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Napolitano SK, Boswell NL, Froese P, Henkel RD, Barnes-Davis ME, Parham DK. Early and consistent safe sleep practices in the neonatal intensive care unit: a sustained regional quality improvement initiative. J Perinatol 2024; 44:908-915. [PMID: 38253677 DOI: 10.1038/s41372-023-01855-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/17/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To increase compliance with standardized safe sleep recommendations for patients in a cohort of regional level III/IV neonatal intensive care units (NICUs) in accordance with recently revised guidelines issued by the American Academy of Pediatrics (AAP). STUDY DESIGN A regional quality improvement (QI) initiative led by a multidisciplinary task force standardized safe sleep criteria across participating NICU sites. Universal and unit-specific interventions were implemented via Plan-Do-Study-Act (PDSA) cycles with evaluation of compliance through routine crib audits, run chart completion, and Pareto chart analysis. RESULTS Following QI implementation, compliance with safe sleep guidelines for eligible NICU infants improved from 34% to 90% from October 2019 through September 2022. CONCLUSION Compliance with early, consistent modeling of safe sleep practices nearly tripled in this cohort of regional NICUs. A standardized, timely approach to safe sleep transition demonstrated dramatic and sustained improvement in the practice and modeling of safe sleep behaviors in the NICU.
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Affiliation(s)
- Stephanie K Napolitano
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Nicole L Boswell
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Patricia Froese
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Rebecca D Henkel
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Maria E Barnes-Davis
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Danielle K Parham
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.
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Caraballo M, Abbe M, Tidwell J, Dutton H, Garcia MG, Punzalan G, Axon A. Steering the Titanic: One tertiary care children's hospital's experience navigating safe sleep for hospitalized infants. J Pediatr Nurs 2023; 73:e1-e9. [PMID: 37330278 DOI: 10.1016/j.pedn.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Sudden Unexpected Infant Death (SUID) is the leading cause of death in infants 1 month to 1 year of age in the United States. Despite extensive efforts in research and public education, rates of sleep-related infant death have plateaued since the late-1990s, largely due to unsafe sleep practices and environments. LOCAL PROBLEM A multidisciplinary team assessed our institution's compliance with its own infant safe sleep policy. Data was collected on infant sleep practices, nurses' knowledge and training on the hospital policy, and teaching practices for parents and caregivers of hospitalized infants. Zero crib environments from our baseline observation met all the American Academy of Pediatrics recommendations for infant safe sleep. METHODS A comprehensive safe sleep program was implemented in a large pediatric hospital system. The purpose of this quality improvement project was to improve compliance with safe sleep practice from 0% to 80%, documentation of infant sleep position and environment every shift from 0% to 90%, and documentation of caregiver education from 12% to 90% within 24 months. INTERVENTIONS Interventions included revision of hospital policy, staff education, family education, environmental modifications, creation of a safe sleep taskforce, and electronic health record modifications. RESULTS Documented compliance with infant safe sleep interventions at the bedside improved from 0% to 88%, while documentation of family safe sleep education improved from 12% to 97% during the study period. CONCLUSIONS A multifaceted, multidisciplinary approach can lead to significant improvements in infant safe sleep practices and education in a large tertiary care children's hospital system.
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Affiliation(s)
- Michelle Caraballo
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9063, United States of America.
| | - Marisa Abbe
- Children's Health System of Texas, 1935 Medical District Drive, Dallas, TX 75235, United States of America
| | - Jerithea Tidwell
- Children's Health System of Texas, 1935 Medical District Drive, Dallas, TX 75235, United States of America
| | - Hayden Dutton
- Children's Health System of Texas, 1935 Medical District Drive, Dallas, TX 75235, United States of America
| | - Mayra G Garcia
- Children's Health System of Texas, 1935 Medical District Drive, Dallas, TX 75235, United States of America
| | - Gemmarie Punzalan
- Children's Health System of Texas, 1935 Medical District Drive, Dallas, TX 75235, United States of America
| | - Alison Axon
- Children's Health System of Texas, 1935 Medical District Drive, Dallas, TX 75235, United States of America
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Johnson M, Simonovich SD, Neuman ME, Gidd-Hoffman K, Simo A, Spurlark RS. Ensuring Safe Sleep in the Pediatric Intensive Care Unit: A Systematic Review of Informed Development of Clinical Guidelines for Implementation in Practice. J Pediatr Health Care 2022; 37:234-243. [PMID: 36402627 DOI: 10.1016/j.pedhc.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Although general safe sleep guidelines have been established, their utility and implementation have yet to be examined systematically for inpatient populations for application to infants in the pediatric intensive care unit (PICU) setting. This study aimed to complete a systematic review of inpatient safe sleep practices studies to develop then safe sleep clinical guidelines for implementation in the care of medically complex infants in the PICU. METHOD This review was registered with PROSPERO and adheres to Preferred Reporting Items for Systematic reviews and Meta-Analyses systematic review guidelines. RESULTS Nineteen articles met the inclusion criteria. A safe sleep guideline algorithm for medically complex infants in the PICU was created for implementation. DISCUSSION Consistent and comprehensive safe sleep education and modeling by health care professionals in the inpatient setting is an effective technique to reduce the risk of harm and promote safe sleep behaviors in the home setting.
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Affiliation(s)
- Maura Johnson
- Maura Johnson, Graduate Student, Doctor of Nursing Practice Program, School of Nursing, DePaul University, Chicago, IL
| | - Shannon D Simonovich
- Shannon D. Simonovich, Associate Professor, School of Nursing, DePaul University, Chicago, IL.
| | - Michelle E Neuman
- Michelle E. Neuman, Assistant Professor, School of Nursing, DePaul University, Chicago, IL
| | - Kirsten Gidd-Hoffman
- Kirsten Gidd-Hoffman, Assistant Manager, Pediatric Intensive Care Unit, Rush University Medical Center, Chicago, IL
| | - Amanda Simo
- Amanda Simo, Clinical Educator, Pediatric Intensive Care Unit, Rush University Medical Center, Chicago, IL
| | - Roxanne S Spurlark
- Roxanne S. Spurlark, Assistant Professor, School of Nursing, DePaul University, Chicago, IL
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Salm Ward TC, Yasin T. Hospital-Based Inpatient Quality Improvement Initiatives on Safe Infant Sleep: Systematic Review and Narrative Synthesis. Sleep Med Rev 2022; 63:101622. [DOI: 10.1016/j.smrv.2022.101622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/25/2022]
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Cornwell B, Yan X, Carlin RF, Fu L, Wang J, Moon RY. Social network influences on new mothers' infant sleep adjustments. Soc Sci Med 2021; 269:113585. [PMID: 33333376 PMCID: PMC7794038 DOI: 10.1016/j.socscimed.2020.113585] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/24/2020] [Accepted: 12/03/2020] [Indexed: 11/27/2022]
Abstract
Despite public awareness campaigns, some parents continue to engage in infant sleep practices that are considered risky by health experts, such as bedsharing or placing their infants on their stomachs. This study examines the role their social networks play in shaping parents' responsiveness to new information and/or suggestions about how they should place their infants for sleep, paying attention to the respective effects of health professionals and their close interpersonal ties. We collected data from a sample of 323 new mothers in Washington, D.C., who described their infant sleep practices and perceived personal social networks. We find evidence that mothers' social networks play a significant role in the likelihood that they adjust their infant sleep practices within the first few months of their infants' lives. Mothers are more likely to change sleep practices when health professionals and/or (lay) family members advise them to do so. The influence of network members is not always positive. For mothers who initially follow safe practices, their probability of change increases if their network members substantially espouse unsafe practices. Among mothers with initially unsafe practices, network members' level of support for safe sleep practices is not predictive of the likelihood of sleep practice change. Implications for potential interventions are discussed.
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Affiliation(s)
| | - Xuewen Yan
- Department of Sociology, Cornell University, Ithaca, NY, USA
| | - Rebecca F Carlin
- Goldberg Center for Community Pediatric Health, Children's National Health System, Washington, D.C., USA; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA
| | - Linda Fu
- Goldberg Center for Community Pediatric Health, Children's National Health System, Washington, D.C., USA; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA
| | - Jichuan Wang
- Center for Translational Science Children's National Health System, Washington, D.C., USA; Department of Epidemiology and Biostatistics George Washington University, Washington, D.C., USA
| | - Rachel Y Moon
- Department of Pediatrics University of Virginia, Charlottesville, VA, USA
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Leong T, Roome K, Miller T, Gorbatkin O, Singleton L, Agarwal M, Lazarus SG. Expansion of a multi-pronged safe sleep quality improvement initiative to three children's hospital campuses. Inj Epidemiol 2020; 7:32. [PMID: 32532333 PMCID: PMC7291418 DOI: 10.1186/s40621-020-00256-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background The American Academy of Pediatrics (AAP) recommends infants should be Alone, on their Back, and in a clear Crib to combat relatively stagnant rates of sudden unexpected infant death (SUID). These are referred to as the ABCs of safe sleep. Studies have shown these recommendations are not consistently followed in the hospital setting, but further investigation would determine how to improve the rate of adherence. The objective of this study was to evaluate the impact of an expanded safe sleep initiative at three Georgia free-standing children’s hospital campuses before and after a multipronged safe sleep initiative. Methods A quality improvement program with a pre/post analysis was performed using a convenience method of sampling. Infants < 12 months old in three inpatient pediatric campuses were analyzed pre- and post- interventions. The intervention included: 1) nursing education, 2) identification of nurse “safe sleep” champions, 3) crib cards, 4) crib audits, and 5) weekly reporting of data showing nursing unit ABC compliance via tracking boards. The goal was ABC compliance of ≥25% for the post-intervention period. A standardized crib audit tool evaluated sleep position/location, sleep environment, and ABC compliance (both safe position/location and environment). Chi square analysis, Fisher’s exact test, and logistic regression were used to compare safe sleep behaviors before and after the interventions. Results There were 204 cribs included pre-intervention and 274 cribs post-intervention. Overall, there was not a significant change in sleep position/location (78.4 to 76.6%, p = 0.64). There was a significant increase in the percent of infants sleeping in a safe sleep environment following the intervention (5.9 to 39.8%, p < 0.01). Overall ABC compliance, including both sleep position/location and environment, improved from 4.4% pre-intervention to 32.5% post-intervention (p < 0.01). There was no significant variability between the hospitals (p = 0.71, p = 1.00). Conclusions The AAP’s safe sleep recommendations are currently not upheld in children’s hospitals, but safer sleep was achieved across three children’s campuses in this study. Significant improvements were made in sleep environment and overall safe sleep compliance with this multi-pronged initiative.
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Affiliation(s)
- Traci Leong
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, 30322, USA
| | - Kerryn Roome
- Emory University School of Medicine, Atlanta, 30322, USA
| | - Terri Miller
- Georgia Department of Public Health, Atlanta, 30303, USA
| | | | - Lori Singleton
- Children's Healthcare of Atlanta, Atlanta, 30322, USA.,Morehouse School of Medicine, Atlanta, 30310, USA
| | - Maneesha Agarwal
- Emory University School of Medicine, Atlanta, 30322, USA.,Children's Healthcare of Atlanta, Atlanta, 30322, USA
| | - Sarah Gard Lazarus
- Children's Healthcare of Atlanta, Atlanta, 30322, USA. .,Pediatric Emergency Medicine Associates, Atlanta, 30342, USA.
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