title: Interventions to Improve Safe Sleep Among Hospitalized Infants at Eight Children's Hospitals.
abstract: OBJECTIVE
  Within hospital pediatric units, there is a lack of consistent application or modeling of the American Academy of Pediatrics recommendations for safe infant sleep. The purpose of this study was to improve safe sleep practices for infants in nonneonatal pediatric units with implementation of specific interventions.
  
  
  METHODS
  This multi-institutional study was conducted by using baseline observations collected for sleep location, position, and environment (collectively, "safe sleep") of infants admitted to pediatric units. Interventions consisted of: (1) staff education, including a commitment to promote safe sleep; (2) implementing site-generated safe sleep policies; (3) designating supply storage in patient rooms; and/or (4) caregiver education. Postintervention observations of safe sleep were collected. Eight hospitals participated from the Inpatient FOCUS Group of the Children's Hospital Association. Each site received institutional review board approval/exemption.
  
  
  RESULTS
  Safe sleep was observed for 4.9% of 264 infants at baseline and 31.2% of 234 infants postintervention (P<.001). Extra blankets, the most common of unsafe items, were present in 77% of cribs at baseline and 44% postintervention. However, the mean number of unsafe items observed in each sleeping environment was reduced by >50% (P=.001).
  
  
  CONCLUSIONS
  Implementation of site-specific interventions seems to improve overall safe sleep in inpatient pediatric units, although continued improvement is needed. Specifically, extra items are persistently left in the sleeping environment. Moving forward, hospitals should evaluate their compliance with American Academy of Pediatrics recommendations and embrace initiatives to improve modeling of safe sleep.
authors.affiliation: Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wichita, Kansas.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kuhlmann
authors.affiliation: Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wichita, Kansas cschmidt3@kumc.edu.
authors.forename: Carolyn R
authors.initials: CR
authors.lastname: Ahlers-Schmidt
authors.affiliation: Children's Hospital Association, Washington, DC; and.
authors.forename: Gloria
authors.initials: G
authors.lastname: Lukasiewicz
authors.affiliation: UCSF Benioff Children's Hospital, San Francisco, California.
authors.forename: Therese Macasiray
authors.initials: TM
authors.lastname: Truong
mesh_terms: D002673:Child, Hospitalized / Q000523:psychology; D005260:Female; D006272:Health Facility Environment / Q000592:standards*; D007722:Health Knowledge, Attitudes, Practice; D006776:Hospitals, Pediatric / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000379:methods / Q000592:standards; D008297:Male; D061214:Patient Safety / Q000592:standards*; D010372:Pediatrics / Q000379:methods / Q000592:standards; D058996:Quality Improvement; D012890:Sleep; D014481:United States