An Interprofessional, Multimodal, Family-Centered Quality Improvement Project for Sleep Safety of Hospitalized Infants

The American Academy of Pediatrics published expanded guidelines for infant safe sleep in 2011, expanding the definition from “back to sleep” to “safe to sleep,” more fully describing risk factors and guidelines. In 2016, the guidelines were revised to promote “providers modeling safe sleep behavior” to the highest level of recommendation. Previous studies have addressed the difficulty in creating clear, consistent communication between health care providers and families during an infant’s inpatient stay. This institutional update describes an interprofessional and family-centered quality improvement project to improve sleep safety for hospitalized infants through a multimodal approach. Five family-centered interventions were designed: a designated safe sleep web page, a clear bedside guide to safe sleep, additional training for nursing staff in motivational interviewing, a Kamishibai card audit system, and electronic health record smart phrases. These coordinated interventions reflect advantages of an interprofessional and family-centered approach: building rapport and achieving improvements to infant sleep safety.

Correction to: Improving infant sleep safety via electronic health record communication: a randomized controlled trial

An amendment to this paper has been published and can be accessed via the original article.

Improving infant sleep safety via electronic health record communication: a randomized controlled trial

Background With increased use of telehealth, interventions to improve infant sleep environments have not been explored. This study sought to assess the feasibility and efficacy of using electronic health record patient portals to transmit photographs of infant sleep between mothers and healthcare professionals as part of an intervention to promote sleep environments consistent with AAP guidelines. Methods One hundred eighty-four mother-newborn dyads consented to participate in a randomized trial requiring patient portal registration within 1 month of delivery. We first assessed feasibility as measured by a) the proportion of consented mothers enrolling in the portal and b) maternal adherence to prompts to submit photographs of their infant sleeping to the research team through the patient portal. Intervention group mothers were prompted at 1 and 2 months; controls were prompted only at 2 months. Efficacy was determined via research assistant review of submitted photographs. These assistants were trained to detect sudden unexplained infant death risk factors utilizing AAP guidelines. Standardized feedback was returned to mothers through the patient portal. We used Fisher’s Exact test to assess group differences in guideline adherence at 2 months. Results One hundred nine mothers (59%) enrolled in the patient portal and were randomized to intervention (N = 55) and control (N = 54) groups. 21 (38, 95% CI 25–52%) intervention group participants sent photographs at 1 month and received personalized feedback. Across both groups at 2 months, 40 (37, 95% CI 28–46%) sent photographs; 56% of intervention group participants who submitted photographs met all safe sleep criteria compared with 46% of controls (difference 0.10, 95% CI − 0.26 to 0.46, p = .75). Common reasons for guideline non-adherence were sleeping in a room without a caregiver (43%), loose bedding (15%) and objects (8%) on the sleep surface. Conclusions Utilizing the patient portal to individualize safe infant sleep is possible, however, we encountered numerous barriers in this trial to assess its effects on promoting safe infant sleep. Photographs of infants sleeping showed substantial non-adherence to AAP guidelines, suggesting further needs for improvement to promote safe infant sleep practices. Trial registration Name: Improving Infant Sleep Safety With the Electronic Health Record; Clinicaltrials.gov: NCT03662048; Date of Registration: September 7, 2018; Data Sharing Statement: None

Field assessment of a safe sleep instrument using smartphone technology

Introduction:Sudden unexpected infant death is the leading cause of infant mortality with black: white infant mortality remaining at 2:1 for the last decade. Smartphone technology provides a convenient and accessible tool for injury prevention anticipatory guidance among at-risk communities.Materials and Methods:A convenience sample of pregnant teen mothers who own a smartphone. During a 1-month postnatal home visit, a safe sleep environment survey was administered, infant sleep practices were observed, and mothers trained to take and submit standard infants’ sleep environment photographs. Photographs were independently assessed for inter-rater reliability (IRR) across five sleep safety domains (primary outcome): sleep location, surface, position, presence of soft items, and hazards near the sleep area. Expert and novice coders IRR was measured using Cohen’s kappa coefficient (K). Sleep safety correlation between photographs and observation, and parent report and observation was determined.Results:Sixteen (57.1%) mothers completed the home visit. Most parents reported infants sleeping supine (78.5) in parents’ bedroom (85.9%). Photographs demonstrated sleep position, soft items without the baby present, and hanging toys had perfect agreement across all three coder pairs. Safe sleep experts’ IRR demonstrated perfect agreement for sleep location, position, and soft items. While 83.8% of parents were observed putting their infants down to sleep on their back, 78.5% of parents reported doing the same and 82.4% of the photographs demonstrated supine infant sleep position.Conclusion:Using photographs, coders can reliably categorize some key infant sleep safety aspects, and photograph sleep safety is comparable to parent report and direct observation.

Trends In Infant Sleep: What Do The Data Show? What Are Caregivers’ Behaviors?

Parents of infants expect their baby will sleep safely in any of a number of products that are intended for overnight sleep (e.g., crib, bassinet, cradle, play yard) as well as products in which infants routinely nap (e.g., infant seat, swing). Yet each year, infants die while napping or sleeping. The Consumer Product Safety Commission (CPSC) is an independent federal agency charged with protecting the public from unreasonable risk of injury associated with consumer products, including infant sleep products. In this panel, technical experts from the CPSC address issues relating to infant sleep safety including physiological factors associated with infant death and findings from incident data. Case studies for two infant products (handheld infant carriers and infant bouncer seats) and focus group research findings with parents of infants shed light on consumer behavior as it relates to perceptions of infant comfort and product use.