Improving Compliance With Safe Sleep Guidelines for Vulnerable Patients in a Community Safety Net Hospital Neonatal Intensive Care Unit

Introduction: Modeling safe sleep in the neonatal intensive care unit (NICU) increases the likelihood that parents will follow these practices after discharge. Many NICU infants are put to sleep unsafely, and unsafe sleep practices are the leading cause of nonnatural death among children locally. We created safe sleep standards for infants older than 32 weeks based on national guidelines: infants should be placed supine in a flat, empty crib and should never be swaddled loosely. We aimed to increase the weekly percentage compliance with safe sleep recommendations from a baseline of 58% (0.58 compliant) to 85% (0.85 compliant) by March 2025 in our level II and III NICUs based on random crib audits. Methods: In plan-do-study-act cycle 1, we educated residents and fellows about safe sleep practices in the NICU and changed our daily electronic medical record smart phrase to integrate safe sleep readiness. In PSDA cycle 2, we educated nurses about safe sleep and implemented nonrecline cribs. In plan-do-study-act cycle 3, we implemented bedside signs for each crib with reminders of our standards. Results: We successfully achieved our aim. Our mean compliance increased from 58% (0.58 compliant) at baseline to 91% (0.91 compliant) postintervention. Conclusions: Our project successfully improved compliance with safe sleep practices of the current nursing staff: our interventions moving forward will focus on embedding safe sleep practices into our NICU culture so that our changes are sustainable. Our ongoing interventions will be promoting “nursing safe sleep champions,” continuing to perform regular audits, and further implementing the use of sleep sacks instead of loose swaddles.