090 - Modeling Safe Sleep in the Neonatal Intensive Care Unit (NICU)

Publication Number: 90.5678

Nadine-Stella Achenjang, UH Rainbow Babies & Children's Hospital, Lakewood, OH, United States; Sheri E. Ricciardi, UH Rainbow Babies & Children's Hospital, Brunswick, OH, United States; Michelle Scheetz, UH Rainbow Babies & Children's Hospital, Cleveland, OH, United States; Mary L. Nock, UH Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, United States

Background: Annually, about 3,500 infants in the United States die from sleep related deaths with premature infants at a 2-3 times increased risk. Premature infants can spend months in neonatal intensive care units (NICU) prior to going home. The American Academy of Pediatrics (AAP) recommends that all medically stable infants at corrected gestational age of 32weeks be placed in a safe sleep environment to decrease the risk of sleep related deaths. In a high acuity NICU this can be overlooked.

Objective: Our 82bed NICU is separated into a level IV and III designated areas. With this QI project, we plan to increase the rates of safe sleep environment for our medically stable patients in our level IV NICU. We aim to increase these rates from 51.1% to 67% for eligible infants over 3months and sustain for 6months.

Design/Methods: As a multidisciplinary team, we used the Institute for Healthcare Improvement model for improvement and devised a key driver diagram (Figure 1) for project development and implementation. Our outcome measure, the percentage of infants in a safe sleep environment was measured via weekly audits. Our balancing measure was the rate of cranial molding impairment requiring outpatient physical therapy referral at discharge. Our process measure evaluated how often the audits were completed.

Key changes to promote safe sleep in our NICU included the use of cards at each patient’s room to designate if they were ready for safe sleep or not. We also performed safe sleep audits during family centered rounds to offer simultaneous parent and staff education. We obtained grant funding to organize an interactive safe sleep educational session for families of infants with birthweight less than 1500grams and have since expanded for all infants born less than 32weeks gestation. We updated our unit and hospital safe sleep guidelines and continue to support our families with other areas that decrease the risk of sleep related deaths including breastfeeding.

Results: We have no changes to the median line in our run chart though audits tend to show improved safe sleep compared to baseline (Figure 2). We have a baseline balancing measure of 33% with physical therapy referral for cranial molding impairment. For our process measure, audits are completed on all eligible patients about 60% of the time.

Conclusion(s): As a result of this project, we have created more staff awareness of the importance of safe sleep in the NICU to continue supporting this vulnerable population. Families respond well to an interactive and intensive safe sleep class and are eager to learn various strategies to keep their baby safe upon discharge.

Figure 1: Key Driver Diagram
Key Driver Diagram .pdf

Figure 2: Safe Sleep Run Chart
Safe Sleep Run Chart.pdf