to bring together key stakeholders from the breastfeeding community and Safe to Sleep® campaign to determine best strategies to promote safe infant sleep and breastfeeding within the parameters of the AAP's safe infant sleep recommendations. Invited speakers included a lactation consultant (International Board-Certified Lactation Consultant) and a public health official, who shared their experiences promoting both breastfeeding and safe infant sleep messages, and one Task Force member. Before a diagnosis for SIDS is made, a complete autopsy (including examination of the heart), review of the clinical history, and death scene investigation are required. The autopsy generally includes repeat newborn metabolic screening. If any condition (e.g., metabolic disorder, heart defect) is found during investigation of a sudden, unexpected infant death that is, in the opinion of the coroner or medical examiner, responsible for the infant's demise, the cause of death will be attributed to that condition. Thus, these cases are not considered SIDS and not included in SIDS statistics. An exception is prolonged Q-T syndrome, which is unlikely to be found at autopsy; however, it is also unlikely to be detected through newborn pulse oximetry. Therefore, although these newborn screenings result in early detection and prevention of early death, because the conditions discovered through these tests have been, for the last 20 years, largely already discovered at autopsy, these mandates will unfortunately not eliminate SIDS or other sleep-related infant deaths. Dr. Lawrence alludes to the imminent release of the Task Force's “final report.” There is no such report currently pending. We refer readers to our current (2011) Policy Statement2 and Technical Report,3 which were approved by the AAP Section on Breastfeeding before publication. In these reports, we strongly support breastfeeding: “Breastfeeding is associated with a reduced risk of SIDS. If possible, mothers should exclusively breastfeed or feed with expressed human milk (i.e., not offer any formula or other non–human milk–based supplements) for 6 months, in alignment with recommendations of the AAP.”2 With regard to our “vigorous” campaign against co-sleeping, we strongly support the form of co-sleeping in which the infant sleeps within arm's reach of the parent in a safety-approved, bedside bassinet, portable crib, or crib, such that the infant is within sight, sound, and/or touch. This arrangement, supported by research, reduces the risk of SIDS and can aid in breastfeeding. However, we stand firmly by our recommendation against bedsharing for infants <1 year, which is based on well-designed, peer-reviewed, case-control studies. We agree that there are circumstances (e.g., one/both parents who smoke, parent who has consumed alcohol or sedating substances, on a couch/armchair, with pillows/blankets) that make bedsharing especially hazardous (all described in the 2011 recommendations). However, there is clear and consistent evidence that bedsharing (compared with roomsharing without bedsharing) increases the risk for SIDS and sleep-related deaths, even for infants who are breastfed and whose mothers do not smoke, who are at lower risk for SIDS. A recent meta-analysis of five major case-control studies (1,472 SIDS cases, 4,679 controls) examined the association between bedsharing and SIDS, with particular emphasis on lower-risk babies (i.e., breastfed, nonsmoking mothers). Even among these lowest-risk infants, bedsharing infants were at a fivefold higher risk for SIDS until 3 months.4 We feel an obligation to provide this information to families to enable them to make informed choices; to not do so is, in our opinion, irresponsible. It is our sincere hope that breastfeeding and safe sleep advocates can work together to achieve our common goals of improving infant health and decreasing infant mortality.