Title: 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
8Hospital 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
11Assessing 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
18Lessons 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
22Lessons from death scenes
23Lessons from death scenes
24Wedging / 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)
28Aspiration and Supine Positioning
Continuing Education Program on SIDS Risk
Reduction, U.S. Department of Health and Human
Services, December 2006.
29Aspiration 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 32 Leading Change
- Be sure to have a passionate champion who will
lead the change on the unit
33Behavioral Change
- Very slow process
- Keep re-enforcing message
- Continue to model safe sleep practices
- Dont forget to include grandparents in education
34Expect Resistors
- Identify them
- Challenge them
- Work with them
- Empower them
- Champion their progress
35 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
38Sustaining 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
42By educating parents, grandparents and all
caregivers about the importance of safe sleep
environment WE CAN MAKE A DIFFERENCE AND
HELP SAVE BABIES LIFES
43OUR 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