title: Improving Safe Sleep Practices for Hospitalized Infants.
abstract: Adherence to the American Academy of Pediatrics safe sleep practice (SSP) recommendations among hospitalized infants is unknown, but is assumed to be low. This quality improvement study aimed to increase adherence to SSPs for infants admitted to a children's hospital general care unit between October 2013 and December 2014.
  
  
  
  After development of a hospital policy and redesign of room setup processes, a multidisciplinary team developed intervention strategies based on root cause analysis and implemented changes using iterative Plan-Do-Study-Act cycles. Nurse knowledge was assessed before and after education. SSPs were measured continuously with room audits during sleeping episodes. Statistical process control and run charts identified improvements and sustainability in hospital SSPs. Caregiver home practices after discharge were assessed via structured questionnaires before and after intervention.
  
  
  
  Nursing knowledge of SSPs increased significantly for each item (P ≤ .001) except avoidance of bed sharing. Audits were completed for 316 sleep episodes. Simultaneous adherence to all SSP recommendations improved significantly from 0% to 26.9% after intervention. Significant improvements were noted in individual practices, including maintaining a flat, empty crib, with an appropriately bundled infant. The largest gains were noted in the proportion of empty cribs (from 3.4% to 60.3% after intervention, P < .001). Improvements in caregiver home practices after discharge were not statistically significant.
  
  
  
  Sustained improvements in hospital SSPs were achieved through this quality improvement initiative, with opportunity for continued improvement. Nurse knowledge increased during the intervention. It is uncertain whether these findings translate to changes in caregiver home practices after discharge.
authors.affiliation: Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; and kshadman@pediatrics.wisc.edu.
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Shadman
authors.affiliation: Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; and.
authors.forename: Ellen R
authors.initials: ER
authors.lastname: Wald
authors.affiliation: American Family Children's Hospital, Madison, Wisconsin.
authors.forename: Windy
authors.initials: W
authors.lastname: Smith
authors.affiliation: Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; and.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Coller
mesh_terms: D017028:Caregivers; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006760:Hospitalization; D006776:Hospitals, Pediatric / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D007231:Infant, Newborn; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D061214:Patient Safety / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D057184:Practice Patterns, Nurses' / Q000706:statistics & numerical data*; D058996:Quality Improvement / Q000706:statistics & numerical data*; D012890:Sleep; D013398:Sudden Infant Death / Q000517:prevention & control*