Improving Inpatient Infant Safe Sleep Practices Danielle Kendall, Department of Nursing, University of New Hampshire background PICO Question Appraisal & Data summary Does the use of staff education and safe sleep policies improve safe sleep practices in the inpatient setting? Sudden Infant Death Syndrome (SIDS) is the leading cause of death in infants > 1 month and < 1 year old (NIH, 2018) Accidental suffocation on the rise (CDC, 2018) Safe sleep compliance in the hospital setting is not routinely followed, despite clear guidelines from the American Academy of Pediatrics (AAP) Cribs are often cluttered with medical supplies, diapers, wipes, toys, extra blankets and pillows, increasing risk for accidental suffocation Studies have shown parents will model behaviors and conditions seen in the hospital (Carrier, 2009) Article Level of Evidence Data Summary Salm Ward & Balfour (2016) 2b Systematic review of infant safe sleep practices from 1990-2015; interventions to reduce risk of SIDS and effectiveness of safe sleep practices; reviewed RCTs, pre/post intervention studies, prospective case controls; Interventions (education, policies, etc.) are helpful to increase safe sleep practices Ahlers-Schmidt, Schunn, Nguyen, Nimeskern-Miller, Ilahe & Kuhlmann (2016) RCT for wearable blankets to increase safe sleep practices; caregivers were given either a water bottle or a wearable blanket; No significant difference in safe sleep practices were found but the wearable blanket reportedly stimulated more conversations regarding safe sleep Task Force on Sudden Infant Death Syndrome (2016) 4a Policy statement on SIDS (2016 Update); Standing clinical practice guideline for SIDS risk reduction Kuhlmann, Ahlers-Schmidt, Lukasiewicz & Truong (2016) 5a Multi-institutional QI project at 8 children’s hospitals on inpatient pediatric units; Interventions included staff education, safe sleep policies, designated storage and caregiver education; Implementation resulted in >50% reduction of unsafe items in the crib and improved safe sleep practices Geyer, Smith & Kair (2016) 5b Hospital-wide QI in one institutions; Used staff education, swaddle sleep sacks, crib cards, and bedside storage to improve safe sleep environments with positive effect Model/theory Kurt Lewin’s Change Theory Three Concepts Driving Forces – facilitate change Restraining Forces – resist change Equilibrium – shifts in forces allow change Three Step Model Methods of data collection Important themes Databases Used: CINAHL, MEDLINE & PubMed Other Resources Used: UpToDate, American Academy of Pediatrics official website Search Terms UpToDate: sudden infant death syndrome, pediatric AAP website: safe sleep, policy Databases: safe sleep, inpatient Selection Criteria Inclusion Criteria: Peer reviewed, academic journals, full text only, 2013 to 2018, in English Exclusion Criteria: Preterm infants, newborn nursery Focus on modeling safe sleep behavior Education for families on risk reduction ABC’s of Safe Sleep (Kuhlmann et al., 2016) Infants should be ALONE On their BACK On a firm surface in a CRIB Practice implications Evidence supports the use of staff education and safe sleep policies to improve safe sleep practices in the hospital setting However, most QI projects used multiple interventions, resulting in a lack of evidence on the effectiveness of individual interventions The use of wearable blankets may be beneficial as part of the safe sleep policy but should not be the only intervention Standardization of safe sleep practices should be used throughout the hospital to reinforce positive safe sleep behaviors for parents and caregivers