Abstract
Background: Thousands of infants each year die from sudden unexpected infant deaths (American Academy of Pediatrics, 2016). Most recent statistics from the State of Missouri data (2018) concluded that Missouri ranks 20th in infant mortality rates and many of these infant deaths were due to sleep-related events. At a regional level, Sudden Unexplained Infant Death (SUID) rates in the St. Louis region remain higher than the national average and particularly in St. Louis County where deaths related to an unsafe sleep environment have almost doubled during 2014-2018 as compared to the 2010 to 2014 timeframe (St. Louis County Department of Public Health, 2019). A large metropolitan teaching institution has not yet successfully implemented safe sleep modeling in the Neonatal Intensive Care Unit (NICU) prior to patient discharge.|Purpose: The purpose of this project is to provide successful safe sleep environment modeling in a large, 125-bed level IV NICU, policy awareness for NICU staff, and improved awareness of safe sleep for infant caregivers. The goal was to increase the proportion of infants placed in a safe sleep environment to at least 90% for those patients that qualified for safe sleep practices.|Methods: Implementation took place over twelve weeks, rounding biweekly on patients that qualify for safe sleep and providing reiteration of AAP recommendations for safe sleep practice for infant caregivers, if they were present. Bedside nurses were also required to display their proficiency in safe sleep by placing an infant in a safe sleep environment in a simulation lab or completing two “mock” safe sleep audits on patients in the unit. These audits were not included in the results of this project. Door signs were created to identify those patients that qualified for safe sleep modeling and aided in holding each team member and infant caregiver accountable for keeping the patient safe. Audits were reviewed at completion of the project and pre-implementation data and post-implementation data were compared.|Findings/Results: There was a significant increase in safe sleep compliance after the implementation period. The goal for each four-week block was to complete 100 audits. This goal was exceeded. A total of 978 audits were completed during the twelve-week implementation. The unit currently has 294 staff nurses and 100% of nursing staff completed the safe sleep competency. Compliance reached greater than 90% by the end of the implementation period.|Implications for Practice: Compliance with safe sleep practices provide effective modeling for infant caregivers and can help promote infant safety and decrease infant mortality from sleep-related events post-discharge.|Implications for Research: Ongoing analysis of barriers to safe sleep compliance can provide information about the sustainability of compliance and effective modeling, to decrease the chance of death from a sleep-related event at home.