Bundle to Improve Safe Sleep Modeling by Neonatal Intensive Care Unit

Abstract

Problem: Neonatal Intensive Care Unit (NICU) nurses in a level IV NICU were noted to provide inconsistent safe sleep environments for hospitalized infants. The NICU population is at high risk for Sudden Infant Death Syndrome (SIDS). Nurses should provide consistent safe sleep modeling to educate and influence families. At the inception of this project, no structures were in place to evaluate infant readiness to receive safe sleep or to document sleep environments. Purpose: The purpose of this quality improvement project was to implement nurse-driven safe sleep modeling in the form of a safe sleep bundle. The bundle consisted of an inclusion algorithm, bedside crib reminder cards, and nursing documentation. Methods: A root cause analysis was conducted with nursing to determine appropriate bundle components. Nurse safe sleep champions provided unit education and performed bedspace audits. Measures included safe sleep compliance comprised of six components supported by the American Academy of Pediatrics, bundle utilization rates, and adverse events. Data was a convenient random sample and bedspaces were selected randomly by champions. The baseline compliance rates were then compared to implementation rates and nursing documentation. Results: Pre-implementation data was obtained from all seventy bed spaces. Overall, the rate of safe sleep compliance (all six categories) increased 37%. The greatest improvement in individual categories was “no position aids” (18% increase) and “no extra bedding” (58% increase). The other categories were mostly unchanged post-implementation with rates greater than 90%. Nursing documentation showed a greater than 80% compliance rate in all categories. No new adverse events were recorded for those infants receiving safe sleep. Nursing used the bundle routinely (algorithm use 20-92%; crib card 67-80%; documentation 4%). Conclusions: Results indicate a bundle improves compliance with safe sleep modeling. Some components gained wider acceptance than others. It appears a bundle has no detrimental effects on sleep environments and does not increase rates of adverse events. Overall, the bundle implementation improved awareness of safe sleep environments by nurses, and it has the potential to significantly increase safe sleep modeling and environments for hospitalized infants.