Perinatal Quality Collaboratives are Partners in Safe Sleep Message Spread

Posted December 10, 2015 by Kristie Velarde

Baby In NICU Sleeping Safely
NICUs are the ideal place to model safe sleep positioning because pre-term infants are at a distinct risk for sleep-related infant mortality.

Safe sleep messages are often contradicted in advertising. Magazines have images of babies sleeping on their stomachs and surrounded by stuffed animals and loose blankets. Furniture sections of baby stores are filled with cribs with matching bumper sets and newborn quilts. This culture of mixed messages not only confuses parents, according to a recent study from the American Academy of Pediatrics, but it also makes clinician’s work on safe sleep practices more challenging.

Recently, several perinatal quality collaboratives (PQCs)—networks of perinatal care providers and public health professionals working to improve pregnancy outcomes for women and newborns—have begun to focus their attention on improving safe sleep practices in neonatal intensive care units (NICUs) as a step toward reducing infant mortality rates. Peggy Settle, RN, PhD, a member of the Massachusetts Neonatal Quality Improvement Collaborative, says that PQCs are the ideal place to work on the safe sleep message because pre-term infants are at a distinct risk for sleep-related infant mortality and lower rates of safe sleep positioning after discharge. Working with NICU clinicians also supports an important prevention technique—modeling behavior.

“Research shows that parents will model the behavior of nurses caring for their babies in the hospital,” says Settle. “And while surveys of nurses show that they are aware of safe sleep practices, they are not necessarily practicing those methods in the clinical setting. If you watch a nurse engage in unsafe practices, of course parents will think they will be appropriate when they get home.”

The Massachusetts collaborative includes nurses and physicians from the nine NICUs across the state. Together they identify core groups of clinicians at each institution and provide teams with information and education about quality improvement and implementing safe sleep practices in each organization. In addition to benchmarking tools and data, the collaborative also shares anecdotal experiences around safe sleep practices.

“Hats are a big issue in NICU—everyone wants to donate knit hats and blankets, but because of safe sleep practices, we can’t use either,” Settle says. Instead, the hospital asked its volunteer knitters to create hammocks to hang outside of the crib. This approach continues to engage volunteers while at the same time providing a safe place to store stuffed animals.

The work of the PQC aligns with the improve safe sleep practices strategy of the Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IM CoIIN), a national initiative to reduce infant mortality and improve birth outcomes in the U.S., which NICHQ is facilitating.

“IM CoIIN is helping to educate parents to do the right thing at home, and these efforts match well with PQC initiatives to improve hospital-based safe sleep practices,” says Munish Gupta, MD, MMSc, a leader of the Massachusetts PQC. “A significant portion of infant deaths are related to safe sleep practices, and hospitals are and should be an important part of our broader safe sleep improvement work.”

The Massachusetts PQC makes key tools available to participants, including a uniform process for identifying the eligibility of newborns for safe sleep practices, which takes into account gestational age and any medical conditions. The PQC also encourages placing cards on each crib in the NICU. One describes infant therapeutic positioning (for babies who are not yet eligible for safe sleep practices) and a second card that emphasizes the “back to sleep” method, including the absence of toys, stuffed animals and loose bedding. A regular auditing process helps the participating hospitals measure their progress and raises the bar overall, Settle says. For example, collaborative member Worcester Memorial Hospital instituted a dashboard that shows how staff are performing on safe sleep practices month-to-month.

“By creating a visual, it helps people implement practices into their work,” says Settle. “Sometimes it’s hard to integrate basic changes into your practice but by creating redundancies, we start to see results,” Settle says.

Perhaps more than anything, the PQCs and IM CoIIN encourage members to learn from each other.

“We encourage our group to share widely and steal shamelessly; it’s the mantra of quality of improvement,” Settle says. “Healthcare has traditionally been very territorial, but we can’t be shy about doing that, particularly when you are focused on changing a culture.”

How are you engaging your state’s PQC in your infant mortality reduction efforts? Tell us on Facebook.

To learn more about state PQCs, visit the CDC PQC website page.

Learn more about NICHQ's infant health work.
Learn more about the IM CoIIN initiative.


Add your comment





sickle cell disease SCD advocacy Baby-Friendly breastfeeding Pediatric journal Best Fed Beginnings infant health safe sleep IM CoIIN QI quality improvement flexibility family partner parent partner vision screening nichq perinatal quality measures sustainabilty preterm birth tips PDSA cycle baby box infant mortality family engagement eccs coiin immunizations health equity health disparities accreditation astho onboarding collaboration engagement partnerships larc nashp new york wic new york state hospitals mom mother partners epilepsy data AAP early childhood pdsas texas community support learning session children's health new technology engineering transgender collaborative learning planning PDSA planning paralysis underplanning analysis paralysis vision eye health smoking smoke-free housing second-hand smoke toolkit e-module dental care oral health underserved populations health inequity public health Maternal and Child Health Journal leadership engagement indiana medicaid perinatal regionalization sudden infant death syndrome national birth defects prevention month birth defects pregnancy planning one key question prepregnancy health preconception health public breastfeeding support families patients experts insights CHOPT childhood obesity innovation food desert telemedicine TBLC breastfeeding supporting prematurity racial disparities audiology ehdi follow-up illinois talana hughes vulnerable populations sports asthma soccer basketball obesity football SIDS Pokemon Go gamification smartphones interconception care birth spacing issue brief contraceptive use postpartum care CoIN HRSA early childhood trauma NHSA community health consumer advocacy womens health interconception health teenage health PATCH wisconsin missouri risk appropriate care community health workers SCD< infographic infant mortality awareness month inspirations childrens health national breastfeeding month maternal health patient engagement hearing loss hearing treatment pediatric vision eyesight pre-term birth early-term birth SCD clinic los angeles LOCATe CDC levels of care neonatal care maternal care smoking cessation project safe sleep practices neonatal abstinence syndrome NAS opioids maternal and child health MCH Family voices quality care mental health hydroxyurea SCDTDP men dads testing change data sharing state government city government apps sleep AJPM preconception care senior leadership breastfeeding support video series access BQIH exclusive breastfeeding long-acting reversible contraception unplanned pregnancies social determinants of health health innovations Best Babies Zone CoIIN baby boxes Rhode Island progesterone rooming-in patient and family engagement healthy weight healthy lifestyles primary care telementoring ECHO video conferencing socioemotional health childhood development pediatric Tennessee interview National Coordinating and Evaluation Center medical-legal partnerships mobile app disparities perinatal care overweight obese healthy weight clinic wellness pilot sites data collection education resources paternal engagement risk-appropriate care preterm infants high-risk babies Ten Steps public relations social movement reversible contraceptives medical home pediatric medical home patient transformation facilitator PTF skin-to-skin rooming in prenatal smoking information visualization charts SUID postpartum new mother webinar AMCHP QI Tips ongoing improvement fourth trimester partnership quality and safety coaching leadership support year end holiday message reflections gratitute Medicaid data doctor relationship PQC perinatal quality collaboratives vision care vision health evidence-based guidelines ASH health and wellness healthy living healthy eating home visitors home visiting programs March of Dimes APHA results evaluation supplementation formula reduction video infant loss social media leadership Berns Ten Steps to Successful Breastfeeding sustainability stress prenatal care data capacity epidemiologists surveillance data PFAC community partners preconception and interconception care motivational interviewing Native Americans ADHD NICHQ Vanderbilt Assessment Scale ADHD Toolkit system design care coordination skin to skin newborn screening reduce smoking aim statement safe birth Texas Ten Step skin-to-skin contact 10 Steps staff training small tests acute care mother-baby couplet collective impact population health preconception Newborn Screening Program substance abuse breast milk formula milk bank crisis first responders NYC improvement healthcare health system sickle cell diease treatment protocol family health partner maternity care Collaborative Improvement and Innovation Network Health Outcomes Cross-Sector Collaboration Knowledge Sharing Child Health