PC1249: Educational Interventions to Improve Infant Safe Sleep in Inpatient Pediatric Setting with Parental Survey

Purpose/Objectives: The United States has 3,400 cases of sudden unexpected infant death (SUID) annually, of which over 40% are identified as sudden infant death syndrome (SIDS) and 24% attributed to accidental strangulation or suffocation in bed. Risk factors include infants placed on sides or stomach in bed, soft or loose bedding, bed-sharing, and over-bundling. While public health efforts have reduced SUIDs in California, the incidence in the Central Valley is nearly twice the statewide rate. Studies show that parents oftentimes mimic practices seen in the hospital. Therefore, modeling infant safe sleep practices in the inpatient setting plays an important role in improving safe sleep at home.

Our goal was to increase compliance with AAP safe sleep recommendations (SSR) for infants < 1 year on three acute care nursing units of Valley Children’s Hospital to 80% by June 2022.

Design/Methods: IHI Model for Improvement was used with PDSA cycles to evaluate two safe
sleep interventions, specifically (1) SBAR education during nursing shift change, and (2) placement of safe sleep educational door signs and crib cards. Weekly random audits of infant sleep were performed for the units, including a three-month baseline pre-intervention period and a month following each intervention. Audits assessed five domains identified in the AAP safe sleep recommendations. Additionally, a 13 question bi-lingual Likert-based Parental Survey of Hospitalized Infants (PSHI) was developed to evaluate parental confidence in safe sleep practices, perception of SSR education and safe sleep behaviors at home. PSHIs were distributed to parents of infants < 1 year on units where interventions were completed.

Results: Compliance increased from baseline in all five safe sleep domains after both interventions. At baseline, 14% of infants were sleeping according to safe sleep guidelines in all five domains. After the first and second intervention, compliance increased to 67% and 50% respectively. The “extra items in crib” safe sleep domain saw the most improvement, with an increase from 15% pre-intervention to 63% post-interventions. The PSHI had a 92% response rate, with a total of 45 completed questionnaires. Forty-four percent of parents strongly agreed and 33% agreed that they were educated about safe sleep during their child’s hospitalization.

Conclusion/Discussion: This study highlights the important role nurses play in modeling safe sleep practices for parents, as interventions substantially increased compliance with infant safe sleep practices. However, improvement still fell below the desired 80% compliance, indicating that education alone is insufficient to sustain behavior change. Our study is novel in that it directly addressed parental knowledge, attitudes, and perceptions regarding infant sleep. Our PSHI demonstrated that most parents (77%) were educated on safe sleep during their infants’ hospitalization, illustrating the efficacy of the interventions. Further post-hospitalization follow-up data are needed to determine if sleep education translated to changes at home.