1. Patrick, Patricia A. DrPH
  2. Canter, Jennifer F. MD, MPH
  3. Brumberg, Heather L. MD, MPH
  4. Dozor, Donna RN, MS
  5. Aboudi, David MPH
  6. Smith, Marichu RNC, MSN
  7. Sandhu, Sumeet MD
  8. Trinidad, Nathalie MD
  9. LaGamma, Edmund MD
  10. Altman, Robin L. MD


Background: An unsafe sleep environment remains the leading contributor to unexpected infant death.


Purpose: To determine the effectiveness of a quality improvement initiative developed to create a hospital-based safe sleep environment for all newborns and infants.


Methods: A multidisciplinary team from the well-baby nursery (WBN) and neonatal intensive care unit (NICU) of a 149-bed academic, quaternary care, regional referral center developed and implemented safe sleep environments within the hospital for all prior to discharge. To monitor compliance, the following were tracked monthly: documentation of parent education, caregiver surveys, and hospital crib check audits. On the inpatient general pediatric units, only hospital crib check audits were tracked. Investigators used Plan-Do-Study-Act (PDSA) cycles to evaluate the impact of the initiative from October 2015 through February 2018.


Results: Safe sleep education was documented for all randomly checked records (n = 440). A survey (n = 348) revealed that almost all caregivers (95.4%) reported receiving information on safe infant sleep. Initial compliance with all criteria in WBN (n = 281), NICU (n = 285), and general pediatric inpatient units (n = 121) was 0%, 0%, and 8.3%, respectively. At 29 months, WBN and NICU compliance with all criteria was 90% and 100%, respectively. At 7 months, general pediatric inpatient units' compliance with all criteria was 20%.


Implications for Practice: WBN, NICU and general pediatric inpatient unit collaboration with content experts led to unit-specific strategies that improved safe sleep practices.


Implications for Research: Future studies on the impact of such an initiative at other hospitals are needed.