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DOI: 10.1055/s-0043-1768705
Safe to Sleep in Tennessee: A Statewide Quality Improvement Initiative
Abstract
Objective Sleep-related deaths were the fourth leading cause of infant death in Tennessee between 2014 and 2018. In response, the Tennessee Initiative for Perinatal Quality Care developed a statewide quality improvement project, which focused on the demonstration and enforcement of a safe sleep environment in participating birthing hospitals to help families learn and practice the same at home. The project's aim was to improve the percent of infants audited for safe sleep practices (0–12 mo of age, cared for in participating newborn nurseries or neonatal intensive care units) that were compliant with the practices recommended by the 2016 American Academy of Pediatrics (AAP) Task Force on Sudden Infant Death Syndrome.
Study Design Participating teams were required to develop and implement safe sleep policies in compliance with the AAP recommendations, provide safe sleep education to staff and families, and complete monthly safe sleep audits. A tool was provided to assess whether each audited infant was compliant with safe sleep recommendations and any reason(s) the infant was not compliant. Teams met virtually for monthly huddles and semiannual learning sessions to discuss the development and testing of change ideas.
Results The project teams were able to improve the percent of infants audited that were compliant with safe sleep recommendations by 22% over the course of the project. Audits revealed the main reasons for noncompliance were additional objects in the crib (49%, 329/671), unsafe bedding (27%, 181/671), and head of bed elevation (24%, 164/671).
Conclusion This project demonstrates the positive impact that a statewide quality improvement initiative can have on identifying and addressing barriers, sharing resources and education, and monitoring local and statewide data, which led to increased compliance with safe sleep recommendations in the hospital. Safe sleep education and monitoring should be ongoing as new parents and staff always need to be educated on safe sleep principles.
Key Points
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In 2020, 25% of all infant deaths in Tennessee were due to an unsafe sleep environment.
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Sleep-related deaths in infants are frequently preventable.
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State quality improvement projects are effective in increasing safe sleep compliance.
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State perinatal quality collaboratives can partner with their State Department of Health, local hospitals, and providers, to increase awareness, educate parents, and model a safe sleep environment.
Keywords
safe sleep - sudden infant death - sudden unexpected infant death - back to sleep - quality improvement - statewide initiativePublication History
Received: 04 October 2022
Accepted: 04 April 2023
Article published online:
11 May 2023
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References
- 1 Moon RY, Darnall RA, Feldman-Winter L, Goodstein M, Hauck FR. TASK FORCE ON SUDDEN INFANT DEATH SYNDROME. SIDS and other sleep-related infant deaths: updated 2016 recommendations for a safe infant sleeping environment. Pediatrics 2016; 138 (05) e20162938
- 2 Centers for Disease Control and Prevention. . Safe sleep for babies. Vital signs. 2018. Accessed June 19, 2022 at: https://www.cdc.gov/vitalsigns/safesleep/index.html
- 3 Tennessee Department of Health. . Child and infant dashboard. Child fatality review. Accessed June 19, 2022 at: https://www.tn.gov/health/health-program-areas/fhw/child-fatality-review.html
- 4 Tennessee Department of Health. . Safe sleep statistics. Tennessee statistics. Accessed June 19, 2022 at: https://www.tn.gov/health/health-program-areas/fhw/vipp/safe-sleep/safe-sleep-statistics.html
- 5 Safe to Sleep. Common SIDS and SUID terms and definitions. Safe infant sleep basics. US Department of Health and Human Services. National Institutes of Health. Accessed June 19, 2022 at: https://safetosleep.nichd.nih.gov/safesleepbasics/SIDS/Common
- 6 Vernacchio L, Corwin MJ, Lesko SM. et al. Sleep position of low birth weight infants. Pediatrics 2003; 111 (03) 633-640
- 7 Eisenberg SR, Bair-Merritt MH, Colson ER, Heeren TC, Geller NL, Corwin MJ. Maternal report of advice received for infant care. Pediatrics 2015; 136 (02) e315-e322
- 8 Colson ER, Geller NL, Heeren T, Corwin MJ. Factors associated with choice of infant sleep position. Pediatrics 2017; 140 (03) e20170596
- 9 Hirai AH, Kortsmit K, Kaplan L. et al. Prevalence and factors associated with safe infant sleep practices. Pediatrics 2019; 144 (05) e20191286
- 10 Leong T, Roome K, Miller T. et al. Expansion of a multi-pronged safe sleep quality improvement initiative to three children's hospital campuses. Inj Epidemiol 2020; 7 (Suppl. 01) 32
- 11 Kellams A, Parker MG, Geller NL. et al. TodaysBaby quality improvement: safe sleep teaching and role modeling in 8 US maternity units. Pediatrics 2017; 140 (05) e20171816
- 12 National Institute for Children's Health Quality. . National Action Partnership to Promote Safe Sleep Improvement and Innovation Network (NAPPSS-IIN). Initiatives. Accessed June 19, 2022 at: https://www.nichq.org/project/national-action-partnership-promote-safe-sleep-improvement-and-innovation-network-nappss
- 13 Erlick M, Fioravanti ID, Yaeger J, Studwell S, Schriefer J. An interprofessional, multimodal, family-centered quality improvement project for sleep safety of hospitalized infants. J Patient Exp 2021; 8: 237437 35211008301
- 14 Hwang SS, Melvin P, Diop H, Settle M, Mourad J, Gupta M. Implementation of safe sleep practices in Massachusetts NICUs: a state-wide QI collaborative. J Perinatol 2018; 38 (05) 593-599
- 15 March of Dimes. Peristats: data for Tennessee. Accessed February 6, 2023 at: https://www.marchofdimes.org/peristats/data?reg=99&top=2&stop=4&lev=1&slev=4&obj=1&sreg=47
- 16 The National Association of Neonatal Nurses (NANN). Newborn Safe Sleep Guideline. . Accessed April 29, 2023 at: https://apps.nann.org/store/product-details?productId=79610090
- 17 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
- 18 Harris PA, Taylor R, Minor BL. et al; REDCap Consortium. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform 2019; 95: 103208
- 19 R Core Team. . (2020). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/
- 20 Tennessee Department of Health. . TDH, THA announce “Best for Babies” award recipients. Newsroom. 2020. Accessed August 30, 2022 at: https://www.tn.gov/health/news/2020/1/6/tdh–tha-announce–best-for-babies–award-recipients.html
- 21 Moon RY, Carlin RF, Hand I. TASK FORCE ON SUDDEN INFANT DEATH SYNDROME AND THE COMMITTEE ON FETUS AND NEWBORN. Sleep-related infant deaths: updated 2022 recommendations for reducing infant deaths in the sleep environment. Pediatrics 2022; 150 (01) e2022057990