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Rholdon, Roger D. (2017). Outcomes of a quality improvement project: An implementation of inpatient infant safe sleep practices. Pediatric Nursing, 43(5), 229-232.

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In 1994, the American Academy of Pediatrics(AAP), introduced an initiative to reduce the rate of Sudden Infant Death Syndrome(SIDS). The "Back to Sleep" campaign states that children under one year of age should always be placed on their back(supine), for sleeping. The intervention reduced the rates of SIDS in the U.S. from 1.4 deaths per 1,000 live births in 1993, to 0.55 per 1,000 live births in 2010.

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Despite these improvements, rates of SIDS did not decline any further in the U.S. or worldwide. In 2011, the AAP expanded it's recommendations for a safe sleep environment for infants. This Quality Improvement project sought to implement education of these expanded recommendations to floor nurses on an  inpatient pediatric unit, and therefore
improve safe sleep practices in the hospital setting.

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The hospital were the QI project was done had no formal policy regarding safe sleep practices. Because behaviors modeled by nurses are often duplicated at home, this project aimed to improve nurses' knowledge of expanded safe sleep practices, and implement them in the inpatient setting.

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The hospital has a pediatric unit with 28 beds, an average of 20 patients daily, and 37 nurses on staff.
The project was approved by the hospital's review board, and management contacted all nurses on the floor to make them aware of the project. The author of the study utilized  a rounding tool  to asses the sleep environment of 40 infants based on the criteria set forth by the AAP. Those 4 elements are: the infant is sleeping on their back, the infant is sleeping on a firm mattress, room sharing without bed sharing, and without loose bedding or any soft objects in the crib.

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After the initial observation, all 37 staff nurses were given a one month time frame to complete an online educational tool based on the 4 factors of a safe sleep environment for infants. At the end of the one month time period, a post-education observation of 40 more patients was conducted using the same rounding tool.

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In the pre-education rounding observation, 85% of patients were found to be sleeping prone, 90% on a firm mattress, and 87% had soft objects or loose bedding in the crib.

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The project used quantitative methods to interpret findings. In the post-education rounding observation, 92% were sleeping on their backs, 90% sleeping on a firm mattress, 93% room sharing but not bed sharing, and 50% had no soft object or loose bedding in the crib.

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Despite the fact that clinical improvements were seen in all 4 categories, only one showed statistical improvement. Using the statistical analysis of Chi-Square with Yates correction, it was found the only significant improvement was in the category of soft object/loose bedding.

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The author of the project acknowledges several limitations of the project. A small sample size, a change in nursing leadership during the project, and a lack of consistancy in the timing of rounds. In addition, there was no prior evaluation of the nurses' knowledge of safe sleep practices going into the project.

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This Quality Improvement project's purpose was to improve nursing knowledge of expanded safe sleep practices and implement them in the inpatient setting. The project emphasizes the importance of setting an example for caregivers by modeling appropriate behaviors of safe sleep practices. After completion of the project, this hospital implemented a policy and procedure for safe sleep practices.

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The author of this project aimed to see if a continuing education tool would increase knowledge and implementation of nurses' safe sleep practices for infants in a hospital setting.

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This project consisted of an initial observation of patients, an online education tool for nurses on the pediatric floor, and a post-education observation of a similar demographic of patients. Data was obtained based on the observations.

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Based on the data collected, there was clinical improvement in all categories, but statistical improvement in only one area.

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The author recommends that expanded safe sleep practices will be successful in reducing SIDS, and that with leadership, policies, and ongoing education, combating SIDS can be a reality.