Best Practice:

1

• Best Practice
• Infant Safe Sleep in the Hospital
• Sandra Frank, JD, CAE
• Executive Director

2

• Nonprofit organization
• Title V SIDS/SUID Program
• Partner with the Michigan
• Department of Community Health

3

• Lead resource for Infant Safe Sleep and Back to
  Sleep
• Grief central referral site
• Grief/interconception initiatives

4
Infant Safe Sleep Hospital Project
5
Michigan PNM

• 71 decline in SIDS rates since 1993
• SIDS diagnosis appeared to be going away
• Postneonatal rate unchanged diagnostic shift
• Sleep environment major risk factor

6
Systems Change

• Why focus on hospitals?
• Existing infrastructure
• Lessons from the literature
• Nurse values and beliefs

7
Safe Sleep Project

• Develop hospital model for institutionalizing
  infant safe sleep
• Evidence based
• Emphasis on evaluation
• Can be replicated

8
Hospital Infant Safe Sleep

• Pilot project at 2 Detroit hospitals in 2003 -The
  Skillman Foundation
• Project expanded to include 4 more hospitals
  Health Disparities Grant
• Replicated in additional 8 hospitals
• Expanding to NICU and Peds units
• Moving into physician clinics

9
Project Objectives

• Assess policies and practice
• Develop and implement policies
• Educate/train staff
• Educate mothers and families
• Sustain change though ongoing audits
• Evaluate compliance

10

Project Objective Assessing Hospitals
Current Practice
11
Assessing Hospitals Current Practice

• Conducted hospital audits to access nursing
  practices and parents knowledge level before
  beginning project
• Position of baby
• Location of baby
• Condition of crib
• Assessed parents knowledge of safe sleep and
  intended practices

12
Assessing Hospital Policies

• Projects were asked to collect and review all
  hospital policies with references to infant sleep
• Admissions forms and information
• Discharge materials
• All policies including
• Thermoregulation Policy
• Newborn Care Policy
• Neonatal Abstinence Policy (Drug withdrawal)

13
Nursing Policy
14
Policy

• Based on AAP guidelines (2005)
• Most critical factor in initiating and
  maintaining change in behavior and practice
• Policy is now standard of practice
• Only with written policy can staff be held
  accountable for actions
• Policy is necessary for any setting

15
Obstacles

• Approval from all hospitals and committees
• Must follow hospital guidelines
• Once policy committee approves must obtain
  signatures from all involved supervisors
• Time issues

16
Educating Staff
17
Lessons from death scenes
18
Lessons from death scenes

• prone position / head covered

19
Lessons from death scenes
CPSC Investigation
20
Lessons from death scenes
CPSC Investigation
21
Lessons from death scenes
22
Lessons from death scenes
23
Lessons from death scenes
24
Wedging / Entrapment
25
Educating staff

• Include factors of unsafe sleep environment
• Prone position
• Soft bedding
• Using bumper pads or stuffed animals in crib
• Baby Sleeping in Adult in or Youth Bed
• Sleeping on a Sofa, Soft Mattress or Water Bed

26
Unsafe Sleep Environment

• Side position is unstable and infants can roll
  into prone position.
• Risk of suffocation for infants rolling prone may
  be even higher than being placed in prone
  position initially.

27
Side Position

• Studies show that 70 90 of maternity hospitals
  still advocate the use of side sleeping position.
• Primary reason stated is fear of aspiration
  although there is no forensic, pathological or
  epidemiological evidence to substantiate these
  fears. (Fleming Blair 2002)

28
Aspiration and Supine Positioning
Continuing Education Program on SIDS Risk
Reduction, U.S. Department of Health and Human
Services, December 2006.
29
Aspiration and Supine Positioning

• When baby in on the back, trachea lies on top of
  the esophagus.
• Any regurgitation or reflux from the esophagus
  must work against gravity to be aspirated into
  the trachea
• In prone position the trachea lies below the
  esophagus
• In this position anything refluxed will pool at
  the opening of the esophagus

30
Education Challenges

• In a hospital setting, there are many challenges
  to getting staff together for mandatory
  education. Completing the education without
  accruing overtime can be a real challenge.
• Ideas to help defeat the Time Issues may
  include
• Offering impromptu trainings by project staff on
  unit when census is low
• Offer on-line program
• Placing binder with written material on unit with
  written test

31

• Implement Policy

32
Leading Change

• Be sure to have a passionate champion who will
  lead the change on the unit

33
Behavioral Change

• Very slow process
• Keep re-enforcing message
• Continue to model safe sleep practices
• Dont forget to include grandparents in education

34
Expect Resistors

• Identify them
• Challenge them
• Work with them
• Empower them
• Champion their progress

35

• Evaluate compliance

36
Quality Improvement

• Use safe sleep project as a quality improvement
  initiative project for your unit
• Set goals
• Discuss progress toward goals at each staff
  meeting

37
Sustaining the Change

• Leaders must communicate their vision for the
  promotion of safe sleep through words and
  behaviors

38
Sustaining Change

• Be sure staff have the tools they need to be
  successful in promoting safe sleep
• Fitted sheets for cribs
• Adequate supply of brochures in several languages
• Educational videos for in-house patient education
  channels
• Sleep sacks for newborns

39
Keep the Idea Fresh

• Make safe sleep a unit-based or annual
  competency
• Include education to every new employee
• Dont forget students, residents and physicians

40
Tell Your Stories

• Use the death scene re-enactment photos
• Communicate near-miss stories
• Tell real-life experiences
• Take advantage of teachable moments

41
Encourage staff outreach

• Provide staff with materials to take the message
  on the road
• Can present to child-care providers, church
  groups, neighborhood
• Staff then becomes the champions

42
By educating parents, grandparents and all
caregivers about the importance of safe sleep
environment WE CAN MAKE A DIFFERENCE AND
HELP SAVE BABIES LIFES
43
OUR GOAL Healthy Babies.
44
. And Healthy Families
45
THANK YOU!
46
For more information or resource
materials Contact Tomorrows Child 1-800-331-7437
Info_at_tcmisids.org