• Article
  • July 19, 2018

How to Model a Safe-Sleep Environment at Your Institution

How to help caregivers and staff know the only way a baby should be sleeping.

Unsafe sleep practices contribute to about 3,500 sleep-related deaths of U.S. babies every year, according to the U.S. Centers for Disease Control and Prevention (CDC). Every children's hospital has the opportunity to chip away at the infant mortality rate and help families create safe sleep environments for their babies by modeling safe sleep behaviors in the hospital setting. That's exactly what Robin Altman is doing—together with a highly collaborative team at Maria Fareri Children's Hospital at Westchester Medical Center in Valhalla, New York.

"We want to role model a safe sleep environment for parents, and in doing so, to educate them so they know this is the only way their baby should be sleeping when they go home," says Altman, M.D., FAAP, professor of pediatrics, New York Medical College; chief of general pediatrics and pediatric hospital medicine, and medical director of quality and safety at Maria Fareri Children's Hospital at Westchester Medical Center.

The "only way" a baby should be sleeping

When Altman talks about the only way a baby should be sleeping, she is referring to these four elements of the safe sleep environment: on the back, crib flat, safe clothing and nothing in the crib. She and her team at Maria Fareri Children's Hospital—from doctors and nurses to pediatric residents and the child protection team and others—have been providing safe sleep education to parents since 2012. But in 2016, they stepped up their efforts even more.

The secret to their success

The team began conducting unannounced audits every month—10 cribs in the well-baby nursery and 10 cribs in the NICU—to see if all four elements of safe sleep were met. In addition to the safe sleep education and ongoing monitoring through crib checks, the team also administered a simple knowledge-base survey to parents and caregivers before they left the hospital to show what they learned about safe sleep. Today, Maria Fareri Children's Hospital reports that:

  • 100 percent of parents of newborns receive education on safe infant sleep
  • The caregiver survey reveals 95 percent of parents say they have adequately learned about safe infant sleep and intend to use that knowledge when they go home

Taking the program to pediatrics

Because of the success the team saw with newborns, they rolled out a safe sleep program on the general pediatric floor, doing 10 crib checks a month there too. Though this part of the program presented different challenges.

On the general pediatric floor, the team was not dealing with a smaller, more controlled environment like a nursery. And parents of newborns are often in a better position to absorb messages about safe sleep than parents of older children who are hospitalized for serious illness, according to Altman.

"Parents of newborns are a captive audience, whereas parents of older babies in the hospital are potentially very distracted by other things and other concerns and the nurses are as well," Altman says. "But we're making strides."

And they are making strides across the board. The crib checks have revealed that more than 65 percent of cribs in the well-baby nursery have successful role modeling of all four safe sleep elements. The same goes for 40 percent of cribs in the NICU and 20 percent of cribs on the general pediatric floor. All of these figures are up from 0 percent at the start of the initiative.

Providing in-the-moment education 

On the general pediatric floor, if any one of the four elements of safe sleep is not met, the auditor will introduce himself or herself to the baby's nurse and the parents and remind them of the safe sleep elements. Altman says the team calls this a "point-of-observation correction," and the response to this newer intervention has been positive.

Nurse training is key to modeling

As part of Maria Fareri Children's Hospital's program, educators have incorporated safe sleep modeling during nurses' training, showing them a crib with a doll or a model inside, saying, "This is what the crib needs to look like. Show us how that could be a problem for you; show us how this may affect your taking care of the baby," Altman says.

Altman says the biggest issue is sometimes nurses want items like a bulb syringe or thermometer readily reachable. They will keep them at the bottom of the crib with the rationale that the items are far away from the baby and therefore, can't harm the baby.

"But we feel modeling a totally empty crib is the way to best communicate to the parents that this is the safest," Altman says. "We're teaching nurses a better place to put those things and having them understand it doesn't compromise care and it keeps the baby safer—all modeling the safe sleep environment for parents."

Tips for nurses' training

  • Administer a survey to test nurses' knowledge of safe sleep
  • Provide safe sleep training
  • Administer a post-training survey to reassess the knowledge base

"This approach really helped us guide our educational program," Altman says. "It helped us modify training when we saw different areas where we needed to improve the knowledge base."

Part of a statewide initiative 

The safe sleep program at Maria Fareri Children's Hospital is an offshoot of a broader initiative called Safe Babies New York. Funded for years through the New York State Office of Children and Family Services, Safe Babies New York is a statewide education initiative focused on safe sleep, as well as normal infant crying and stress management.

Maria Fareri Children's Hospital leads this initiative's Downstate Region, including seven counties in New York's Lower Hudson Valley Region, the New York City area and Long Island, spearheading the education of parents and hospital staff across 70 New York hospitals where babies are delivered.

Beginning in 2016, Maria Fareri Children's Hospital's safe sleep program was also done in collaboration with the Perinatal Quality Collaborative led by the New York State Department of Health. While the Safe Babies New York initiative will conclude in October 2018, Maria Fareri Children’s Hospital will continue to build on its safe sleep programs. 

A wake-up call: learn more

To learn more about infant sleep risks, safe sleep recommendations and what other children's hospitals are doing to help families create safe sleep environments, don't miss "Wake-up call," the cover story in the summer issue of Children's Hospitals Today magazine, coming Aug. 1.

Send questions or comments to magazine@childrenshospitals.org.