1. 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 ; 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