Franklin County Infant Safe Sleep and SIDS Risk Reduction Initiative

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Franklin County Infant Safe Sleep and SIDS Risk
Reduction Initiative
Healthy Start Grantee Meeting August 7, 2007
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Learning Objectives

• Describe how the Task Force collaborated with
  Franklin County hospital systems to
  institutionalize an educational curriculum
  addressing infant safe sleep
• Identify key components of a hospital-based
  infant safe sleep initiative
• Identify potential barriers encountered when
  working with hospital systems

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Sudden Infant Death Syndrome

• To make a diagnosis of SIDS, the following
  criteria must be fully met
• 1. Infant under 1 year of age
• 2. No cause of death determined after scene
  investigation
• 3. Review of the clinical history
• 4. Complete autopsy
• Definition according to the National Institute of
  Child Health and Human Development and used by
  the National Association of Medical Examiners

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Franklin County SIDS Statistics

• Of all deaths reviewed by the FC CFR
• In 2004, 19 infant deaths (11) were from SIDS.
• In 2003, 15 infant deaths (8) were from SIDS.
• For the period 2000-2003, 57 infant deaths (7)
  were from SIDS.

Source Columbus Public Health, Franklin County
Child Fatality Review, Annual Community Report,
January 2007, Columbus, Ohio.
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Franklin County SIDS Statistics

• In 2004, SIDS deaths among male infants (63) and
  among Black infants (53) were high relative to
  their representation in Franklin Countys
  population
• According to the U.S. Census Bureau, 23 of
  children in Franklin County are Black and 51 are
  male (2000).

• Proportion of SIDS Fatality Reviews by Gender and
  Race, 2004 (N19)

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Significant Finding

• In Franklin County in 2003, the rate of SIDS for
  Black infants was 3 times higher than the rate
  for White infants

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Environmental Conditions

• Franklin County Child Fatality Review statistics
  about SIDS deaths in 2000-2003 indicate
• 46 had moms who smoked during pregnancy
• 88 had been exposed to ETS
• 38 were not sleeping alone at the time of death
• 47 were not on a firm sleeping surface
• 41 were found in areas with heavy bedding/
  pillows

Of those SIDS deaths for which this information
is known
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SIDS Risks Exposure to Smoke

• Among Franklin County SIDS deaths in 2004
• 58 percent of the mothers smoked during pregnancy
• 63 percent were exposed to 2nd hand smoke

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SIDS Risks - Infants Sleep Position

• Among Franklin County SIDS deaths in 2004
• 42 percent were found on their stomach or side at
  time of death
• 32 percent were found sleeping on same surface
  with an adult

Sleep position not captured in previous FC CFR
data reporting and analysis. Proportion of SIDS
Deaths by Sleep Position, 2004 (N19)
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SIDS Risks Sleep Location

• Of all SIDS deaths in 2004, 26 occurred in a
  crib or bassinette, while 69 of SIDS deaths
  occurred in locations considered unsafe, i.e., in
  other beds, on couches and other locations

• Proportion of SIDS Fatality Reviews by Incident
  Sleep Place, 2004 (N19)

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FC CFR SIDS Recommendations

• Healthcare providers should educate parents/
  caregivers at hospital discharge about the
  importance of safe sleep habits for the infant,
  including
• sleep position an infant should be placed on
  its back to sleep,
• sleep location in a crib, assembled according
  to manufacturers instructions,
• sleep surface infants should sleep on a firm
  surface, that is free from other children or
  adults, excess bedding, and stuffed animals.

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FC CFR SIDS Recommendations

• Healthcare providers should educate pregnant
  women of the serious health risks of exposing a
  fetus to tobacco smoke (second hand smoke),
  alcohol, or other drugs during pregnancy.
• Healthcare providers should educate parents and
  caregivers about the danger of exposing a fetus
  or an infant to environmental tobacco smoke
  (second hand smoke).

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Shifting The Focus toInfant Safe Sleep

• Funding Provided By
• Columbus Public Health to the
• Council on Healthy Mothers and Babies
• Ohio Department of Health/Federal Government,
  Bureau of Child and Family Health Services, Child
  and Family Health Services Program

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Columbus Caring For 2 Project

• Local Health System Action Plan
• Increase PNC access and capacity
• Decrease risk factors and subsequently deaths
  caused by SIDS
• Decrease alcohol and other drug use and effects
  through improved services for pregnant women
• Decrease tobacco use and ETS and its effects on
  pregnant women
• Improve access to care for interconceptional
  services

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Member Organizations

• Childrens Hospital
• Columbus Public Health
• Communities in Schools
• Council on Healthy Mothers and Babies
• Doctors Hospital
• Grant Medical Center
• Help Me Grow
• March of Dimes
• Mount Carmel Health System

• Northwest Counseling Services
• Ohio Dept. of Health
• Ohio Dept. of Jobs and Family Services
• OSU Medical Center
• Region IV Perinatal Center
• Riverside Methodist Hospital
• St. Anns Hospital

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Task Force Objective

• To reduce infant sleep-related deaths by
  promoting safe sleep and SIDS risk reduction
  techniques, and through educating healthcare
  professionals about safe sleep environments

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• A New Understanding Beyond Back to Sleep
• Back sleep position, by itself, is not protective
  when other unsafe factors are present.
• Too many babies are dying in unsafe sleep
  environments.
• These deaths are PREVENTABLE.

Information from Tomorrows Child Michigan
SIDS Infant Safe Sleep Hospital Project
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Project Goal Develop hospital model for
institutionalizing infant safe sleep

• Objectives
• 1. Assess current hospital practice and policies
  regarding infant safe sleep.
• 2. Develop hospital policy addressing infant safe
  sleep.
• 3. Educate hospital staff regarding policy.
• 4. Implement policy.
• 5. Evaluate compliance with policy.

Information from Tomorrows Child Michigan
SIDS Infant Safe Sleep Hospital Project
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Franklin County Program Components

• Hospital observational audits
• Pre/post surveys for hospitals, OB clinics and
  pediatric clinics assessing staff knowledge,
  beliefs and behaviors
• Education component includes power point
  presentation for health professionals (i.e.
  nurses and patient educators)

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Where are we now?

• Observational audit tool developed and
  administered
• Survey tool for hospitals, OB and pediatric
  clinics developed (administered among hospitals)
• Power point presentation for health
  professionals developed
• Some hospitals utilizing educational tool
• Tracking mechanism developed

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Project Timeline

• November, 2006 hospital observational audits
• November, 2006 pre-survey hospitals
• December, 2006 finalized standardized education
  component for use in hospital setting
• January, 2007 education component roll-out
  begins in hospital setting
• Spring/Summer, 2007 follow-up hospital
  observational audits
• Summer, 2007 post-survey hospitals

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Project Timeline (cont.)

• November, 2007 pre-survey OB and pediatric
  clinics
• January, 2008 education component roll-out
  begins in OB and pediatric clinics
• Summer, 2008 post-survey OB and pediatric
  clinics
• Spring/Summer, 2008 expand program to include
  day care providers, faith-based organizations,
  etc.

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Observational Audit Tool

• Location (hospital)
• Shift
• Location of infant (nursery, moms room)
• Position of infant (back, side, stomach)
• Condition of crib (blankets, stuffed animals,
  toys, loose items, etc.)
• General comments section

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Observational Audit Results

• Within Franklin County Birthing Hospitals
• Position of Baby
• 50 were placed to sleep on their backs
• 49 were placed to sleep on their sides
• Condition of Crib
• 22 had blankets
• 13 had toys
• 83 of babies were swaddled/bundled

Eighty-six percent of babies audited were located
in the well baby nursery thirteen percent were
in moms room
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Hospital Staff Survey Assessment

• Discipline
• Length of employment
• Responsibility for safe sleep education
• When education occurs
• Components of safe sleep education
• Hospital policy
• 5 questions about beliefs/attitudes regarding
  infant safe sleep

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Hospital Staff Survey

• Within Franklin County Birthing Hospitals
• 97 of staff recommend back sleeping position
• Education typically occurs during hospitalization
• 65 of staff havent received formal training on
  safe sleep in past 3 years
• 42 of staff dont feel theyve received enough
  training

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Follow-up Observational Audit Results

• Within Franklin County Birthing Hospitals
• Position of Baby
• 81 were placed to sleep on their backs
• 19 were placed to sleep on their sides
• Condition of Crib
• 9 had blankets
• 3 had toys
• 73 of babies were swaddled/bundled

only 2 hospitals reporting, to date
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Comparison of Pre/Post Audits
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(No Transcript)
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Learning Objectives

• Define SIDS
• Learn current SIDS statistics
• List Franklin County Child Fatality Review SIDS
  Recommendations
• List the critical SIDS risk-reduction messages
  for parents/caregivers
• Describe your key role as educator to
  parents/caregivers about safe sleep

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Educational Intervention

• Hospitals had flexibility in determining
• - method of implementation
• - contact hours provided
• Examples of methods selected include
• - grand rounds
• - staff in-service trainings
• - computer-based education with test

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Nurses as Role Models

• Nurses can model Safe Sleep techniques to ensure
  families know how to reduce SIDS risk
• Nurses who placed infants to sleep on their
  backs during the postpartum hospital stay changed
  parents behaviors significantly
• The most critical period during which nurses can
  influence parents behavior is during the 24 to
  48 hours following delivery

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Safe Sleep Recommendations In Hospital

• All infants are always placed on their backs to
  sleep.
• Infants will only be in bed with mom if mom is
  wide awake.
• If mom is tired or sleeping, infant must be
  placed in crib.
• Cribs to be free of all toys and equipment.

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Safe Sleep Recommendations In Hospital

• If a baby is bundled, arms should be loosely
  wrapped so that infant can still have some
  freedom and movement of arms to bring hands up to
  face.
• Make sure that infants face and head remain
  uncovered during sleep.
• Bundling may be indicated for medical conditions
  such as thermoregulation or management of drug
  withdrawal.
• An explanation as to the reason for bundling
  will be given to the mother.

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Safe Sleep Recommendations What To Teach New Moms

• Always place the baby on his or her back to sleep
  for naps and at night
• Place the baby to sleep on a firm sleep surface,
  such as on a safety-approved crib mattress,
  covered by a fitted sheet
• Keep soft objects, toys, loose bedding and
  padding out of the babys sleep area
• Do not allow smoking around the baby

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Safe Sleep Recommendations What To Teach New Moms

• Breastfeeding may decrease the risk of sudden
  infant death, so encourage moms to breastfeed
  their babies
• Keep the babys sleep area close to, but separate
  from, where parents sleep
• During babys first year, consider using a clean,
  dry pacifier when placing the baby down to sleep.
  For breastfed infants, do not introduce pacifier
  until 1 month of age
• Do not let the baby overheat during sleep. Babies
  usually need one layer more than an adult

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Safe Sleep Recommendations What To Teach New Moms

• Avoid products that claim to reduce the risk of
  SIDS
• Do not use home monitors to reduce the risk of
  SIDS
• Reduce the chance that flat spots will develop on
  the babys head (Tummy Time)
• Talk about SIDS to child care providers,
  grandparents, babysitters, and everyone who cares
  for the baby

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Challenges

• Producing hospital education program roll-out
  plan while managing differing institutional
  readiness for implementation
• Ensuring consistent implementation of education
  component
• Offering education during all shifts
• Securing additional funding to advance our
  efforts
• Staying up-to-date with new information regarding
  SIDS

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Lessons Learned

• Addressing infant safe sleep in the hospital
  setting positively influenced staff attitudes and
  behaviors
• Safe sleep practice is strongly influenced by
  nurse modeling and verbal instruction
• Theres an important role for health department
  leadership in group facilitation, coordination of
  intervention, and outcome evaluation

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Karen Gray, Program ManagerCFHS and MCH
Planning614-645-2134kareng_at_columbus.govMonica
Juenger, Project ManagerCouncil on Healthy
Mothers and Babies614-586-1914cohmab03_at_yahoo.com