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  • Quality Improvement Article
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Early and consistent safe sleep practices in the neonatal intensive care unit: a sustained regional quality improvement initiative

Journal of Perinatology (2024)Cite this article

Subjects

Abstract

Objective

To increase compliance with standardized safe sleep recommendations for patients in a cohort of regional level III/IV neonatal intensive care units (NICUs) in accordance with recently revised guidelines issued by the American Academy of Pediatrics (AAP).

Study design

A regional quality improvement (QI) initiative led by a multidisciplinary task force standardized safe sleep criteria across participating NICU sites. Universal and unit-specific interventions were implemented via Plan-Do-Study-Act (PDSA) cycles with evaluation of compliance through routine crib audits, run chart completion, and Pareto chart analysis.

Results

Following QI implementation, compliance with safe sleep guidelines for eligible NICU infants improved from 34% to 90% from October 2019 through September 2022.

Conclusion

Compliance with early, consistent modeling of safe sleep practices nearly tripled in this cohort of regional NICUs. A standardized, timely approach to safe sleep transition demonstrated dramatic and sustained improvement in the practice and modeling of safe sleep behaviors in the NICU.

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Fig. 1: Sleep-related infant deaths showed an increase in Hamilton County, Ohio in 2019–2020.
Fig. 2: Regional Key Driver Diagram (KDD).
Fig. 3: NICU safe sleep eligibility criteria and readiness assessment.
Fig. 4: Regional NICU run chart.
Fig. 5: Regional Pareto chart.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We acknowledge the Perinatal Institute, Cincinnati Children’s Hospital, our partnering sites, the members of our multidisciplinary team, and all who participated in this work for their support.

Funding

Internal funding and project support were provided by the Perinatal Institute and the James M. Anderson Center for Health Systems Excellence at Cincinnati Children’s Hospital Medical Center.

Author information

Author notes

  1. These authors contributed equally: Stephanie K. Napolitano, Danielle K. Parham.

Authors and Affiliations

  1. Perinatal Institute, Division of Neonatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Stephanie K. Napolitano, Nicole L. Boswell, Patricia Froese, Rebecca D. Henkel, Maria E. Barnes-Davis & Danielle K. Parham

  2. Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA

    Stephanie K. Napolitano, Rebecca D. Henkel, Maria E. Barnes-Davis & Danielle K. Parham

  3. Division of Neonatology, Nationwide Children’s Hospital, Columbus, OH, USA

    Stephanie K. Napolitano

  4. Department of Pediatrics, The Ohio State University, Columbus, OH, USA

    Stephanie K. Napolitano

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Contributions

DKP and SKN conceptualized and designed the study, collected and analyzed study data, drafted the initial manuscript, and critically reviewed and revised the manuscript. NLB refined the study design, supervised study activities and data collection, analyzed data, and critically reviewed and revised the manuscript. MEBD and PF refined the study design, collected and analyzed study data, and critically reviewed and revised the manuscript. RDH collected and analyzed data, and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Danielle K. Parham.

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The authors declare no competing interests.

Ethics approval

This study was reviewed by the CCHMC Institutional Review Board and deemed exempt, IRB ID 2019-1152.

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Napolitano, S.K., Boswell, N.L., Froese, P. et al. Early and consistent safe sleep practices in the neonatal intensive care unit: a sustained regional quality improvement initiative. J Perinatol (2024). https://doi.org/10.1038/s41372-023-01855-6

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  • DOI: https://doi.org/10.1038/s41372-023-01855-6

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