Creating a Comprehensive Safe Sleep Program Webinar 3: Gaining champions and educating staff Sponsored by a grant from the CJ Foundation for SIDS

Your hosts Jason Jarzembowski, MD, PhD Abby Collier, MS Chair, Safe Sleep Initiative, Children’s Hospital of Wisconsin Interim Medical Director, Pathology and Laboratory Medicine, Children's Hospital of Wisconsin Interim Chief (Pediatric Pathology) and Associate Professor, Department of Pathology, Medical College of Wisconsin Abby Collier, MS Injury Prevention and Death Review Manager, Children’s Health Alliance of Wisconsin

Last time… A uniform, comprehensive policy is the best way to ensure the safety of sleeping infants The best way to create such a policy is a multidisciplinary effort using the collaborative efforts of nurses, physicians, other caregivers, educators, public relations specialists, and other experts Education is the key to success Explain policy & rationale to parents and caregivers to promote short- and long-term compliance. Reinforce a single safe sleep message using different people, different media, and different times.

This time… Gaining champions Educating staff

CHAMPIONS

Need for Champions Diversity of approaches, opinions, and ideas Expertise in various areas, for example: Nursing – “in the trenches,” have to live with and by the policy Neonatologist – medical indications for exceptions Lactation consultants – safe sleep while encouraging breast- feeding Risk Management – how to enforce policy amongst hospital staff and parents/guardian/visitors Advocates with different people and in departments No one person in the organization can do this alone

Who are your champions? Nurses Physicians Physical / occupational therapists Educational services Public relations and community outreach Risk management Patient/family liaisons Researchers Administrators Other staff

Where are your champions? Labor & Delivery NICU Other inpatient units? Emergency department PT/OT Outpatient clinics OB, pediatrics, family med Administration

What will your champions do? Bring ideas and perspective to the table Provide “hands on” experience and practical advice Help get the work done Promote values and attitude in different areas Spread knowledge and serve as resource

The best way to promote safe sleep Role-modeling!

Role modeling Your champions are role models for your staff Your staff are role models for each other, and for families Therefore, staff must know, understand, and model safe sleep at all times!

EDUCATING STAFF

Education Staff compliance with the policy was poor. Recognition of the magnitude of the practice change was critical. Audience for the change implementation is broad.

Identifying Messages What are the messages? What are our measurable results? What are the crucial moments and vital behaviors? Are they evidence-based? Are they clear, keeping in mind plain language and health literacy strategies? What are our best tools to use with staff and families?

Framework for Change Influencer model Provided the framework to make effective change. Evidence based approach to making sustainable change. Previous success with hand-washing campaign.

Influencer model - Measurable Results Goals Success Admission screening completed 100% with consults clearly charted. Compliance with safe sleep environment in- hospital stay = 100% by December. Discharge review of teaching = 100%.

Influencer model – Crucial Moments Admission/initial encounter screening Leaving a room after caring for a baby Observing a family member sleeping with an infant Observing a co-worker needing to change environment for safe sleep Follow-up with family not following in hospital safe sleep practice Discharge of infant home

Influencer model – Vital Behaviors Screening on admission Anticipatory discussion related to safe sleep in hospital on admission Check that infant is in safe sleep environment after each interaction Review of ABCs with family at least once during hospital stay

Six sources

How are we influencing? Continue educating and reminding staff with updates, posters, displays, web-casts, grand rounds. Include it in education updates and courses. Available resources for questions. Focus on common deficiencies found in audits. Students and faculty have helped gather data. One message, many people, many ways, many times. Enlist a village of support!

Surveys Before rolling out educational module, administered a short pre-test via SurveyMonkey. Most staff had good knowledge of safe sleep practices, but wanted help in approaching families about it. Room for improvement with what is ok in the crib and safest position to prevent choking. Needed clear information to feel confident in their knowledge and resources when talking to families.

Created Online Module A 30 min. interactive module through our online platform was created. Objectives were: Define safe sleep, SIDS, and the scope of the problem Share safe sleep practice and the hospital policy for infant safe sleep Identify critical safe sleep messages and opportunities to make a difference for babies and their families Identify barriers and challenging situations with safe sleep Locate resources

Online Module Required of all CHW staff if they have any interaction with babies or parents. A broad audience needed education: In-patient, ambulatory specialty clinics and primary care. Community based social services agency, community based managed care, school nurses and community education. Abbreviated education for volunteers. Recommended for CHW physicians, residents/fellows, and others. To date, over 1500 people have completed the training!

Infant Safe Sleep: Making It a Reality

Internal PR Campaign Safe sleep clings in all CHW patient rooms and CMG clinic rooms Ads on hallway monitors and in elevators Safety screen saver Safe sleep website Updates in newsletters

Initial Audits Random inspections of infant sleep environments throughout hospital. Initial audits (pre- and early- education) showed poor compliance (5-50%). Supplies (wipes, diapers) in crib Extra linens in crib Improper use of developmental / positioning devices

Recent Audits

Take-Home Messages We must teach and model the basics of safe sleep – Alone, Back, Crib. The best way to share this message is having multiple people saying and doing the same thing multiple times. We need to help each other keep our babies safe – reminders, incident reports, double checks. Administrative sponsorship and a steering committee is critical. Safe sleep will help Wisconsin’s kids be the healthiest in the nation!

Next Webinar Questions? Comments? Webinar 4: ABC’s for families Wednesday, May 6, noon CST https://connect.wisconsin.gov/dhsdphbchpsafesleep/ Questions? Comments? jjarzemb@mcw.edu ajcollier@chw.org