IntroductionPromoting Safe Sleep to decrease sudden unexpected infant death is challenging in the hospital setting. Local ProblemConcern for adherence to Safe Sleep practice across inpatient units at a large pediatric hospital. MethodsUtilized Quality improvement (QI) methodologies to promote Safe Sleep across all units. InterventionsDevelopment of a multidisciplinary expert group, hospital-wide guidelines, targeted interventions, and bedside audits to track progress. ResultsAdherence to Safe Sleep practices improved from 9% to 53%. Objects in the crib were a major barrier to maintaining a Safe Sleep environment. Safe Sleep practices were less likely to be observed in infants with increased medical complexity (p=.027). ConclusionsQI methodology improved adherence to infant Safe Sleep guidelines across multiple units. Medically complex infants continue to be a challenge to Safe Sleep. Therefore, ongoing education for staff and further research into best practices for the most complex infant populations are necessary.