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Butler SC, Carroll K, Catalano K, Atkinson C, Chiujdea M, Kerr J, Severtson K, Drumm S, Gustafson K, Gingrasfield J. Sleeping Safe and Sound: A Multidisciplinary Hospital-wide Infant Safe Sleep Quality Improvement Initiative. J Pediatr Health Care 2024:S0891-5245(24)00048-8. [PMID: 38647508 DOI: 10.1016/j.pedhc.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Promoting safe sleep to decrease sudden unexpected infant death is challenging in the hospital setting. LOCAL PROBLEM Concern for adherence to safe sleep practice across inpatient units at a large pediatric hospital. METHODS Used quality improvement methodologies to promote safe sleep across all units. INTERVENTIONS Development of a multidisciplinary expert group, hospital-wide guidelines, targeted interventions, and bedside audits to track progress. RESULTS Adherence to safe sleep practices improved from 9% to 53%. Objects in the crib were a major barrier to maintaining a safe sleep environment. Safe sleep practices were less likely to be observed in infants with increased medical complexity (p = .027). CONCLUSIONS Quality improvement methodology improved adherence to infant safe sleep guidelines across multiple units. Medically complex infants continue to be a challenge to safe sleep. Therefore, ongoing education for staff and further research into best practices for the most complex infant populations are necessary.
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Affiliation(s)
- Samantha C Butler
- Attending Psychologist, Associate Professor, Departments of Psychiatry and Behavioral Services, Boston Children's Hospital, Boston, MA; Associate Professor, Departments of Psychiatry, Harvard Medical School, Boston, MA.
| | - Kayleigh Carroll
- Magnet and Patient Care Quality Improvement Consultant, Clinical Education, Informatics, Practice and Quality, Boston Children's Hospital, Boston, MA
| | - Katie Catalano
- Program Administration Manager, Quality Program, Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Carole Atkinson
- Nurse Practice Specialist, Department of Neurology, Boston Children's Hospital, Boston, MA
| | - Madeline Chiujdea
- Senior Quality Improvement Consultant, Department of Neurology, Boston Children's Hospital, Boston, MA
| | - Jessica Kerr
- Senior Quality Improvement Consultation, Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Katrina Severtson
- Clinical Research Assistant, Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Sara Drumm
- Staff Nurse, Neonatal Intensive Care Unit, Department of Newborn Medicine, Boston Children's Hospital, Boston, MA
| | - Kathryn Gustafson
- Clinical Quality Improvement Specialist, Clinical Education, Informatics, Practice and Quality Program, Boston Children's Hospital, Boston, MA
| | - Jennifer Gingrasfield
- Pediatric Nurse Practitioner, Sleep Center and Department of Neurology, Boston Children's Hospital, Boston, MA
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Caraballo M, Abbe M, Tidwell J, Dutton H, Garcia MG, Punzalan G, Axon A. Steering the Titanic: One tertiary care children's hospital's experience navigating safe sleep for hospitalized infants. J Pediatr Nurs 2023; 73:e1-e9. [PMID: 37330278 DOI: 10.1016/j.pedn.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Sudden Unexpected Infant Death (SUID) is the leading cause of death in infants 1 month to 1 year of age in the United States. Despite extensive efforts in research and public education, rates of sleep-related infant death have plateaued since the late-1990s, largely due to unsafe sleep practices and environments. LOCAL PROBLEM A multidisciplinary team assessed our institution's compliance with its own infant safe sleep policy. Data was collected on infant sleep practices, nurses' knowledge and training on the hospital policy, and teaching practices for parents and caregivers of hospitalized infants. Zero crib environments from our baseline observation met all the American Academy of Pediatrics recommendations for infant safe sleep. METHODS A comprehensive safe sleep program was implemented in a large pediatric hospital system. The purpose of this quality improvement project was to improve compliance with safe sleep practice from 0% to 80%, documentation of infant sleep position and environment every shift from 0% to 90%, and documentation of caregiver education from 12% to 90% within 24 months. INTERVENTIONS Interventions included revision of hospital policy, staff education, family education, environmental modifications, creation of a safe sleep taskforce, and electronic health record modifications. RESULTS Documented compliance with infant safe sleep interventions at the bedside improved from 0% to 88%, while documentation of family safe sleep education improved from 12% to 97% during the study period. CONCLUSIONS A multifaceted, multidisciplinary approach can lead to significant improvements in infant safe sleep practices and education in a large tertiary care children's hospital system.
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Affiliation(s)
- Michelle Caraballo
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9063, United States of America.
| | - Marisa Abbe
- Children's Health System of Texas, 1935 Medical District Drive, Dallas, TX 75235, United States of America
| | - Jerithea Tidwell
- Children's Health System of Texas, 1935 Medical District Drive, Dallas, TX 75235, United States of America
| | - Hayden Dutton
- Children's Health System of Texas, 1935 Medical District Drive, Dallas, TX 75235, United States of America
| | - Mayra G Garcia
- Children's Health System of Texas, 1935 Medical District Drive, Dallas, TX 75235, United States of America
| | - Gemmarie Punzalan
- Children's Health System of Texas, 1935 Medical District Drive, Dallas, TX 75235, United States of America
| | - Alison Axon
- Children's Health System of Texas, 1935 Medical District Drive, Dallas, TX 75235, United States of America
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Lowe T, Johnson J, Blanco M, Yassine K, Ansar S, Schnurman D, Al-Naemi H, Sutherland H. What are the barriers to sustaining a safe sleep program for infants within hospital settings: An integrative review of the literature. J Pediatr Nurs 2023; 71:23-31. [PMID: 36989868 DOI: 10.1016/j.pedn.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 02/27/2023] [Accepted: 03/07/2023] [Indexed: 03/31/2023]
Abstract
PROBLEM Safe sleep programs have been existing since the concept was first defined in 1969. The need for health care providers to model safe sleep practices is essential for successful adherence; however, barriers to promoting safe sleep practices hinder healthcare providers' ability to implement safe sleep in hospital settings. AIM To determine the barriers to promoting safe sleep practices amongst healthcare workers in the hospital setting. METHODS Whittemore & Knafl's framework (2005) guided this integrative review. CINAHL, PubMed, and Academic Search Complete databases were used as a search strategy. Inclusion criteria was limited to studies between 2010 and 2021, were peer-reviewed, in English, and quality improvement projects consisting of barriers to implementing safe sleep practices within hospitals. To assess quality of the included studies, the Mixed Methods Appraisal Tool and Standards for Quality Improvement Reporting Excellence were used. The studies were analyzed by two of the authors with data further categorized using the Social Ecological Model (SEM) to develop themes. RESULTS Findings of the 10 included studies were presented in the form of a data display matrix. The authors used the SEM to categorize the findings under three main categories at the organizational, individual, and cultural levels. CONCLUSIONS Barriers need to be addressed in hospital settings to reduce the risk of sudden infant death syndrome. Therefore, it is vital to consider those barriers while providing teaching programs in hospital settings. IMPLICATIONS Findings from this review provide the core elements to consider for the development of safe sleep programs in the hospital setting.
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Affiliation(s)
- Tawny Lowe
- Faculty of Nursing, The University of Calgary in Qatar.
| | | | - Melody Blanco
- Faculty of Nursing, The University of Calgary in Qatar.
| | | | - Sumayya Ansar
- Faculty of Nursing, The University of Calgary in Qatar.
| | | | | | - Helen Sutherland
- Clinical Nurse Manager, Education and Professional Practice, Sidra Medicine.
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Improving Safe Infant Sleep Compliance Through Implementation of a Safe Sleep Bundle. Adv Neonatal Care 2023; 23:4-9. [PMID: 36700678 DOI: 10.1097/anc.0000000000000992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sleep-related infant deaths continue to be a significant public health issue that nondiscriminately impacts family units with increased risk notably in premature infants discharged home from the neonatal intensive care unit (NICU). The American Academy of Pediatrics endorses the use of safe sleep practices with specific recognition of the unique challenges faced in the NICU setting. PURPOSE The purpose of this quality improvement (QI) project was to implement a safe sleep bundle and evaluate its effectiveness in improving caregiver compliance to safe sleep practices in a level III NICU at a large joint military medical facility. METHODS A QI initiative with a pre- and postanalysis was performed using a convenience method of sampling. Infants 32 weeks or more post-menstrual age in a level III NICU were analyzed pre- and post-interventions. The intervention included a safe sleep bundle that encompassed: (1) policy update, (2) standardized sleep sacks, (3) crib cards and certificates, and (4) creation of a provider order set in the electronic health record (EHR). A standardized crib audit tool evaluated sleep and bed position, items in the crib, order set in the EHR with consideration of special medical circumstances. RESULTS Postintervention assessment after the implementation resulted in a significant improvement of overall safe sleep compliance modeled by NICU staff, increasing to 100% from a baseline of 18% pre-intervention (P = .029). IMPLICATIONS FOR PRACTICE AND RESEARCH Role-modeling behaviors of clinical staff may reduce the risk of sleep-related infant deaths upon discharge. A multifactorial approach can leverage successful strategies for improving safe sleep compliance in a NICU setting.
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Johnson M, Simonovich SD, Neuman ME, Gidd-Hoffman K, Simo A, Spurlark RS. Ensuring Safe Sleep in the Pediatric Intensive Care Unit: A Systematic Review of Informed Development of Clinical Guidelines for Implementation in Practice. J Pediatr Health Care 2022; 37:234-243. [PMID: 36402627 DOI: 10.1016/j.pedhc.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Although general safe sleep guidelines have been established, their utility and implementation have yet to be examined systematically for inpatient populations for application to infants in the pediatric intensive care unit (PICU) setting. This study aimed to complete a systematic review of inpatient safe sleep practices studies to develop then safe sleep clinical guidelines for implementation in the care of medically complex infants in the PICU. METHOD This review was registered with PROSPERO and adheres to Preferred Reporting Items for Systematic reviews and Meta-Analyses systematic review guidelines. RESULTS Nineteen articles met the inclusion criteria. A safe sleep guideline algorithm for medically complex infants in the PICU was created for implementation. DISCUSSION Consistent and comprehensive safe sleep education and modeling by health care professionals in the inpatient setting is an effective technique to reduce the risk of harm and promote safe sleep behaviors in the home setting.
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Affiliation(s)
- Maura Johnson
- Maura Johnson, Graduate Student, Doctor of Nursing Practice Program, School of Nursing, DePaul University, Chicago, IL
| | - Shannon D Simonovich
- Shannon D. Simonovich, Associate Professor, School of Nursing, DePaul University, Chicago, IL.
| | - Michelle E Neuman
- Michelle E. Neuman, Assistant Professor, School of Nursing, DePaul University, Chicago, IL
| | - Kirsten Gidd-Hoffman
- Kirsten Gidd-Hoffman, Assistant Manager, Pediatric Intensive Care Unit, Rush University Medical Center, Chicago, IL
| | - Amanda Simo
- Amanda Simo, Clinical Educator, Pediatric Intensive Care Unit, Rush University Medical Center, Chicago, IL
| | - Roxanne S Spurlark
- Roxanne S. Spurlark, Assistant Professor, School of Nursing, DePaul University, Chicago, IL
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Practicing What We Preach: An Effort to Improve Safe Sleep of Hospitalized Infants. Pediatr Qual Saf 2022; 7:e561. [PMID: 35720873 PMCID: PMC9197363 DOI: 10.1097/pq9.0000000000000561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/26/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction: To prevent sudden unexpected infant death, pediatric providers recommend the ABCs of infant sleep: Alone, on the Back, and in an empty Crib. This study’s objective was to document sleep practices of infants admitted to a large children’s hospital, examine adherence to American Academy of Pediatrics safe sleep guidelines, and develop interventions to improve guideline adherence. Methods: We conducted a pre/post quality improvement study at a single quaternary care medical center from 2015 to 2019. Infants 0 to younger than 12 months were observed in their sleeping environment pre- and post-implementation of multiple hospital-wide interventions to improve the sleep safety of hospitalized infants. Results: Only 1.3% of 221 infants observed preintervention met all ABCs of safe sleep; 10.6% of 237 infants met the ABCs of safe sleep postintervention. Significant improvements in the post-intervention cohort included sleeping in a crib (94% versus 80% preintervention; P < 0.001), avoidance of co-sleeping (3% versus 15% preintervention; P < 0.001), absence of supplies in the crib (58% versus 15% preintervention; P < 0.001), and presence of an empty crib (13% versus 2% preintervention; P < 0.001). Conclusions: Most infants hospitalized at our institution do not sleep in a safe environment. However, the implementation of a care bundle led to improvements in the sleep environment in the hospital. Further research is necessary to continue improving in-hospital safe sleep and to assess whether these practices impact the home sleep environment.
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Salm Ward TC, Yasin T. Hospital-Based Inpatient Quality Improvement Initiatives on Safe Infant Sleep: Systematic Review and Narrative Synthesis. Sleep Med Rev 2022; 63:101622. [DOI: 10.1016/j.smrv.2022.101622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/25/2022]
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Salada KO, Badke CM. Missed Opportunities: Healthcare Encounters Prior to Sudden Unexpected Infant Death. Front Pediatr 2022; 10:880713. [PMID: 35592846 PMCID: PMC9110659 DOI: 10.3389/fped.2022.880713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/14/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Sudden unexpected infant death (SUID) is the leading cause of death in children 28 days to 1 year of age. The study aim was to identify opportunities for healthcare professionals to provide families with education on sleep and prevention of SUID. METHODS We performed a retrospective chart review of SUID infants over 10 years (12/2010-12/2020). The study included patients 0-12 months who presented to single institution with SUID (including asphyxia, suffocation, and SIDS). Baseline descriptive characteristics, sleep patterns (location, position, co-sleeping, presence of pillows/blankets), and prior healthcare encounters (type, duration, frequency, timing) were described. RESULTS Thirty-five infants met inclusion criteria. Twenty-three percent of families routinely practiced unsafe sleep, while 63% practiced unsafe sleep at the time of SUID. All unsafe sleep behaviors increased during the SUID event compared to routine, including inappropriate location (60%), co-sleeping (46%), and inappropriate position (37%) at the time of SUID. There were 54 total healthcare encounters (mean 1.5 per patient +/- 2.1) prior to SUID. Primary care physicians (57%) and NICU (29%) were the most frequent prior healthcare encounters, however visits spanned multiple specialties. Twenty-six percent had a healthcare encounter within 7 days of their death. DISCUSSION We demonstrated the frequency and variability in healthcare encounters among SUID infants prior to their death. Majority of infants had prior healthcare encounters, with 26% seen by healthcare professionals within 7 days of their death. These results highlight the important role healthcare professionals across all specialties have the potential to play in educating families about safe sleep and SUID.
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Affiliation(s)
- Katherine O Salada
- Division of Hospital Based Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Colleen M Badke
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
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Molina AL, Harrison M, Dye C, Stoops C, Schmit EO. Improving Adherence to Safe Sleep Guidelines for Hospitalized Infants at a Children’s Hospital. Pediatr Qual Saf 2022; 7:e508. [PMID: 35071951 PMCID: PMC8782121 DOI: 10.1097/pq9.0000000000000508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/13/2021] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is available in the text. Introduction: Sudden unexpected infant deaths are a major problem nationally. We had poor adherence to safe sleep recommendations locally at our institution. Given the significance of this problem, hospital administration at a tertiary children’s hospital tasked a multidisciplinary group of faculty and staff with improving sleep environments for hospitalized infants. Methods: Our safe sleep task force implemented targeted interventions using the American Academy of Pediatrics policy statement as the gold standard and based on hospital data to address areas of greatest nonadherence to recommendations. We aimed to improve weekly average adherence to 95% over 12 months. A proportions process control chart (p-chart) tracked average weekly adherence over a 52-week time frame. In addition, we performed Student’s t-testing to evaluate differences in adherence over time. Results: There was a significant improvement in overall adherence to safe sleep recommendations from baseline (M = 70.8%, SD 21.6) to end of study period (M = 94.7%, SD 10.0) [t(427) = −15.1, P ≤ 0.001]. Crib audits with 100% adherence increased from a baseline (M = 0%, SD 0) to the end of the study period M = 70.4%, SD = 46) [t(381)= −21.4, P ≤ 0.001]. This resulted in two trend shifts on the p-chart using Institute for Healthcare Improvement control chart rules. Conclusions: Targeted interventions using QI methodology led to significant increases in adherence to safe sleep guidelines. Notable improvements in behavior indicated significant changes in safe sleep culture. We also noted continued adherence in follow-up audits reflecting sustainability.
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Goodstein MH, Stewart DL, Keels EL, Moon RY. Transition to a Safe Home Sleep Environment for the NICU Patient. Pediatrics 2021; 148:peds.2021-052046. [PMID: 34155135 DOI: 10.1542/peds.2021-052046] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Of the nearly 3.8 million infants born in the United States in 2018, 8.3% had low birth weight (<2500 g [5.5 lb]) and 10% were born preterm (gestational age of <37 completed weeks). Many of these infants and others with congenital anomalies, perinatally acquired infections, and other disease require admission to a NICU. In the past decade, admission rates to NICUs have been increasing; it is estimated that between 10% and 15% of infants will spend time in a NICU, representing approximately 500 000 neonates annually. Approximately 3600 infants die annually in the United States from sleep-related deaths, including sudden infant death syndrome International Classification of Diseases, 10th Revision (R95), ill-defined deaths (R99), and accidental suffocation and strangulation in bed (W75). Preterm and low birth weight infants are particularly vulnerable, with an incidence of death 2 to 3 times greater than healthy term infants. Thus, it is important for health care professionals to prepare families to maintain their infant in a safe sleep environment, as per the recommendations of the American Academy of Pediatrics. However, infants in the NICU setting commonly require care that is inconsistent with infant sleep safety recommendations. The conflicting needs of the NICU infant with the necessity to provide a safe sleep environment before hospital discharge can create confusion for providers and distress for families. This technical report is intended to assist in the establishment of appropriate NICU protocols to achieve a consistent approach to transitioning NICU infants to a safe sleep environment as soon as medically possible, well before hospital discharge.
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Affiliation(s)
- Michael H Goodstein
- Division of Newborn Services, WellSpan Health, York, Pennsylvania .,Department of Pediatrics, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Dan L Stewart
- Department of Pediatrics, Norton Children's and School of Medicine, University of Louisville, Louisville, Kentucky
| | - Erin L Keels
- National Association of Neonatal Nurse Practitioners, National Association of Neonatal Nurses, Chicago, Illinois.,Neonatal Advanced Practice, Nationwide Children's Hospital, Columbus, Ohio
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Leong T, Roome K, Miller T, Gorbatkin O, Singleton L, Agarwal M, Lazarus SG. Expansion of a multi-pronged safe sleep quality improvement initiative to three children's hospital campuses. Inj Epidemiol 2020; 7:32. [PMID: 32532333 PMCID: PMC7291418 DOI: 10.1186/s40621-020-00256-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background The American Academy of Pediatrics (AAP) recommends infants should be Alone, on their Back, and in a clear Crib to combat relatively stagnant rates of sudden unexpected infant death (SUID). These are referred to as the ABCs of safe sleep. Studies have shown these recommendations are not consistently followed in the hospital setting, but further investigation would determine how to improve the rate of adherence. The objective of this study was to evaluate the impact of an expanded safe sleep initiative at three Georgia free-standing children’s hospital campuses before and after a multipronged safe sleep initiative. Methods A quality improvement program with a pre/post analysis was performed using a convenience method of sampling. Infants < 12 months old in three inpatient pediatric campuses were analyzed pre- and post- interventions. The intervention included: 1) nursing education, 2) identification of nurse “safe sleep” champions, 3) crib cards, 4) crib audits, and 5) weekly reporting of data showing nursing unit ABC compliance via tracking boards. The goal was ABC compliance of ≥25% for the post-intervention period. A standardized crib audit tool evaluated sleep position/location, sleep environment, and ABC compliance (both safe position/location and environment). Chi square analysis, Fisher’s exact test, and logistic regression were used to compare safe sleep behaviors before and after the interventions. Results There were 204 cribs included pre-intervention and 274 cribs post-intervention. Overall, there was not a significant change in sleep position/location (78.4 to 76.6%, p = 0.64). There was a significant increase in the percent of infants sleeping in a safe sleep environment following the intervention (5.9 to 39.8%, p < 0.01). Overall ABC compliance, including both sleep position/location and environment, improved from 4.4% pre-intervention to 32.5% post-intervention (p < 0.01). There was no significant variability between the hospitals (p = 0.71, p = 1.00). Conclusions The AAP’s safe sleep recommendations are currently not upheld in children’s hospitals, but safer sleep was achieved across three children’s campuses in this study. Significant improvements were made in sleep environment and overall safe sleep compliance with this multi-pronged initiative.
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Affiliation(s)
- Traci Leong
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, 30322, USA
| | - Kerryn Roome
- Emory University School of Medicine, Atlanta, 30322, USA
| | - Terri Miller
- Georgia Department of Public Health, Atlanta, 30303, USA
| | | | - Lori Singleton
- Children's Healthcare of Atlanta, Atlanta, 30322, USA.,Morehouse School of Medicine, Atlanta, 30310, USA
| | - Maneesha Agarwal
- Emory University School of Medicine, Atlanta, 30322, USA.,Children's Healthcare of Atlanta, Atlanta, 30322, USA
| | - Sarah Gard Lazarus
- Children's Healthcare of Atlanta, Atlanta, 30322, USA. .,Pediatric Emergency Medicine Associates, Atlanta, 30342, USA.
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Havers SM, Kate Martin E, Wilson A, Hall L. A systematic review and meta-synthesis of policy intervention characteristics that influence the implementation of government-directed policy in the hospital setting: implications for infection prevention and control. J Infect Prev 2020; 21:84-96. [PMID: 32494292 DOI: 10.1177/1757177420907696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 01/02/2020] [Indexed: 01/26/2023] Open
Abstract
Background Government-directed policy plays an important role in the regulation and supervision of healthcare quality. Effective implementation of these policies has the potential to significantly improve clinical practice and patient outcomes, including the prevention of healthcare-associated infections. A systematic review of research describing the implementation of government-directed policy in the hospital setting was performed with the aim to identify policy intervention characteristics that influence implementation. Methods A systematic search of four electronic databases was undertaken to identify eligible articles published between 2007 and 2017. Studies were included if published in the English language and described the implementation of government-directed policy in a high-income country hospital setting. Data on policy and implementation were extracted for each article and interpretive syntheses performed. Results A total of 925 articles were retrieved and titles and abstracts reviewed, with 69 articles included after review of abstract and full text. Qualitative synthesis of implementation data showed three overarching themes related to intervention characteristics associated with implementation: clarity; infrastructure; and alignment. Conclusion Better understanding and consideration of policy intervention characteristics during development and planning will facilitate more effective implementation although research describing implementation of government-directed policy in the hospital setting is limited and of variable quality. The findings of this study provide guidance to staff tasked with the development or implementation of government-directed policy in the hospital setting, infection prevention and control professionals seeking to maximise the impact of policy on practice and improve patient outcomes.
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Affiliation(s)
- Sally M Havers
- Queensland University of Technology Faculty of Health, Kelvin Grove, QLD, Australia
| | | | | | - Lisa Hall
- University of Queensland, Brisbane, QLD, Australia
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Abstract
Risk of sleep-related infant deaths can be reduced by improving safe sleep practices.
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Affiliation(s)
- Jennifer M Bombard
- Jennifer M. Bombard is an epidemiologist in the Division of Reproductive Health, National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention, Atlanta, where Katherine Kortsmit is an Oak Ridge Institute for Science and Education fellow, Carri Cottengim is a health scientist, and Emily O. Johnston is a public health advisor. Contact author: Jennifer M. Bombard, . The authors have disclosed no potential conflicts of interest, financial or otherwise. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention
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Bombard JM, Kortsmit K, Warner L, Shapiro-Mendoza CK, Cox S, Kroelinger CD, Parks SE, Dee DL, D’Angelo DV, Smith RA, Burley K, Morrow B, Olson CK, Shulman HB, Harrison L, Cottengim C, Barfield WD. Vital Signs: Trends and Disparities in Infant Safe Sleep Practices - United States, 2009-2015. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2018; 67:39-46. [PMID: 29324729 PMCID: PMC5769799 DOI: 10.15585/mmwr.mm6701e1] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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