Improving Safe Sleep Modeling in the Hospital through Policy Implementation

• Published in: Maternal and child health journal Vol. 21; no. 11; pp. 1995 - 2000
• Main Authors: Heitmann, Rachel, Nilles, Ester K., Jeans, Ashley, Moreland, Jackie, Clarke, Chris, McDonald, Morgan F., Warren, Michael D.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-11-2017; Springer; Springer Nature B.V
• Subjects: Babies; Evaluation; Female; From the Field; Guideline Adherence; Gynecology; Health aspects; Health Knowledge, Attitudes, Practice; Health Personnel; Health Policy; Hospitals; Humans; Infant; Infant Care - methods; Infant mortality; Infant, Newborn; Infants; Maternal and Child Health; Medical care quality; Medical personnel; Medicine; Medicine & Public Health; Patient Safety - standards; Pediatrics; Population Economics; Practice; Public Health; Risk factors; Sleep; Sociology; Sudden Infant Death - prevention & control; Tennessee; Training; United States > US; Tennessee; Safe sleep; Back to sleep; Safe sleep hospital policy
• ISSN: 1092-7875; 1573-6628
• DOI: 10.1007/s10995-017-2334-8

Introduction
Sleep-related infant deaths are major contributors to Tennessee’s high infant mortality rate. The purpose of this initiative was to evaluate the impact of policy-based efforts to improve modeling of safe sleep practices by health care providers in hospital settings across Tennessee.
Methods
Safe sleep policies were developed and implemented at 71 hospitals in Tennessee. Policies, at minimum, were required to address staff training on the American Academy of Pediatrics’ safe sleep recommendations, correct modeling of infant safe sleep practices, and parent education. Hospital data on process measures related to training and results of crib audits were compiled for analysis.
Results
The overall observance of infants who were found with any risk factors for unsafe sleep decreased 45.6% (p ≤ 0.001) from the first crib audit to the last crib audit. Significant decreases were noted for specific risk factors, including infants found asleep not on their back, with a toy or object in the crib, and not sleeping in a crib. Significant improvements were observed at hospitals where printed materials or video were utilized for training staff compared to face-to-face training.
Discussion
Statewide implementation of the hospital policy intervention resulted in significant reductions in infants found in unsafe sleep situations. The most common risk factors for sleep-related infant deaths can be modeled in hospitals. This effort has the potential to reduce sleep-related infant deaths and ultimately infant mortality.