Karen Gray, M'S', C'H'E'S'

1
Franklin County Infant Safe Sleep and SIDS Risk
Reduction Initiative

• Karen Gray, M.S., C.H.E.S.
• Columbus Public Health
• Maternal and Child Health Division

2
Task Force Purpose

• To reduce infant sleep-related deaths by
  promoting safe sleep and SIDS risk reduction
  techniques, and by educating about safe sleep
  environments to all individuals who are
  responsible for caring for infants

3
Objectives

• To educate healthcare professionals about infant
  safe sleep and the risks associated with SIDS
  through implementation of a standardized
  hospital-based infant safe sleep curriculum
  (Phase I)
• To provide educational materials to the community
  about infant safe sleep and
• To conduct 3 trainings on infant safe sleep that
  will target childcare providers, home day care
  providers, home health care professionals, and
  staff of public OB and pediatric clinics (Phase
  II)

4
Significant Findings

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

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

• Among Franklin County SIDS deaths in 2004
• 42 were found on their stomach or side at time
  of death
• 32 were found sleeping on same surface with an
  adult
• 58 of the mothers smoked during pregnancy
• 63 were exposed to 2nd hand smoke

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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Conclusions from Child Fatality Review Process

• Data highlight unsafe sleep practices
• 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

9
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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Member Organizations

• 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

• 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
• Nationwide Childrens Hospital

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Why Focus on Hospitals?

• Findings from several studies indicate
• most nurses aware of back sleep recommendation
• most nurses afraid of aspiration
• preference for side position
• parent preference influenced by nurse behavior

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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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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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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Curriculum Content

• Definition of SIDS
• Introduce concept of sleep-related death
• Franklin County and national statistics
• Reducing SIDS risks
• Obstacles to complying with AAP guidelines
• Role of the RN
• Hospital safe sleep recommendations
• Hospital staff
• Parents
• What to teach new parents
• 2005 AAP guidelines
• Resources

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Educational Intervention

• Success was dependent on
• Hospitals having flexibility to determine method
  of implementation
• Examples of methods selected include
• - grand rounds
• - staff in-service trainings
• - computer-based education with test

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Beginning Steps Hospital A

• Met with management
• Back to sleep already in newborn policy
• How to enforce compliance
• Need to change policy to include 2005 AAP
  recommendations
• Task force involvement
• Identified safe sleep champions for each shift
• Acquired photographic evidence

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Pre-Audit Photographic Evidence
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Safe Sleep Champion Recommendations

• Interview staff
• 1 reason for continuing to place infants on
  their side was fear of aspiration
• Revise newborn policy
• Change verbage on clinical pathway and discharge
  summary to reflect safe sleep practices
• Re-educate staff

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Revision of Newborn Policy

• Infant is to be placed on back while in the crib
• Instruct parents not to position infant on
  stomach or side
• Toys, stuffed animals, and extra blankets are not
  allowed in the crib
• Parents will receive education on SIDS/safe sleep
  practices

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Staff Education

• Open house with free food from Thurs 0600 - Sat
  0800
• Invited all womens health staff
• Continuous PowerPoint presentation
• Placed resource manuals on each unit
• Education posters on every womens health unit

Benefits of Education Process

• Minimal non-productive hours
• 100 of staff on duty educated
• Parent tours, parents, and visitors asked to be
  educated

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Position of Baby
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Non-Essential Items in Crib
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Outcomes
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Ongoing Plans

• Continue with safe sleep audits
• Continue with safe sleep champions
• Safe sleep education incorporated into new staff
  orientation

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Hospital B

• Guidelines reviewed at Staff Meetings
• In-services offered
• Online Education with post-test

27
(No Transcript)
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Future Education Plans

• Infant safe sleep online education will continue
  to be a requirement for all Perinatal staff to
  complete at initial hire and annually
• An Infant Safe Sleep Station was part of
  Mandatory OB Education Days last fall
• Audits will be conducted as requested by the
  Franklin County Infant Safe Sleep and SIDS Risk
  Reduction Task Force to confirm that AAP
  Guidelines are being followed

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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
• Less than half (49) of staff indicated their
  hospital has a safe sleep policy 6 said no 45
  didnt know

N 209
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Position of Baby
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Non-Essential Items in Crib
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Summary Points

• Addressing infant safe sleep in the hospital
  setting positively influenced staff behaviors
• Positive behavior change has been maintained
  12-months post-intervention
• The Initiative demonstrates that theres an
  important role for health department leadership
  in group facilitation, coordination of
  intervention, and outcome evaluation
• The Initiative has been recognized nationally

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Safe Sleep Symposium

• April 12, 2008
• 94 nurses, social workers, and childcare
  providers attended
• Grant through CJ Foundation for SIDS
• Highlighted infant sleep-related death data and
  safe sleep recommendations

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Next StepsPhase II

• Development of childcare provider educational
  PowerPoint
• Conduct 3 county-wide trainings (secured March of
  Dimes funding)
• Continue monitoring hospital-based safe sleep
  initiative
• Strengthen public information on infant safe
  sleep group

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Contact Information

• Karen Gray, MS, CHES
• Columbus Public Health
• Public Health Program Manager
• 614-645-2134
• kareng_at_columbus.gov