Safe Infant Sleep

Nurses at the Intensive Care Nursery (ICN) at the Hospital of the University of Pennsylvania (HUP) were distraught when they learned some of their former patients had passed of sudden infant death syndrome (SIDS). Philadelphia has high rates of SIDS, with 45 babies dying suddenly or unexpectedly in 2010, the last year data is available. SIDS occurs when there is no explanation for the death of a baby under the age of one.

Safe Infant Sleep

WARM & SAFE: Noelle Bass, BSN, RN, clinical nurse at the Intensive Care Nursery at HUP, shows a mother how to use a wearable blanket to keep her infant safe during sleep. (KYLE KIELINSKI / thanks to Hospital of the University of Pennsylvania)

“We felt as registered nurses we could have had more education for parents,” said Megan Fulmer, BSN, RN, clinical nurse. Together with Whitney Zachritz, MSN, RN, PNP-BC, clinical nurse specialist, and Nicole Chaney, RN, clinical nurse, Fulmer spearheaded the efforts to create the Safe Sleep program at HUP, which educates nurses and parents about proper infant sleep protocol. Although there are no set causes of SIDS, research has shown following sleep guidelines can reduce its occurrence and the occurrence of other infant-sleep related deaths.

SEE ALSO: Striving for Neonatal Excellence

Best for Baby
Fulmer, Zachritz, and Chaney researched what other hospitals were doing in terms of safe infant sleep practices. Since there was no local program dedicated to helping nurses and parents, they needed to create their own. As a starting point, they turned to the American Academy of Pediatrics (AAP) best guidelines. Fulmer explained, “The best practice is for the infant to be alone, on their back, on a firm, flat surface with nothing else in the crib – no toys and no blankets.”

The medical director audited the unit’s practices and they learned they were not compliant with the current best practice guidelines from the AAP. It was a wake-up call. “Hospitals need to take SIDS seriously because it’s a major problem,” said Fulmer. Change begins at home, so the first part of their project was to show fellow nurses ideal sleep practices for their tiny patients. ICN patients are preemies, multiples (which are often born early and/or underweight), and full-term babies with health issues.

Learning Opportunity
The nurses procured grants from the March of Dimes and Penn Medicine to fund their efforts. In the nursery, they created a new standard of no longer lifting the head of an open crib, so the infants remain in a flat position. They used the funding to purchase a sleep sack for every patient in the ICN, which the parents can later take home with them. Since loose blankets can post a danger to sleeping infants, wrapping them in sleep sacks can lower their sleep-related death risk.

When the babies at the ICN move from isolation to open cribs, it’s a learning opportunity for parents. “We try to implement best practices as soon as a baby is getting ready to go home,” noted Fulmer. Parents observe the nurses so they can replicate the best practices at home. “It’s good to see our parents taking the preps home and modeling what we showed them,” said Fulmer. The education empowers the parents.

The Safer Way to Sleep Program

Halo Innovations created the HALO Safer Way to Sleep In-Hospital Program eight years ago to provide healthcare professionals with an innovative method to teach safe sleep to parents as soon as their baby is born. The program is quite simple: it replaces the traditional blankets in the well-baby nursery and NICU with a free supply of wearable blankets to model a safe, blanket-free alternative for parents. In addition, hospitals are provided with safe sleep materials to distribute to parents.

The program was created by Bill Schmid, a SIDS dad and founder of HALO Innovations. Knowing the nursing staff at the hospital is often responsible for educating the parents on safe sleep for baby, Schmid developed this unique approach to safe sleep education that could be easily incorporated into the post-natal baby care in the hospital.

“The goal of the HALO Safer Way to Sleep Program is to support and promote safe sleep education for parents by providing hospital professionals with the necessary tools to teach safe sleep for baby while in the hospital,” he noted.

The key to the program’s efficacy is based on the fact that studies consistently indicate that what parents see nurses do in the hospital is retained better than simply being told what to do. The act of modeling the safe sleep behavior of a medical professional has a positive effect on the parents’ retention of safe sleep practices, which they are more likely to replicate at home. And since the modeling is being done on their newborn, the parents’ transition to practicing safe sleep at home is simple and natural.

Currently, the Safer Way to Sleep program is being used by more than 1,400 hospital birth centers and in NICUs. This equates to approximately one of every three babies born in the U.S. each year being touched by the program. Some of the hospitals have taken safe sleep one step further by incorporating a take-home element providing a sleepsack as a discharge gift for the baby.

–HALO Innovations

Success Stories
As for the nurses at the ICN, they are empowered themselves. After implementing the program, they are now 80%-100% compliant with the AAP guidelines. They are including their project in HUP’s Magnet raccreditation application. Fulmer and Zachritz will be writing an American Journal of Nursing article on their Safe Sleep efforts.

The Cribs for Kids Foundation started a National Safe Sleep Hospital Certification. Fulmer and her colleagues are applying for gold certification for both the ICN and the well-baby nursery. The process will consist of self-audits, site visits from the foundation, and demonstrating they meet staff and parent educational standards.

Fulmer reminded nurses, “Education and modeling are the most important things.” She encouraged other units to audit themselves and see where they stand with best practices. For HUP, “the change was amazing.”

Danielle Bullen is on staff at ADVANCE. Contact:

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