Improving Safe Sleep Practices in a Level III Neonatal Intensive Care Unit

Abstract

Problem & Purpose: In a level III Neonatal Intensive Care Unit (NICU) at a large inner-city hospital in the mid-Atlantic region, healthcare providers were not uniformly transitioning premature infants to safe sleep positioning (SSP) as recommended by the American Academy of Pediatrics (AAP). Based on a random bedside audit in March 2022, 40% of infants in the NICU met the eligibility criteria for safe sleep, and 0% of those patients were in accordance with the guidelines. The purpose of this quality improvement initiative was to increase the number of neonates in accordance with the AAP’s safe sleep guidelines for hospitalized infants. Methods: An evidence based safe sleep bundle was implemented and included the development of an evidence-based sleep algorithm, standardization of an educational video, and a parent safe sleep discharge survey. Staff completed formalized education on the bundle and new practice. Positioning guidelines were strategically placed in high traffic locations throughout the unit. At discharge, parents completed a survey that assessed their comfort level with safe sleep implementation at home. Weekly bedside audits were conducted to identify infants eligible for safe sleep, and if infants were placed using safe sleep practices. Results: Over fourteen weeks of data collection, the average safe sleep compliance rate was 79%, with 100% compliance met at 3 separate data intervals. Conclusion: The incorporation of an evidence based safe sleep bundle in the NICU can improve compliance with safe sleep practices and reinforce safe sleep strategies at discharge.