Improving Adherence to Safe Sleep Guidelines for Hospitalized Infants at a Children's Hospital

Adolfo L Molina; Meghan Harrison; Candice Dye; Christine Stoops; Erinn O Schmit

doi:10.1097/pq9.0000000000000508

Improving Adherence to Safe Sleep Guidelines for Hospitalized Infants at a Children's Hospital

Pediatr Qual Saf. 2022 Jan 21;7(1):e508. doi: 10.1097/pq9.0000000000000508. eCollection 2022 Jan-Feb.

Authors

Adolfo L Molina¹, Meghan Harrison², Candice Dye³, Christine Stoops⁴, Erinn O Schmit¹

Affiliations

¹ Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Alabama at Birmingham, Birmingham, Ala.
² Department of Pediatrics, General Pediatric Residency, University of Alabama at Birmingham, Birmingham, Ala.
³ Department of Pediatrics, Division of Academic General Pediatric Medicine, University of Alabama at Birmingham, Birmingham, Ala.
⁴ Department of Pediatrics, Division of Neonatology, University of Alabama at Birmingham, Birmingham, Ala.

Abstract

Introduction: Sudden unexpected infant deaths are a major problem nationally. We had poor adherence to safe sleep recommendations locally at our institution. Given the significance of this problem, hospital administration at a tertiary children's hospital tasked a multidisciplinary group of faculty and staff with improving sleep environments for hospitalized infants.

Methods: Our safe sleep task force implemented targeted interventions using the American Academy of Pediatrics policy statement as the gold standard and based on hospital data to address areas of greatest nonadherence to recommendations. We aimed to improve weekly average adherence to 95% over 12 months. A proportions process control chart (p-chart) tracked average weekly adherence over a 52-week time frame. In addition, we performed Student's t-testing to evaluate differences in adherence over time.

Results: There was a significant improvement in overall adherence to safe sleep recommendations from baseline (M = 70.8%, SD 21.6) to end of study period (M = 94.7%, SD 10.0) [t(427) = -15.1, P ≤ 0.001]. Crib audits with 100% adherence increased from a baseline (M = 0%, SD 0) to the end of the study period M = 70.4%, SD = 46) [t(381)= -21.4, P ≤ 0.001]. This resulted in two trend shifts on the p-chart using Institute for Healthcare Improvement control chart rules.

Conclusions: Targeted interventions using QI methodology led to significant increases in adherence to safe sleep guidelines. Notable improvements in behavior indicated significant changes in safe sleep culture. We also noted continued adherence in follow-up audits reflecting sustainability.