Improving Safe Infant Sleep Compliance Through Implementation of a Safe Sleep Bundle

Background:Sleep-related infant deaths continue to be a significant public health issue that nondiscriminately impacts family units with increased risk notably in premature infants discharged home from the neonatal intensive care unit (NICU). The American Academy of Pediatrics endorses the use of safe sleep practices with specific recognition of the unique challenges faced in the NICU setting. Purpose:The purpose of this quality improvement (QI) project was to implement a safe sleep bundle and evaluate its effectiveness in improving caregiver compliance to safe sleep practices in a level III NICU at a large joint military medical facility. Methods:A QI initiative with a pre- and postanalysis was performed using a convenience method of sampling. Infants 32 weeks or more post-menstrual age in a level III NICU were analyzed pre- and post-interventions. The intervention included a safe sleep bundle that encompassed: (1) policy update, (2) standardized sleep sacks, (3) crib cards and certificates, and (4) creation of a provider order set in the electronic health record (EHR). A standardized crib audit tool evaluated sleep and bed position, items in the crib, order set in the EHR with consideration of special medical circumstances. Results:Postintervention assessment after the implementation resulted in a significant improvement of overall safe sleep compliance modeled by NICU staff, increasing to 100% from a baseline of 18% pre-intervention (P = .029). Implications for Practice and Research:Role-modeling behaviors of clinical staff may reduce the risk of sleep-related infant deaths upon discharge. A multifactorial approach can leverage successful strategies for improving safe sleep compliance in a NICU setting.