1 Best Practice: Infant Safe Sleep in the Hospital Sandra Frank, JD, CAE Executive Director

2  Nonprofit organization  Title V SIDS/SUID Program  Partner with the Michigan Department of Community Health

3  Lead resource for Infant Safe Sleep and Back to Sleep  Grief central referral site  Grief/interconception initiatives

4 Infant Safe Sleep Hospital Project

5 Michigan PNM 71% decline in SIDS rates since 1993 SIDS diagnosis appeared to be going away Postneonatal rate unchanged – diagnostic shift Sleep environment major risk factor

6 Systems Change Why focus on hospitals? Existing infrastructure Lessons from the literature Nurse values and beliefs

7 Safe Sleep Project  Develop hospital model for institutionalizing infant safe sleep  Evidence based  Emphasis on evaluation  Can be replicated

8 Hospital Infant Safe Sleep Pilot project at 2 Detroit hospitals in The Skillman Foundation Project expanded to include 4 more hospitals – Health Disparities Grant Replicated in additional 8 hospitals Expanding to NICU and Peds units Moving into physician clinics

9 Project Objectives Assess policies and practice Develop and implement policies Educate/train staff Educate mothers and families Sustain change though ongoing audits Evaluate compliance

10 Project Objective: Assessing Hospital’s Current Practice

11 Assessing Hospital’s Current Practice Conducted hospital audits to access nursing practices and parents knowledge level before beginning project Position of baby Location of baby Condition of crib Assessed parent’s knowledge of safe sleep and intended practices

12 Assessing Hospital Policies  Projects were asked to collect and review all hospital policies with references to infant sleep Admissions forms and information Discharge materials All policies including Thermoregulation Policy Newborn Care Policy Neonatal Abstinence Policy (Drug withdrawal )

13 Nursing Policy

14 Policy Based on AAP guidelines (2005) Most critical factor in initiating and maintaining change in behavior and practice Policy is now standard of practice Only with written policy can staff be held accountable for actions Policy is necessary for any setting

15 Obstacles Approval from all hospitals and committees Must follow hospital guidelines Once policy committee approves must obtain signatures from all involved supervisors Time issues

16 Educating Staff

17 Lessons from death scenes

18 Lessons from death scenes prone position / head covered

19 Lessons from death scenes CPSC Investigation

20 Lessons from death scenes CPSC Investigation

21 Lessons from death scenes

22 Lessons from death scenes

23 Lessons from death scenes

24 Wedging / Entrapment

25 Educating staff Include factors of unsafe sleep environment Prone position Soft bedding Using bumper pads or stuffed animals in crib Baby Sleeping in Adult in or Youth Bed Sleeping on a Sofa, Soft Mattress or Water Bed

26 Unsafe Sleep Environment  Side position is unstable and infants can roll into prone position.  Risk of suffocation for infants rolling prone may be even higher than being placed in prone position initially.

27 Side Position  Studies show that 70 – 90% of maternity hospitals still advocate the use of side sleeping position.  Primary reason stated is fear of aspiration – although there is no forensic, pathological or epidemiological evidence to substantiate these fears. (Fleming & Blair 2002)

28 Aspiration and Supine Positioning Continuing Education Program on SIDS Risk Reduction, U.S. Department of Health and Human Services, December 2006.

29 Aspiration and Supine Positioning When baby in on the back, trachea lies on top of the esophagus. Any regurgitation or reflux from the esophagus must work against gravity to be aspirated into the trachea In prone position the trachea lies below the esophagus In this position anything refluxed will pool at the opening of the esophagus

30 Education Challenges  In a hospital setting, there are many challenges to getting staff together for mandatory education. Completing the education without accruing overtime can be a real challenge.  Ideas to help defeat the “Time Issues” may include: Offering impromptu trainings by project staff on unit when census is low Offer on-line program Placing binder with written material on unit with written test

31 Implement Policy

32 Leading Change  Be sure to have a passionate champion who will lead the change on the unit

33 Behavioral Change  Very slow process  Keep re-enforcing message  Continue to model safe sleep practices  Don’t forget to include grandparents in education

34 Expect Resistors  Identify them  Challenge them  Work with them  Empower them  Champion their progress

35 Evaluate compliance

36 Quality Improvement  Use “safe sleep” project as a quality improvement initiative project for your unit  Set goals  Discuss progress toward goals at each staff meeting

37 Sustaining the Change  Leaders must communicate their vision for the promotion of safe sleep through words and behaviors

38 Sustaining Change  Be sure staff have the tools they need to be successful in promoting safe sleep Fitted sheets for cribs Adequate supply of brochures in several languages Educational videos for in-house patient education channels Sleep sacks for newborns

39 Keep the Idea Fresh  Make “safe sleep” a unit-based or annual competency  Include education to every new employee  Don’t forget students, residents and physicians

40 Tell Your Stories  Use the death scene re-enactment photos  Communicate “near-miss” stories  Tell real-life experiences  Take advantage of teachable moments

41 Encourage staff outreach  Provide staff with materials to “take the message on the road”  Can present to child-care providers, church groups, neighborhood  Staff then becomes the champions

42 By educating parents, grandparents and all caregivers about the importance of safe sleep environment WE CAN MAKE A DIFFERENCE AND HELP SAVE BABIES’ LIFES

43 OUR GOAL: Healthy Babies….

44 …. And Healthy Families

45 THANK YOU!

46 For more information or resource materials: Contact Tomorrow’s Child