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Infant Safe Sleep Protocols Not Always Followed in Hospitals

COLUMBUS, OH – Despite the intense focus on the American Academy of Pediatrics (AAP) recommendations on creating a safe sleep environment at home for infants, many hospitals don’t follow all of those protocols consistently.

The issue is not only immediate danger to the child, according to a new article in the journal Pediatrics, but that parents and caregivers tend to model sleep patterns observed in a hospital setting.

A project led by researchers from Nationwide Children’s Hospital assessed the change in infant safe sleep practices within six children's hospitals after the implementation of a statewide quality improvement program in Ohio.

As part of the effort, the AAP recruited hospitalists from each of the state’s children’s hospitals and asked them to form “safe sleep teams” within their institutions. A standardized data tool was used to collect information on the infants’ age and sleep position/environment. Data included baseline as well as weekly updates for the duration of the 12-month project.

In addition, the safe sleep teams were required to implement at least three Plan-Do-Study-Act cycles. Changes in safe sleep practices were calculated over time, with providers receiving Maintenance of Certification Part IV credit for participation.

Overall, the teams collected 5,343 audits at participating sites. At baseline, only 32.6% of the sleeping infants were observed to follow AAP recommendations. Results indicate at the project’s conclusion, however, that percentage had jumped to 58.2%.

Study authors emphasized that the greatest improvement — 77.8% from 50.0% — was the presence of cribs without extraneous items. To that end, removing loose blankets was the most common change made, they explained.

Audits also showed an increase in education of families about safe sleep practices from 48.2% to 75.4%.

“Multifactorial interventions by hospitalist teams in a multi-institutional program within one state’s children's hospitals improved observed infant safe sleep behaviors and family report of safe sleep education,” the study authors concluded. “These behavior changes may lead to more appropriate safe sleep practices at home.”