Find Established Evidence

NPM: 7-1: Child Safety/Injury (0-9 years) 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), Training (Parent/Family), CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), Sleep Environment Modification, PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Nurse/Nurse Practitioner, Guideline Change and Implementation
Intervention Description: We evaluated a comprehensive hospital-based infant safe sleep education program on parental education and safe sleep behaviors in the home using a cross-sectional survey of new parents at hospital discharge (HD) and 4-month follow-up (F/U).
Conclusion: Reinforcing the infant sleep safety message through intensive hospital-based education improves parental compliance with sudden infant death syndrome risk reduction guidelines.
Study Design: Quasi-experimental nonequivalent control group design
Setting: Hospital, postpartum maternity units
Target Audience: Nurses + New parents
Data Source: Cross-sectional survey of parents at time of hospital discharge and at 4-month well-child visit
Sample Size: 1,092 in hospital sample 490 at 4-month follow-up
Age Range: Infant

NPM: 7-1: Child Safety/Injury (0-9 years) 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, CAREGIVER, Educational Material (caregiver), Provider Training/Education, Nurse/Nurse Practitioner, HOSPITAL, Quality Improvement, Policy/Guideline (Hospital)
Intervention Description: The authors describe a 4-year demonstration project (2004-2007) to reduce infant deaths related to sleep environments by changing attitudes and practices among nurses who work with African American parents and caregivers in urban Michigan hospitals.
Conclusion: Following the policy change effort, nurses changed their behavior and placed infants on the back to sleep.
Study Design: QE: pretest-posttest
Setting: 7 maternity wards in urban hospitals in MI
Target Audience: Nursing staff and parents
Data Source: Crib audit; infant observation
Sample Size: Baseline: n=579 Follow-up: n=692
Age Range: Infant

NPM: 7-1: Child Safety/Injury (0-9 years) 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Policy/Guideline (Hospital), Quality Improvement, Continuing Education of Hospital Providers, Sleep Environment Modification, PROVIDER/PRACTICE, Nurse/Nurse Practitioner, Provider Training/Education, CAREGIVER, Educational Material (caregiver)
Intervention Description: The dual aims of this project were to develop a safe sleep educational model for our neonatal intensive care unit (NICU), and to increase the percentage of eligible infants in a safe sleep environment.
Conclusion: With formal staff and family education, optional wearable blanket, and data sharing, safe sleep compliance increased and patient safety improved.
Study Design: QE: pretest-posttest
Setting: NICU
Target Audience: Neonatal nurses; staff Parents of newborns
Data Source: Crib audit/infant observation
Sample Size: 28 families at baseline 26 families at follow-up
Age Range: Infant

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Provision of Safe Sleep Item, Assessment (Provider), HOSPITAL, Quality Improvement, Policy/Guideline (Hospital), Crib Card, CAREGIVER, Education/Training (caregiver), Assessment (caregiver), Educational Material (caregiver)
Intervention Description: The aims of this project were to increase the percentage of infants following safe sleep practices in the NICU before discharge and to determine if improving compliance with these practices would influence parent behavior at home.
Conclusion: Multifactorial interventions improved compliance with safe sleep practices in the NICU and at home.
Study Design: QE: pretest-posttest
Significant Findings: Yes
Setting: Children’s Memorial Hermann Hospital NICU in Houston, TX
Target Audience: Infants in open cribs eligible for safe sleep practices; Parents of infants after discharge
Data Source: Crib audit/infant observation; Parent report
Sample Size: Baseline (n=62) Follow-up (n=79); Baseline (n=66) Follow-up (n=98)
Age Range: Not specified

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, HOSPITAL, Quality Improvement, Policy/Guideline (Hospital), Crib Card, Sleep Environment Modification, Promotional Event, POPULATION-BASED SYSTEMS, COMMUNITY, Social Media, CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), Visual Display (Community)
Intervention Description: To improve sleep environment safety for inpatient infants.
Conclusion: Staff education, swaddle sleep sacks, and bedside storage containers were associated with improved sleep safety among pediatric inpatients at our institution and may help at other institutions.
Study Design: QE: pretest-posttest
Significant Findings: No
Setting: University of Iowa Children’s Hospital
Target Audience: Infants less than 1 year of age developmentally ready for a crib and asleep
Data Source: Crib audit/infant observation
Sample Size: Baseline (n=22) Follow-up 1 (not reported) Follow-up 2 (n=37) Follow-up 3 (n=18)
Age Range: Not specified

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, HOSPITAL, Crib Card, Visual Display (Hospital), CAREGIVER, Education/Training (caregiver)
Intervention Description: To increase the percentage of eligible infants engaging in safe sleep practices (SSP) in two level III neonatal intensive care units (NICUs) in the Boston, Massachusetts area.
Conclusion: Safe infant sleep practices can be integrated into the routine care of preterm infants in the NICU. Modeling SSP to families far in advance of hospital discharge may improve adherence to SSP at home and reduce the risk of sleep-related morbidity and mortality in this vulnerable population of infants.
Study Design: QE: pretest-posttest
Significant Findings: Yes
Setting: Two level III NICUs at South Shore Hospital and St Elizabeth’s Medical Center in MA
Target Audience: Infants eligible for safe sleep practices as determined by an algorithm and clinical status of the infant
Data Source: Crib audit/infant observation
Sample Size: Baseline (n=112) Follow-up (n=118)
Age Range: Not specified

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Provision of Safe Sleep Item, HOSPITAL, Policy/Guideline (Hospital), Sleep Environment Modification, CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation
Intervention Description: The purpose of this study was to improve safe sleep practices for infants in nonneonatal pediatric units with implementation of specific interventions.
Conclusion: Implementation of site-specific interventions seems to improve overall safe sleep in inpatient pediatric units, although continued improvement is needed. Specifically, extra items are persistently left in the sleeping environment.
Study Design: QE: pretest-posttest
Significant Findings: Yes
Setting: Eight children’s hospitals
Target Audience: Infants aged 0 to 6 months admitted to the general pediatric unit (excluding infants in the NICUs, PICUs, and maternal fetal units)
Data Source: Crib audit/infant observation
Sample Size: Baseline (n=234) Follow-up (n=210)
Age Range: Not specified

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, HOSPITAL, Quality Improvement, Policy/Guideline (Hospital), Sleep Environment Modification, CAREGIVER, Education/Training (caregiver)
Intervention Description: This project assessed the change in infant safe sleep practices within 6 children's hospitals after the implementation of a statewide quality improvement program.
Conclusion: Multifactorial interventions by hospitalist teams in a multi-institutional program within 1 state's children's hospitals improved observed infant safe sleep behaviors and family report of safe sleep education. These behavior changes may lead to more appropriate safe sleep practices at home.
Study Design: QE: pretest-posttest
Significant Findings: No
Setting: Six children’s hospitals without internal maternity centers or wellbaby nurseries (academic tertiary or quaternary care institutions) in OH
Target Audience: Infants ≤1 year of age admitted to the general medical/surgical units who were not awake during the audit (excluding those in the ICUs, with tracheostomies, ventilator or noninvasive ventilator dependence, recent spinal surgeries, or upper airway anatomic abnormalities)
Data Source: Crib audit/infant observation
Sample Size: Baseline (n=856) Follow-up (n=189)
Age Range: Not specified

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Provision of Safe Sleep Item, HOSPITAL, Quality Improvement, Policy/Guideline (Hospital), Crib Card, Visual Display (Hospital), Sleep Environment Modification, Promotional Event, CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), Attestation (caregiver), HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation
Intervention Description: The purpose of this quality improvement project was to promote the AAP safe sleep recommendations and provide appropriate role modeling of these recommendations for hemodynamically stable infants throughout their hospital stay.
Conclusion: There was inconsistency between nursing knowledge and practice about safe infant sleep. Nurses were aware of the AAP recommendations, but it took time to achieve close to full compliance in changing clinical practice. Observation was an important part of this initiative to reinforce knowledge and role model best practice for parents.
Study Design: QE: pretest-posttest
Significant Findings: Yes
Setting: Golisano Children’s Hospital at the University of Rochester in NY
Target Audience: Hemodynamically stable infants less than 1 year of age in the mother-baby unit and nine pediatric units
Data Source: Crib audit/infant observation
Sample Size: Baseline (n=65) Follow-up (n=60)
Age Range: Not specified

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), HOSPITAL, Crib Card, Visual Display (Hospital), CAREGIVER, Education/Training (caregiver), Educational Material (caregiver)
Intervention Description: To determine the impact, at 60 days of life, of an educational intervention conducted in maternity centers aimed at improving adherence to the recommendations on safe infant sleep.
Conclusion: The educational intervention was useful to improve adherence to the recommendations on safe sleep at 60 days of life: using the supine position and breastfeeding improved, and the rate of co-sleeping decreased. No changes were observed in the number of household members who smoke, bedroom sharing, and pacifier use.
Study Design: QE: pretest-posttest
Significant Findings: Yes
Setting: Hospital Municipal Comodoro Meisner and Hospital Universitario Austral
Target Audience: Live newborns with >36 gestation weeks born in two hospitals whose mothers lived in the District of Pilar without major congenital malformations and/or hospitalization in the NICU for more than 10 days
Data Source: Caregiver report
Sample Size: Baseline (n=251) Follow-up (n=248)
Age Range: Not specified

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, HOSPITAL, Quality Improvement, Policy/Guideline (Hospital), Sleep Environment Modification, CAREGIVER, Educational Material (caregiver), HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation
Intervention Description: A quality improvement project for implementing safe sleep practices (SSP) was conducted at a large, U.S children's hospital.
Conclusion: Infant safe sleep practices have the potential to reduce infant mortality.
Study Design: QE: pretest-posttest
Significant Findings: No
Setting: A tertiary care children’s hospital in AR
Target Audience: Infants 0-12 months in intensive care and medical-surgical units caring asleep at the time of the audit
Data Source: Crib audit/infant observation
Sample Size: Baseline (n=398) Follow-up (n=498)
Age Range: Not specified

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provision of Safe Sleep Item, Provider Training/Education, HOSPITAL, Quality Improvement, Policy/Guideline (Hospital), Visual Display (Hospital), Sleep Environment Modification, CAREGIVER
Intervention Description: This quality improvement study aimed to increase adherence to SSPs for infants admitted to a children's hospital general care unit between October 2013 and December 2014.
Conclusion: Sustained improvements in hospital SSPs were achieved through this quality improvement initiative, with opportunity for continued improvement. Nurse knowledge increased during the intervention. It is uncertain whether these findings translate to changes in caregiver home practices after discharge.
Study Design: QE: pretest-posttest
Significant Findings: No
Setting: American Family Children’s Hospital in WI
Target Audience: Infants <12 months admitted to medical and surgical units; Caregivers of infants <6 months after hospital discharge
Data Source: Crib audit/infant observation; Caregiver report
Sample Size: Baseline (n=59) Follow-up (n=257); Baseline (n=56) Follow-up (n=48)
Age Range: Not specified

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, HOSPITAL, Quality Improvement, Policy/Guideline (Hospital), CAREGIVER, Educational Material (caregiver)
Intervention Description: The authors describe a 4-year demonstration project (2004-2007) to reduce infant deaths related to sleep environments by changing attitudes and practices among nurses who work with African American parents and caregivers in urban Michigan hospitals.
Conclusion: Following the policy change effort, nurses changed their behavior and placed infants on the back to sleep.
Study Design: QE: pretest-posttest
Significant Findings: Yes
Setting: Seven urban hospitals in MI
Target Audience: Healthy newborn infants in cribs at the time of the audit B
Data Source: Crib audit/infant observation
Sample Size: Baseline (n=579) Follow-up (n=692)
Age Range: Not specified

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, HOSPITAL, CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), Visual Display (Hospital)
Intervention Description: To determine infant sleep positioning practices and SIDS awareness before and after a hospital-based Back to Sleep campaign.
Conclusion: The Back to Sleep campaign was effective in our hospital setting. Our data indicate the need for special targeting of young, unmarried, and non-breast-feeding mothers. Fear of choking remains an important deterrent to proper infant sleep positioning.
Study Design: QE: pretest-posttest
Significant Findings: No
Setting: Pediatric ambulatory care center of Wyckoff Heights Medical Center in NY
Target Audience: Mothers of healthy term infants 6 months and younger born in the hospital and attending the pediatric outpatient clinics
Data Source: Mother report
Sample Size: Baseline (n=250) Follow-up (n=250)
Age Range: Not specified

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Assessment (Provider), HOSPITAL, Quality Improvement, Policy/Guideline (Hospital), CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), Sleep Environment Modification
Intervention Description: The dual aims of this project were to develop a safe sleep educational model for our neonatal intensive care unit (NICU), and to increase the percentage of eligible infants in a safe sleep environment.
Conclusion: With formal staff and family education, optional wearable blanket, and data sharing, safe sleep compliance increased and patient safety improved.
Study Design: QE: pretest-posttest
Significant Findings: No
Setting: The Children’s Mercy Hospital NICU in MO
Target Audience: Safe sleep eligible infants (medically stable and transitioned to open cribs)
Data Source: Crib audit/infant observation
Sample Size: Baseline (n=28) Follow-up (n=26)
Age Range: Not specified

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, HOSPITAL, Quality Improvement
Intervention Description: A hospital-wide safe sleep bundle, based on a hospital-acquired conditions (HAC) model, was implemented in September 2017. Interventions were chosen by team members during multidisciplinary team meetings. Four key time points and/or interventions across the study period were (1) nursing education on the safe sleep bundle; 2) policy update and implementation; (3) collection and sharing of audit data; and (4) peer-to-peer bundle checklist reviews during registered nurse shift handoffs and electronic medical record (EMR) input. Other notable education interventions included subject matter expert training by guest speakers from the University of Pennsylvania and education to parents through updating newborn video instruction and increased exposure to appropriate safe sleep modeling.
Conclusion: Using an HAC bundle safety prevention model to improve adherence to infant safe sleep guidelines is a feasible and effective method to improve the sleep environment for infants in all areas of a children's hospital.
Significant Findings: Yes
Setting: Penn State Children's Hospital
Target Audience: Hospital healthcare providers

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Training/Education, Educational Material (provider), Audit/Attestation (provider), PROFESSIONAL_CAREGIVER, Education/Training (caregiver), HOSPITAL, Quality Improvement, Crib Card
Intervention Description: This quality improvement project used an interprofessional, multimodal approach to improve sleep safety for hospitalized infants. The working group for this project included the Director of Quality Improvement for the Department of Pediatrics, a Pediatric Hospitalist, a Senior Advanced Practice Nurse in Pediatrics, Senior Associate Counsel for the Office of Counsel, and a medical student with a background in social work. The interdisciplinary group met to review and discuss improvements to communication and facilitated the development of five family interventions: a designated safe sleep web page, a clear bedside guide to safe sleep, additional training for nursing staff in motivational interviewing, a card audit system, and electronic health record smart phrases. A short survey was conducted to assess how the safe sleep toolkit has been useful to care providers in the Children’s Hospital. 
Conclusion: These coordinated interventions reflect advantages of an interprofessional and family-centered approach: building rapport and achieving improvements to infant sleep safety.
Significant Findings: No
Setting: Golisano Children’s Hospital
Target Audience: Hospital healthcare providers

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, HOSPITAL, Quality Improvement, Visual Display (Hospital)
Intervention Description: The purpose of this study was to improve safe sleep practice (SSP) adherence by healthcare providers working with infants admitted to an inpatient pediatric unit in an urban academic center, specifically increasing compliance on five core SSP (supine, alone in the crib, no objects in crib, appropriate bundling, and flat crib). Targeted pediatric hospitalists (attending physicians who exclusively work in the hospital setting), residents, and nurses working on the general pediatric wards were invited to complete a safe sleep survey prior to receiving a brief educational intervention tailored to their specific provider group. All participants received the same basic information on the current rates of SIDS, associated disparities, current hospital practices, AAP-endorsed safe sleep practices, and the impact of healthcare provider practices on caregivers. In-person presentations, handouts, posters, and “Ask me about safe sleep” buttons for nursing staff were among the teaching tools used. Efficacy of the intervention was assessed by comparing audits of sleeping infants in hospital rooms prior to (baseline) and following (post-intervention) the education sessions.
Conclusion: This quality improvement project suggests that the inpatient setting provides opportunities for providers to demonstrate SSP but that healthcare providers often do not follow SSP in practice. Continued education can lead to improvements in SSP adherence ensuring that hospitals are modeling SSP for the families of infants.
Significant Findings: No
Setting: The University of Chicago Medicine Comer Children’s Hospital
Target Audience: Pediatric healthcare providers

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): PROFESSIONAL_CAREGIVER, Provision of Safe Sleep Item, Educational Material (caregiver), HOSPITAL, Sleep Environment Modification
Intervention Description: This was a multicenter prospective study in which exposed/unexposed mothers answered questionnaires (by telephone and online) one month after giving birth. The exposed group consisted of mothers who had given birth in a maternity hospital of the ELENA perinatal network in which an embroidered sleeping bag with a safe-sleep message was used as a preventive action; the unexposed group of mothers gave birth in a maternity hospital of the RP2S network, without this specific preventive action. Devised by the perinatal network to promote and encourage back sleeping, the embroidered “I sleep on my back” (baby) sleeping bags are systematically used in postpartum recovery rooms.
Conclusion: Sleeping practices when infants were 1 month old were not optimal in our study population. A simple preventive initiative in maternity hospitals, using the embroidered "I sleep on my back" sleeping bags, is relevant and effective in improving compliance with the sleeping recommendations for infants at home.
Significant Findings: Yes
Setting: Three maternity hospitals in the ELENA perinatal network in France
Target Audience: Mothers of newborns

NPM: 5: Safe Sleep
Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Quality Improvement, Crib Card, HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Nurse/Nurse Practioner, Audit/Attestation
Intervention Description: A multi-pronged, safe sleep quality improvement initiative was introduced in three inpatient pediatric hospitals. The intervention included: 1) nursing education, 2) identification of nurse "safe sleep" champions, 3) crib cards, 4) crib audits, and 5) weekly reporting of data showing nursing unit ABC compliance via tracking boards. A pre/post analysis of infants <12 months old was performed using a convenience method of sampling. The goal was ABC compliance of ≥25% for the post-intervention period.
Conclusion: The AAP's safe sleep recommendations are currently not upheld in children's hospitals, but safer sleep was achieved across three children's campuses in this study. Significant improvements were made in sleep environment and overall safe sleep compliance with this multi-pronged initiative.
Significant Findings: Yes
Setting: Three children's hospital campuses
Target Audience: Hospital staff