PC1077: Improving Adherence to Safe Sleep in the Neonatal Intensive Care Unit

Purpose/Objectives: Sleep-related infant deaths and sudden infant death syndrome (SIDS) account for ~3400 deaths annually in the US and are the leading cause of mortality in infants. Preterm and low birth weight infants have a 2-3 times higher risk of SIDS. The AAP Task Force on SIDS recommends that preterm infants be transitioned to a supine position by 32 weeks postmenstrual age. Sleep position modeling by NICU staff strongly influences post-discharge practices by families. The goal of this quality improvement initiative was to increase the percentage of eligible infants in our NICU complying with all elements of safe sleep from a baseline of 25% to 95% by March 2022.

Design/Methods: The setting is an urban academic 46 bed NICU in Portland, OR. It is a quaternary referral center with approximately 700 admissions per year, 30% of which are transferred from outside hospitals and remainder inborn. Project initiated in August of 2021, data reported here through April 2022. Information documented included audit date, shift (day/night), eligibility for safe sleep, and compliance with criteria for safe sleep. The criteria used to define and assess safe sleep were: supine positioning of the infant, flat sleeping surface, absence of loose blankets, and no other objects in the sleeping space. Additionally, we tracked preferred language, if the family was present at the bedside, their report of safe sleep education, and the staff involved in this education. Qualitative interviews were conducted with caregivers and staff following baseline data collection. This data was used to generate a key driver diagram (Figure 1). Interventions focused on safe sleep education for families (bedside during admission and a hospital to home class at discharge), visual reminders at bedside (bedside card), providing safe sleep resources (sleep surfaces, sleep sacs), and introducing functions to document compliance to safe sleep in the electronic medical record. The outcome measure was the total percentage of infants in compliance with all safe sleep criteria. Random audits were performed 5 days a week on the day shift-7p), on approximately 5-10 infants who met criteria per day (initially ~20 infants/week, increased audit capacity to the current of ~50 infants/week). The impact of the interventions was assessed using a run chart.

Results: At baseline, 25% of eligible infants were in compliance with safe sleep criteria. After interventions, this increased to a median of 78% (Figure 2). Staff reported that the preferred interventions were staff education and documentation in the electronic medical record regarding infant eligibility. Caregivers reported discharge teaching and bedside modeling by staff were the most effective education modalities. Since implementation, caregiver-reported education has been 90-100%.

Conclusion/Discussion: Compliance increased and patient safety improved with staff education, caregiver education, infant sleep resources, and improved tracking of infants eligible for safe sleep.