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Best Practice:Infant Safe Sleep in the

HospitalSandra Frank, JD, CAE

Executive Director

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Nonprofit organization Title V SIDS/SUID Program Partner with the Michigan

Department of Community Health

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Lead resource for Infant Safe Sleep and Back to Sleep

Grief central referral site Grief/interconception initiatives

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Infant Safe Sleep

Hospital Project

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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

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Systems Change

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

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Safe Sleep Project

Develop hospital model for institutionalizing infant safe sleep

Evidence based Emphasis on evaluation Can be replicated

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Hospital Infant Safe Sleep • Pilot project at 2 Detroit hospitals in

2003 -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

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

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Project Objective:Assessing Hospital’s Current Practice

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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

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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)

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Nursing Policy

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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

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Obstacles Approval from all hospitals and

committees Must follow hospital guidelines Once policy committee approves

must obtain signatures from all involved supervisors

Time issues

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Educating Staff

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Lessons from death scenes

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Lessons from death scenes

prone position / head covered

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Lessons from death scenes

CPSC Investigation

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Lessons from death scenes

CPSC Investigation

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Lessons from death scenes

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Lessons from death scenes

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Lessons from death scenes

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Wedging / Entrapment

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Educating staffInclude 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

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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.

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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)

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Aspiration and Supine Positioning

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

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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

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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

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Implement Policy

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Leading Change

Be sure to have a passionate champion who will lead the change on the unit

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

education

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Expect Resistors

Identify them Challenge them Work with them Empower them Champion their

progress

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Evaluate compliance

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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

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Sustaining the Change

Leaders must communicate their vision for the promotion of safe sleep through words and behaviors

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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

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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

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Tell Your Stories Use the death scene re-enactment

photos Communicate “near-miss” stories Tell real-life experiences Take advantage of teachable moments

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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

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By educating parents, grandparents and all caregivers about the importance of safe sleep environment

WE CAN MAKE A DIFFERENCE AND HELP SAVE BABIES’ LIFES

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OUR GOAL: Healthy Babies….

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…. And Healthy Families

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THANK YOU!

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For more information or resource materials:

Contact Tomorrow’s Child1-800-331-7437

Info@tcmisids.org