ABSTRACT
Purpose of Study Sleep-related deaths account for 18.2% of all infant mortalities in Tennessee. In 2019, Shelby County had the highest number of infant sleep-related deaths in the state of Tennessee with 23 cases (22% of all infant deaths in the county). Most occur while in an unsafe sleep environment, including co-sleeping or from suffocation items in the crib. A committee was formed at our tertiary care children's hospital to implement and model safe sleep practices. The purpose of this study is to evaluate the effectiveness of our safe sleep interventions by comparing type and proportion of unsafe sleep practices before and after implementation of a safe sleep policy and staff education. Methods Used Residents and medical students assessed infant (less than 6 months old) sleep practices with a 6-question survey evaluating sleep location, position, and presence of suffocation items. ICU and NICU patients were excluded. Baseline data was collected from May 2019 to January 2020, with the following interventions implemented thereafter: crib cards explaining safe sleep, [ASLR1] recommendations for removal of extra blankets and other items from the crib, an updated hospital policy based on American Academy of Pediatrics guidelines, and online training for staff. Follow up data was collected from May 2020 to October 2020. Further data collection was limited due to the COVID-19 pandemic until February 2021. Summary of Results Data was collected for 105 infants in the baseline group and only 29.5% were sleeping safely: 87.6% were in a safe position, 90.5% were in a safe location, but only 30.5% had no suffocation items in the crib. After safe sleep interventions were implemented, data from May to October 2020 in 46 infants showed a slight decline in safe sleep to 23.9%: 84.8% in a safe position, 89.1% in a safe location, and 26.1% with no suffocation items in the crib. Among 116 infants evaluated from February to August 2021, only 13% were sleeping safely: 83% in a safe position, 77% in a safe location, and 30% with no suffocation items in the crib. Conclusions Overall, infants tend to sleep in safe positions and locations in our hospital, but many continue to have suffocation items in the cribs. Differences in results of the two periods of follow up data could be related to a stricter definition of 'overall safe sleep' for survey responses. Due to lack of improvement after initial safe sleep policy implementation, new interventions, including requirement for a physician order for head of bed elevation, involvement of nursing staff as 'Safe Sleep Champions', and additional education on suffocation items are planned in order to improve safe sleep in our hospital.