Improving Safe Sleep Practice in a Level IV Neonatal Intensive Care Unit

Abstract

Problem: Approximately 3500 infants die of sleep-related deaths in the United States annually, and data from the American Academy of Pediatrics (AAP) suggest that most hospitalized infants who are less than 12 months of age are not consistently placed in a safe sleep environment prior to discharge (Goodstein et al., 2021). A three-month audit of safe sleep practice (SSP) in a level IV urban Neonatal Intensive Care Unit (NICU) showed that 17.5% of infants were eligible for SSP, but only 25% of the 17.5% eligible infants were fully compliant with SSP. Purpose: The purpose of this quality improvement (QI) project was to improve the consistent application of SSP in a 24-bed level IV medical NICU using the unit's SSP bundle. The bundle consisted of the unit's AAP-based SSP algorithm, the discussion of SSP eligibility in daily rounds, and the placement of safe sleep crib cards in the cribs of eligible infants. The crib cards included the SSP algorithm as well as an eligibility statement. Methods: The nursing staff was educated regarding SSP and received a pre and posttest survey after completion of the education. Weekly audits were conducted to identify infants eligible for SSP. In eligible infants, weekly crib audits were conducted to determine overall SSP compliance and compliance with the individual components of SSP. Results: Fifty-six nursing staff (48.7%) completed the offered education. Forty infants were eligible for SSP, and 25 of them (62.5%) were found to be fully compliant with all the components of SSP compared to pre-implementation SSP compliance of 25%. Supine positioning improved from 24% to 85%, and head of the bed (HOB) flat improved from 61% to 82.5%. Conclusions: SSP education for NICU nursing staff, the use of crib cards with an evidence-based SSP algorithm, and daily rounding to identify infants eligible for safe sleep can help promote consistent NICU safe sleep practices.