Outcomes of a Quality Improvement Project

An Implementation of Inpatient Infant Safe Sleep Practices

Roger D. Rholdon


Pediatr Nurs. 2017;43(5):229-232. 

In This Article

Abstract and Introduction


Safe sleep practices in the inpatient setting are important to further reinforce behaviors that parents should practice in the home environment. Improving the knowledge of inpatient pediatric nurses may translate to improved safe sleep practices while infants are hospitalized. In this 28-bed inpatient pediatric unit, practices were assessed for congruence with current recommendations by the American Academy of Pediatrics for a safe sleep environment. Staff nurses were then educated on the proper safe sleep environment for infants. After this intervention was completed, the environment was reassessed to determine if any improvements in safe sleep practices were noted. Improvements were seen in all areas assessed. However, the only improvement statistically significant was a decrease in the number of patients found with soft objects and loose bedding. Education for inpatient nurses may improve behaviors for safe sleep practices in inpatients.


Sudden infant death syndrome (SIDS) is the death of an infant under the age of one year that remains unexplained despite a thorough investigation (Centers for Disease Control and Prevention [CDC], 2016). Education and awareness have been goals of numerous organizations, such as the American Academy of Pediatrics (AAP). In the late 1980s, prior to the release of AAP's first policy statement for supine sleep position, rates of SIDS in the United States were 1.4 deaths per 1,000 live births (MacDorman & Rosenberg, 1993). These rates saw a decline after the AAP released its "Back to Sleep Campaign" in 1994. The campaign was credited with decreasing SIDS to a rate of 0.55 infant deaths per 1,000 live births (Heron et al., 2010). A downward trend has been noted in other European and Asian countries as well (International Society for the Study and Prevention of Perinatal and Infant Death, 2015). However, rates of decline have slowed both in the United States and worldwide, prompting new recommendations and guidelines (Moon, Darnall, Goodstein, & Hauck, 2011).

Nursing personnel are critical role models for parents, and the way they position infants and their behaviors toward safe sleep practice in the hospital influences parental practices at home. Carrier (2009) demonstrated that parents are more likely to practice what they observe healthcare providers do in the neonatal intensive care unit. Modeling appropriate behaviors in inpatient pediatric units is important for parents and caregivers to better understand the risks of SIDS. Educational programs targeted at the inpatient nurse are important to lead to a further decrease in the rate of SIDS.

The purpose of this quality improvement project was to establish if a formal educational program for inpatient nurses would improve safe sleep practices on a pediatric unit. To establish baseline practices, a rounding tool was developed based on the AAP guidelines for a safe sleep environment (see Figure 1). This tool was used to gather baseline information of safe sleep practices on the unit. Nursing staff then participated in an online educational tool developed by the National Institutes of Health (NIH) (2013) entitled, "Continuing Education Program on SIDS Risk Reduction." Upon completion of the educational tool, informal observation was performed to determine if improvements were seen in safe sleep practices.

Figure 1.

Safe Sleeping Rounding Tool
Source: Moon et al., 2011. Adapted from the American Academy of Pediatrics (AAP) Expansion of Recommendations for a Safe Infant Sleeping Environment.