Improving Safe Sleep in the Neonatal Intensive Care Unit

Abstract

BACKGROUND: Sleep related death rates have declined since the 1990s following the American Academy of Pediatrics (AAP) back to sleep campaign, yet accidental suffocation and strangulation were top causes of infant mortality since 2019. Currently there are approximately 3500 sleep related infant deaths per year. Following the AAPs safe sleep guidelines that include sleeping on a flat firm surface in supine positioning, can greatly reduce sleep related deaths. Research has shown that NICU clinicians do not consistently follow safe sleep guidelines due to medical and developmental concerns. Lack of compliance with safe sleep practices in the NICU may influence parental adherence following discharge.

LOCAL PROBLEM: The setting for this project was an 18 bed Level III NICU in the Eastern US with the current safe sleep policy compliant with the AAP guidelines. Based on unit priorities an organizational assessment revealed the lack of compliance with unit policy included inadequate staffing, provider hesitancy, and dependence on float and travel nurses. Strengths of the unit included nursing management support, staff nurse cooperative in learning and willing to remediate and receive education on the proposed practice change.

METHODS: The Model for Improvement guided this project including PDSA cycles to support real time project adjustments. Pre and post implementation data was used to measure safe sleep guideline understanding based on an evidence based educational module. Practice changes that align with safe sleep policy compliance by the NICU nursing staff were evaluated using bedside audits.

INTERVENTIONS: The intervention process included an initial survey of staff knowledge on the AAP safe sleeping recommendations and unit policy. Bedspace audits were conducted to assess compliance with safe sleep guidelines prior to education. Survey data was collected post education to evaluate safe sleep guideline adherence by nurse participants, and post survey and post intervention bedside compliance audits to assess the effectiveness of the intervention.

RESULTS: The statistical analysis included a paired-sample t-test to determine whether there was a statistically significant mean difference between the pre education tests scores compared to the post education test scores. Results demonstrated participants scored higher after the education was complete (p < 0.001). Results also demonstrated an increase in safe sleep compliance following the intervention based on post educational bed space audits (p < 0.001).

CONCLUSIONS: Safe sleep compliance begins in the NICU, and those practices are translated home following discharge. The safe sleep educational intervention will become a part of the unit orientation and information booklet. Safe sleep champions will continue bedside audits to measure compliance and report findings to the nursing staff. Research and data from this project and similar projects should be used to assess and implement safe sleep practices in all NICUs.