Kandice Duns, MSN, RN, C
Jeanne Ings, MSN, RN, RNC
OB, C EFM
Kandice Duns, MSN, RN, C EFM Jeanne Ings, MSN, RN, RNC OB, C EFM
UC DAVIS HEALTH - QUALITY IMPROVEMENT
In 2016, approximately 25% of the 3600 sudden unexpected infant deaths (SUID), were due to accidental suffocation and strangulation in bed. To think that 900 infants died because of an unsafe sleep environment is more than a tragedy, this is a call to action! A nurse-led multidisciplinary team of physicians, nurses, lactation consultants, and birth certificate clerks collaborated on this project to provide parents with the education, tools, and examples necessary to follow safe sleep practices for the health and well-being of their newborn.
To determine if consistency amongst practitioners would lead parents to a higher rate of compliance with safe sleep environment practices.
Design & Methods
A Plan, Do, Study, Act (PDSA) model was used for this project. A variety of educational interventions were deployed to the interdisciplinary team. Successful delivery of this content was confirmed with a post-test. A sleep environment audit tool was used for baseline and post-implementation data of newborn sleep environment findings. Pre and post implementation chart audits of parent education documentation were performed to assess consistency of education.
Education and Tools
Written, verbal and video education was provided to parents. Halo Sleep Sacks were added to the Safe Sleep Project for newborns to wear during hospitalization. Parents were also provided a take-home sleep sack.
Post education, parents were asked to verbalize in a teach-back method to state the tenets of safe sleep practices. A play pen/crib was given to parents who were unable to provide a safe sleep environment at home.
Studies show that parents are more likely to follow practices that are modeled by their care providers. Inconsistent messages and unsafe sleep environment practices on the unit was found to be an area that needed significant improvement. Hospitals that provide care to infants should implement an evidence-based Safe Sleep Policy that begins with an audit of the maternal/newborn unit to discover the typical state of the sleep environment when entering the room.
Post-implementation audit results demonstrate a significant decrease in unsafe sleep environments (83% to 4%), and a substantial increase in documented parental education (42% to 100%). These findings reinforce the value of consistent education and modeling of safe sleep practices to parents. The results support literature indicating parents are more likely to follow safe sleep practices if they have observed nurses model them during their hospitalization.
Hospitals that provide care to infants should implement an evidence-based Safe Sleep Policy that begins with an audit of the maternal/newborn unit to discover the typical state of the sleep environment when entering the room.
Limitations & Further Study
Limitations of this project included: post-implementation follow-up restricted to hospital setting; absence of long-term follow up.
Further studies should be designed to include post-discharge follow up with parents to identify if safe sleep practices continue at home.
1. American Academy of Pediatrics Policy Statement. (2016). SIDS and other sleep-related deaths: Updated 2016 recommendations for a safe infant sleeping environment. Pediatrics 138(5), 1-12. doi:10.1542/peds.2016-2938.
2. Geyer, J.E., Smith, P.K., & Kair, L.R. (2016). Safe sleep for pediatric inpatients. Journal for Specialists in Pediatric Nursing, 21(3), 119-130.
3. Hitchcock, S. (2012). Endorsing safe infant sleep. Nursing for Women’s Health 16(5),
4. Moon, R. Y., Hauck, F.R. & Colson, E.R. (2016). Safe infant sleep interventions: What is the evidence for successful behavior change? Current Pediatric Reviews, 12(1), 67-75. doi:10.2174/157339631166615102611048.
5. National Institutes of Health ([NIH], 2011). Safe sleep for all babies. Retrieved from https://www.nichd.nih.gov/news/resources/spotlight/Pages/101811-safe-sleep-for-all-babies.aspx.
Funding & Acknowledgements
Sleep Sacks were purchased with a grant from UC Davis Children’s Miracle Network Hospital
Play Pen/Crib Grant provided by First 5 of California in association with The Child Abuse Prevention Center, Sacramento County