Safe to Sleep: A Community Quality Improvement Project Cari - PowerPoint PPT Presentation

Safe to Sleep: A Community Quality Improvement Project Cari Schmidt, PhD

Background: Infant Mortality Rate • Sedgwick County IMR = 7.2/1,000 – Higher than Kansas and US rates • A Perinatal Period of Risk (PPOR) analysis suggested nearly 150 PREVENTABLE deaths (2008 – 2012) Figure: KDHE. Infant Deaths by Cause 2008-2012. Sedgwick County (N=291).

Background: Safe Sleep Guidelines • American Academy of Pediatrics has recommendations to reduce the risk of sleep-related death. • ABC’s of Safe Sleep – Alone – Back – Clutter-free Crib

Background: Community Collaborative

Safe Sleep Research Study • Tested a Safe Sleep Bundle on hospital’s well newborn floor – Hospital policy, nurse training & agreement to promote infant safe sleep – Safe sleep instruction at room orientation instead of dismissal – Required viewing of “ABC’s of Safe Sleep” video – Posters in rooms & take-home materials for parents • Implementing a Safe Sleep Bundle improved safe sleep in the hospital from 25% of well newborns to 58% (Mason 2013) • At 2 month well-child check following hospital education, knowledge does not improve & behavior does not reflect intentions

Quality Improvement Pediatric Inpatient Unit • Setting and Population – Tertiary community hospital • 34 bed general pediatric acute care unit • Annual pediatric admissions exceed 3,000 – March 2012 – June 2012 – Infant 0-6 months of age admitted to the general pediatric unit were observed for sleep location, position and environment (e.g. items in crib)

Quality Improvement Pediatric Inpatient Unit

Quality Improvement Pediatric Inpatient Unit 80% 60% • Baseline Data (N=20) – 100% safe positon (back) 40% – 70% safe location – 1% safe environment (no 20% unsafe items in crib) 0%

Quality Improvement Pediatric Inpatient Unit • Key Drivers – No policy for infants 0-12 months of age – Inconsistent practices/knowledge of staff – Full-sized infant cribs and lack of alternate storage meant diapers, wipes, blankets, extra linens, etc. were often found in cribs

Quality Improvement Pediatric Inpatient Unit • Bundle components : – Safe sleep policy for infants – Training for staff with a signed Declaration of Safe Sleep • Staff included respiratory therapists, and allied health (e.g. child life specialists) – Caregivers required to watch Safe Sleep video and provided take-home materials – Environmental modifications • Three-drawer carts in each room

Quality Improvement Pediatric Inpatient Unit • Observations began 1 month after training and implementation • Post-intervention (N=31) – 100% safe position – 68% safe location – 13% safe environment – 2% with all three components

Quality Improvement Pediatric Inpatient Unit 80% 70% 60% 50% 40% Pre 30% Post 20% 10% 0% Burp Extra Diapers* Clothes Pillow Stuffed Cloths* Blankets Animals * Indicates statistically significant difference

Interpretation of Results and Next Steps • Disappointing results • Next steps – Don’t give up – Recognize changing culture takes time – Enhance intervention • Safe Sleep reminders in staff meetings and daily huddles

Monthly Audits of Safe Sleep

References • American Academy of Pediatrics (AAP). (October 2011). AAP expands guidelines for infant sleep safety and SIDS risk reduction. Retrieved from the American Academy of Pediatrics website: http://www.aap.org/en-us/about-the-aap/aap-press- room/pages/AAP-Expands-Guidelines-for-Infant-Sleep-Safety-and-SIDS-Risk- Reduction.aspx. • American Academy of Pediatrics (AAP). (October 2011b). SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment. Retrieved from the American Academy of Pediatrics website: http://pediatrics.aappublications.org/content/128/5/e1341.full.pdf+html. • Colson, E.R., Rybin, D., Smith, L.A., Colton, T., Lister, G., Corwin, M.J. (2009). Trends and factors associated with infant sleeping position: The national infant sleep position study 1993-2007. Archives of Pediatrics & Adolescent Medicine , 163(12):1122-8. • Crawford, G. Kansas Department of Health and Environment. Sedgwick County Infant Mortality presentation to the Maternal Infant Health Coalition. Nov. 2015. • Mason B, Ahlers-Schmidt CR, Schunn C. Improving safe sleep environments for well newborns in the hospital setting. Clin Pediatr (Phila). 2013 Oct;52(10):969-75. doi: 10.1177/0009922813495954. Epub 2013 Jul 19. PubMed PMID: 23872346. • Smith, L.A., Colson, E.R., Rybin, D., Margolis, A., Colton, T., Lister, G., et al. (2010). Maternal assessment of physician qualification to give advice on AAP-Recommended infant sleep practices related to SIDS. Academic Pediatrics , 10(6): 383-8. doi: 10.1016/j.acap.2010.08.006.