1. Safe Sleep in the NICU Problem SWOT Analysis Fishbone Diagram
Renee Aumua, MSN, RNC
Improvement Theme: Safety
Problem
SWOT Analysis
Fishbone Diagram
Conclusion
SIDS remains a leading cause of infant mortality for < 1 yr.
To reduce the risk of SIDS every infant should be placed for sleep in a supine position (wholly on the back) for every sleep until 1 year of age (AAP, 2011).
Increased risk of SIDS for premature infants, and a strong association between prone positioning and SIDS for low birth weight infants (AAP, 2011).
Recommendation is that NICU infants of 32 weeks postmenstrual age are placed in the supine sleep position as soon as medically stable and significantly before anticipated discharge (AAP, 2011).
In a random bed audit of our NICU, 33% of infants in this category were incorrectly placed in a non-supine sleep position.
Once supine sleep positioning has appropriately been established as a norm in the unit, we can move on to PDSA cycles of change re: the other factors of a safe sleep environment for our patients in accordance with the AAP guidelines. This will be followed and conducted by the Family Centered Care Committee.
Our bed audit already includes the other factors to help with data collection in preparation of future PDSA cycles. These factors include a flat bed vs. a raised head of the bed, items in the bed while the infant is sleeping and blankets secured below the arms of the infant while sleeping. We started with supine sleep positioning for this project because it is considered the most critical factor in SIDS prevention
Timeline- Ganntt Chart
Objectives
The NICU patient population contains several variables that lead to non-supine positioning.
RN opinion/beliefs are another major cause for noncompliance.
RN skill level is key factor.
Global Aim: To ensure a safe sleep environment for our NICU patients by following the recommended AAP SIDS prevention guidelines.
Specific Aim: we aim to improve the NICU RNs’ knowledge that supine positioning is safer for our patients starting at 32 weeks gestation or postmenstrual age, by 10% by May 10th.
References
Results
Improvement interventions consisted of:
Updating our unit SIDS prevention policy in alignment with the 2011 AAP guidelines
Education of RNs regarding the guidelines, dispelling common myths that prevent compliance, and the safety of a supine sleep position.
Educating RNs to the importance of proper role modeling of sleep safety in the NICU for continued compliance by parents upon discharge home.
Emphasizing to RNs the very high-risk category for SIDS that our patient population falls into
Current changes observed in the unit:
Patient SBAR reports now have noted medical exemptions when a patient necessitates a different sleep position
The physician order is documented for these exceptions
A re-audit of patient beds resulted in a drop to 23% of infants incorrectly placed in a non-supine sleep position.
Next Steps:
Make the bed audits part of monthly safety audits
Re-Survey RNs to assess for specific aim
Monitor the use of medical exemptions to positioning for correct application and appropriate discontinuance when no longer applicable.
Theoretical Framework for Change
Roger’s Change Theory Scorecard
Relative Advantage
Simplicity
Compatibility
Trialability
Observability
Definition
The degree to which an innovation is perceived as better than the idea it supersedes
The degree to which an innovation is perceived as simple to understand and use
The degree to which an innovation is perceived as being consistent with the existing values, experiences, beliefs, and needs of potential adopters
The degree to which an innovation can be tested on a small scale
The degree to which the use of an innovation and the results it produces are visible to those who should consider it
Score 1 5 3
RN Pre-Survey
At what gestational age should a NICU baby be positioned supine
59% answered correctly
A NICU patient is at higher risk for aspiration when placed supine
27% incorrectly answered true
I believe it’s ok for a NICU baby to be prone or side-lying because they are on monitors and I will teach parents the proper home guidelines
32% incorrectly answered true
Acknowledgements
Michelle Dishman, MSN- Department Manager -NICU
Andrea Hidalgo, CNS- NICU
Family Centered Care Committee- Women’s and Children’s Services Department
Score:
1 — “The change is very weak relative to this attribute.”
3 — “The change is okay relative to this attribute.”
5 — “The change is very strong relative to this attribute."