Safe to Sleep: A Community Quality Improvement Project Cari - - PowerPoint PPT Presentation

Safe to Sleep: A Community Quality Improvement Project

Cari Schmidt, PhD

Background: Infant Mortality Rate

• Sedgwick County IMR = 7.2/1,000

– Higher than Kansas and US rates

• A Perinatal Period of

Risk (PPOR) analysis suggested nearly 150 PREVENTABLE deaths (2008 – 2012)

Figure: KDHE. Infant Deaths by Cause 2008-2012. Sedgwick County (N=291).

Background: Safe Sleep Guidelines

• American Academy of Pediatrics has

recommendations to reduce the risk

• f sleep-related death.
• ABC’s of Safe Sleep

– Alone – Back – Clutter-free Crib

Background: Community Collaborative

Safe Sleep Research Study

• Tested a Safe Sleep Bundle on hospital’s well

newborn floor

– Hospital policy, nurse training & agreement to promote infant safe sleep – Safe sleep instruction at room orientation instead of dismissal – Required viewing of “ABC’s of Safe Sleep” video – Posters in rooms & take-home materials for parents

• Implementing a Safe Sleep Bundle improved safe

sleep in the hospital from 25% of well newborns to 58% (Mason 2013)

• At 2 month well-child check following hospital

education, knowledge does not improve & behavior does not reflect intentions

Quality Improvement Pediatric Inpatient Unit

• Setting and Population

– Tertiary community hospital

• 34 bed general pediatric acute care unit
• Annual pediatric admissions exceed 3,000

– March 2012 – June 2012 – Infant 0-6 months of age admitted to the general pediatric unit were

• bserved for sleep location, position

and environment (e.g. items in crib)

Quality Improvement Pediatric Inpatient Unit

Quality Improvement Pediatric Inpatient Unit

• Baseline Data (N=20)

– 100% safe positon (back) – 70% safe location – 1% safe environment (no unsafe items in crib) 0% 20% 40% 60% 80%

Quality Improvement Pediatric Inpatient Unit

• Key Drivers

– No policy for infants 0-12 months of age – Inconsistent practices/knowledge of staff – Full-sized infant cribs and lack of alternate storage meant diapers, wipes, blankets, extra linens,

• etc. were often found

in cribs

Quality Improvement Pediatric Inpatient Unit

• Bundle components :

– Safe sleep policy for infants – Training for staff with a signed Declaration

• f Safe Sleep
• Staff included respiratory therapists, and

allied health (e.g. child life specialists)

– Caregivers required to watch Safe Sleep video and provided take-home materials – Environmental modifications

• Three-drawer carts in each room

Quality Improvement Pediatric Inpatient Unit

• Observations began 1 month after

training and implementation

• Post-intervention (N=31)

– 100% safe position – 68% safe location – 13% safe environment – 2% with all three components

Quality Improvement Pediatric Inpatient Unit

0% 10% 20% 30% 40% 50% 60% 70% 80% Burp Cloths* Extra Blankets Diapers* Clothes Pillow Stuffed Animals Pre Post

* Indicates statistically significant difference

Interpretation of Results and Next Steps

• Disappointing results
• Next steps

– Don’t give up – Recognize changing culture takes time – Enhance intervention

• Safe Sleep reminders in staff meetings and

daily huddles

Monthly Audits of Safe Sleep

References

• American Academy of Pediatrics (AAP). (October 2011). AAP expands guidelines for

infant sleep safety and SIDS risk reduction. Retrieved from the American Academy of Pediatrics website: http://www.aap.org/en-us/about-the-aap/aap-press- room/pages/AAP-Expands-Guidelines-for-Infant-Sleep-Safety-and-SIDS-Risk- Reduction.aspx.

• American Academy of Pediatrics (AAP). (October 2011b). SIDS and Other Sleep-Related

Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment. Retrieved from the American Academy of Pediatrics website: http://pediatrics.aappublications.org/content/128/5/e1341.full.pdf+html.

• Colson, E.R., Rybin, D., Smith, L.A., Colton, T., Lister, G., Corwin, M.J. (2009). Trends and

factors associated with infant sleeping position: The national infant sleep position study 1993-2007. Archives of Pediatrics & Adolescent Medicine, 163(12):1122-8.

• Crawford, G. Kansas Department of Health and Environment. Sedgwick County Infant

Mortality presentation to the Maternal Infant Health Coalition. Nov. 2015.

• Mason B, Ahlers-Schmidt CR, Schunn C. Improving safe sleep environments for well

newborns in the hospital setting. Clin Pediatr (Phila). 2013 Oct;52(10):969-75. doi: 10.1177/0009922813495954. Epub 2013 Jul 19. PubMed PMID: 23872346.

• Smith, L.A., Colson, E.R., Rybin, D., Margolis, A., Colton, T., Lister, G., et al. (2010).

Maternal assessment of physician qualification to give advice on AAP-Recommended infant sleep practices related to SIDS. Academic Pediatrics, 10(6): 383-8. doi: 10.1016/j.acap.2010.08.006.