1. Natalie Shafer Creighton University
The Role of Health Promotion in Pediatric Acute Care: Implementing a Comprehensive Safe Sleep Program
Natalie Shafer
Creighton University

2. Disclosure Statement
I have no financial interests or potential conflicts of interest to report.

3. Objectives
1. Recognize the role of health promotion and safe sleep education in the pediatric acute care setting.
2. Understand how to implement and evaluate a comprehensive safe sleep program.
3. Identify methods for providing staff and patient education.

4. Background/Significance
SIDS leading cause of mortality for all infants age 1-12 months in the U.S.
Since implementation of the “Safe to Sleep” campaign in (formerly known as “Back to Sleep”), the number of SIDS cases declined by half
In the last decade, SIDS rates have remained stagnant with no further decrease in mortality
The key to reducing and preventing deaths from SIDS and SUID: Safe Sleep Education!

5. Purpose Statement
The purpose of this quality improvement (QI) project was to evaluate the effectiveness of a comprehensive safe sleep program at a Midwestern pediatric inpatient hospital.

6. Safe Sleep Program Elements
1. Education for staff
2. Room signs demonstrating safe sleep guidelines in each infant room
3. Educational brochure for parents
4. Smart phone application for parents to play:
Safe Sleep Sweep©

7. Project Aims
1. Improvement in staff knowledge of safe sleep practices after receiving safe sleep education
2. Improvement in parental knowledge of safe sleep practices after exposure to educational materials
3. Evaluation of parental satisfaction with the room signs, brochure, and smart phone application as effective ways to learn about safe sleep practices.

8. Theoretical Framework
The Health Belief Model (Rosenstock, Strecher, & Becker, 1988)
Initially developed in the 1950s but eventually revised to include the constructs of:
Perceived susceptibility
Severity
Beliefs
Barriers
Health motivation
Self-efficacy

9. Design FADE Method for QI Focus Analyze Develop Execute/Evaluate

10. Setting, Population, and Sample
14-bed inpatient pediatric unit in a Midwestern hospital
Two target populations:
1. All designated staff members in the inpatient unit
Respiratory Therapy, Child Life, Registered Nurses
2. Parents of infants age 0-12 months who are admitted to the inpatient unit.
Exclusion criteria: parents who speak a primary language other than English

11. Education for Staff
Provided for RT, Child Life, and all RNs in the Inpatient Unit
Five small-group sessions using a PowerPoint and lecture format
Taught AAP safe sleep recommendations
Emphasized importance of role modeling a safe sleep environment
Pre-Test prior to education
Post-Test to evaluate effectiveness of education (increase in staff knowledge)

12. Room Signs
Room signs with pictures demonstrating safe sleep guidelines were hung in each infant room
The signs are free resources from the National Institute of Health (NIH) “Safe to Sleep” campaign
Effectiveness evaluated with Likert scale question on parental post-test

13. Educational Brochures
Provided to all parents upon admission
Also free resources from the NIH “Safe to Sleep Campaign”
Effectiveness evaluated with Likert scale question on parental post-test

14. Safe Sleep Sweep© Smart phone application played on an iPad
Parents create a safe sleep environment for a virtual baby using an interactive game format

15. Evaluation

16. Staff Results
23 registered nurses, 1 respiratory therapist, and 1 child life specialist
48% of staff had 20+ years of experience in their respective profession
The completion rate of staff education was 100% (n=25)
Average pre-test score for staff members: 71%
Average post-test score improved to 94% (p<.01)
Staff improved in identifying “back only” as the safest sleeping position
pre-test: 56%, post-test: 100% (p<.01)

19. Staff Results
No statistically significant difference in staff identifying risk factors for SIDS; however, staff scored relatively high in this area on the pre and post-tests
Increase in staff members recognizing SIDS as the leading cause of death in infants 1-12 months old
pre-test: 80%, post-test: 100% (p=.063)
On both the pre and post-tests, 100% of staff correctly identified:
It is not safe to put toys or stuffed animals in the crib with an infant
It is not safe to share a sleep surface with an infant

20. Parent Demographics 19 parents completed a pre and post-test
11% of parent participants were male (n=2), while 89% were female (n=17)
The average infant age was 4.16 months
16% (n=3) of parents reported never receiving safe sleep education before

21. Parent Results
39 eligible infants admitted to the unit during the implementation of the QI project
11 infants missed entirely
Parents of 9 infants received some elements of safe sleep education but were missing pre and/or post-test data
19 parents (49%) completed all three educational components as well as both a pre and post-test
72% (n=28) of families received at least some elements of safe sleep education
only parents who completed all 3 elements and the pre/post-tests included for statistical analysis

22. Parent Results Average pre-test score for parents: 77%
Average post-test score of 80%
On both the pre and post-tests, 89% of parents identified “back only” positioning as the safest sleeping position
No statistically significant change in parental identification of protective and risk factors for SIDS
On both the pre and post-tests, 100% of parents correctly identified:
It is not safe to put toys or stuffed animals in the crib with an infant or to share a sleep surface with an infant
SIDS is the leading cause of death for infants 1-12 months

23. Parent Results
The mean Likert score (5=strongly agree) for helpfulness of the educational materials:
4.12 for the room signs
4.29 for the informational brochures
4.2 for the safe sleep smart phone application

25. Discussion/Implications
Staff members working in the pediatric acute care setting benefited from safe sleep education
Staff members who have direct patient contact with children under one year of age receive safe sleep education
Institutions caring for children under one year of age should have a clear safe sleep policy to encourage staff commitment and compliance with safe sleep practices

26. Discussion/Implications
All methods of safe sleep education were rated positively by parents
Parents perceived the use of a smart phone application for safe sleep education to be comparable in helpfulness to alternative methods
Offering multiple educational interventions may cater to various parental learning styles

27. QI Process
Frequent audits took place to assess if parents were receiving all elements of the safe sleep program
Reasons for missed data and/or incomplete pre and post-tests included
“forgetting”
holidays
high census levels
Methods to improve compliance:
communication
in-person reminders
staff engaged in a pre-shift “huddle” to discuss the process
Safe Sleep “Champion”

28. Limitations
Small sample size related to the small-scale rapid cycle changes QI projects require
Missed parent education opportunities
Incomplete parent pre and post-test surveys
Difficult to determine at which point during the inpatient stay that parents received each educational intervention
limits analysis of parental knowledge improvement

29. Future Research
Additional studies with a larger sample size may be advantageous
Randomizing parents by educational method to better evaluate effectiveness
Assess changes in safe sleep practices by both health care providers and parents in response to education
Audits to evaluate behavior changes

30. Lessons Learned Don’t forget to educate the staff!
This group of staff members was very experienced, but still had the most significant improvement in knowledge of safe sleep practices.
Guidelines are updated over the years
YEARLY education important!
Identify a Safe Sleep Champion

31. Thank You!
Many thanks to my committee members for their hard work, feedback, and support this past year:
Committee Chair: Anne Schoening, PhD, RN, CNE
Meghan Potthoff, PhD, APRN-NP, PNP-PC, CPNP-AC
Jacqueline Loomis, BSN, RN, CPN
Thank you to Dr. Kandis McCafferty for her assistance with statistical analysis.