P0595 - Implementation of Safe Sleep Practices in an Urban Inpatient Newborn Nursery

Background:
Infant mortality due to unsafe sleep practices accounts for 26% of all sudden unexpected infant deaths and accounted for 24.6 deaths per 100,000 live births in 2017. Of even greater concern is that this rate continues to rise. The American Academy of Pediatrics states medical providers should educate parents and model safe sleep practices in the hospital setting. Despite these recommendations and the increasing number of sleep-related infant deaths, compliance with safe sleep practices in the hospital setting remains low. The aim of this project is to increase safe sleep compliance in a community hospital nursery to > 80% by July 31, 2020.

Methodology:
A multidisciplinary team was created, and safe sleep was the focus of the 2018-2019 nurse resident program. Interventions focused on parent and staff education as well as systems processes that posed as barriers to compliance with safe sleep. To target our interventions, team members conducted a survey of nurses, nurse practitioners, and physicians to assess knowledge of safe sleep. To better understand cultural barriers among families, we surveyed members of the Spanish Speaking Parent Advisory Board (SSPAB) at our institution. The team collected baseline data through audits of infants in the nursery, and audits continued to monitor for signs of improvement.


Discussion:
Healthcare provider survey participants identified co-sleeping and supine positioning as the most important aspects of safe sleep. Baseline data demonstrated large variability in compliance ranging from 10-63% (Figure 1). The run chart outlines a timeline of interventions. There was an acute decrease in compliance in July 2019 which we suspect is related to the completion of the nurse resident project. For 6 consecutive months, the variability in compliance decreased ranging from 60-80%, which indicates improvement.

Further analysis of our data revealed compliance with supine position and head of bed flat was excellent at 80-100% corresponding with provider survey responses regarding knowledge of safe sleep practices. However, extra or fluffy blankets in the crib were identified as a major barrier to compliance with safe sleep (Figure 2). These practices reflect cultural beliefs identified on surveys of the SSPAB, where respondents conveyed that Hispanic families worry infants will become sick without blankets to keep them warm and that soft bedding increases infant comfort and honors the baby.


Conclusion:
Through initial data collection and analysis, we identified extra blankets as the most common reason for noncompliance with safe sleep in the nursery. This knowledge allows us to tailor future PDSA cycles towards improvement in this area, which we anticipate will result in an increased overall compliance with safe sleep. By demonstrating appropriate safe sleep practices in the healthcare setting and providing education on safe sleep, parents are more likely to utilize safe sleep practices at home.