P0118 - A Quality Improvement Initiative on Implementing Hospital-Based Safe Infant Sleep Practices for High Risk Population.

Background:
Sleep related infant deaths (SRID) are a leading cause of infant mortality in New York, causing 50 infant deaths in New York City annually. The Bronx ranks second highest among the boroughs at 0.5 SRID cases per 1000 deaths. Parents who observe safe sleep practices (SSP) in hospital are twice as likely to continue this practice at home.

Objective:
To prevent SRID in high risk population by increasing SSP in newborn nursery (NBN) and Neonatal Intensive Care Unit (NICU) by 20% by December 2019.

Design/

Methods:
Pediatric physicians and staff completed IHI Risk Reduction for SIDS online modules. Nurse champions then led an initiative to improve SSP of infants in the NBN and NICU. Cribs were audited from 5-7/18 pre-intervention and 12/18-12/19 post-intervention. Parents were surveyed in the postpartum unit and at the 2 week and 2 month clinic visits. Surveys were aimed at understanding cultural perspectives in a diverse patient population. Housestaff were surveyed to assess knowledge of SSP. PDSA cycles were conducted to adopt the use of sleep sacks.

Results:
A total of 248 crib audits were performed over 19 months. In NICU, SSP education and huddles succeeded in increasing supine position, eliminating fluffy blankets & reducing use of excess blankets. In NBN, co-sleeping was down from 18% to 0%, however excess blanket use continued. Sleep sacks were given to families in NBN with subsequent decrease in swaddling following small tests of change. Fifty-five parents were surveyed in clinic. Eighty-two percent of parents reported receiving SSP education from a provider prior to discharge; 31% reported receiving it in clinic. Ninety-one percent of residents completed an assessment survey; 98% of them believed in-hospital modeling of SSP was important in preventing SRID. Only 32% of residents recalled receiving formal training; 12% recalled completing online modules. Head nurses participated in a focus group to understand provider beliefs around SSP. The biggest improvement for babies during hospitalization was supine positioning. However, clinic survey data showed that unsafe sleep practices, especially co-sleeping, were still occurring in families with concerns about SSP.

Conclusions:
Staff education and nursing involvement have led to improvement in SSP at our institution. However, online safe sleep education for staff does not address cultural barriers nor prepare staff to tackle cultural beliefs around infant sleep in a diverse and immigrant patient population. A mixed methods approach to addressing families and cultural influences is in process.