• Bundle to Improve Safe Sleep Modeling by Neonatal Intensive Care Unit

      Schmidt, Katelyn E.; Fitzgerald, Jennifer (2021-05)
      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.
    • Transitioning to Electronic Safe Sleep Documentation in the Neonatal Intensive Care Unit

      Lee, Morgan N.; Wise, Barbara V. (2022-05)
      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.