Facilitators and Barriers to Implementation of Safe Infant Sleep Recommendations in the Hospital Setting

Abstract

Objective: To identify facilitators and barriers to the implementation of safe sleep recommendations from the American Academy of Pediatrics from the perspective of hospital staff as part of a needs assessment that was used to design a successful quality improvement intervention to change clinical practice.

Design: Qualitative design.

Setting: Multiple sites of three hospitals in the northeastern and southern United States.

Participants: We used purposeful sampling to identify 46 participants who cared for infants on inpatient hospital units (nurses and other staff members).

Methods: A qualitative researcher used grounded theory to moderate the focus groups. We constructed the initial interview guide and then changed it as needed to capture more information about new ideas as they arose. Researchers from diverse backgrounds participated in the analysis and used the constant comparative method to select important concepts and to develop codes and subsequent themes. We continued to collect data until saturation was reached.

Results: We identified themes and subthemes, and the taxonomy fit into the Grol and Wensing framework for change in clinical practice. The six primary themes included The Innovation Itself, The Individual Health Care Professional, The Patient, The Social Context, The Organizational Context, and The Economic and Political Context.

Conclusion: Participants described facilitators and barriers to the implementation of the American Academy of Pediatrics recommendations for safe infant sleep. Identification of these themes informed our quality improvement intervention to promote safe infant sleep. Findings can be used by others when faced with the need for similar change.

Keywords: clinical practice; infants; quality improvement; recommendations; safe sleep.