Transitioning to Electronic Safe Sleep Documentation in the Neonatal Intensive Care Unit

Abstract

Problem: Sudden infant death syndrome (SIDS) continues to be a leading cause of infant death in the United States. Premature infants born at less than 37 weeks gestation have an increased risk of dying from SIDS. Safe sleep (SS) modeling by the care team during a hospital admission is recommended in order to increase the sleep safety once discharged home. SS modeling adherence among nurses in a level IV inner city NICU is only 21%. Despite clear recommendations that all healthcare providers should model SS this NICU has ample room for improvement. Purpose: The purpose of this quality improvement (QI) project is to implement electronic documentation of SS practices to increase adherence of SS modeling among NICU nurses. Methods: This QI project took place from September to December 2021. SS documentation was designed and introduced in the electronic health record. Nurses were educated on the new documentation. A NICU SS algorithm and crib card (SS bundle) were utilized at the patient’s bedside to indicate whether patients were practicing SS or not. Weekly observational bedside audits assessed SS modeling and crib card compliance. Electronic health record audits conducted weekly along with observational audits determined the accuracy and compliance of the documentation. Results: Bedspace audits indicated an improvement from 21% to 58% in adherence with SS practices among the nursing staff. Chart audits revealed 100% of nursing staff documenting SS in the electronic health record by week four of the implementation phase. Accuracy of documentation with sleep position averaged 78%. Conclusions: Implementation of electronic documentation combined with a SS bundle improved modeling of SS practices. Project sustainability strategies included continuing weekly SS rounds, inserting SS training materials and documenting procedures into the new employee orientation materials, annual training and finalizing a SS order set. Although the results are not generalizable, this project can be adapted to implement a SS bundle and electronic documentation in other NICUs, newborn nurseries, and infant care units.