Education and Guidelines for the Safe Sleep of Infants

Maternity Care Center & Lactation Departments

Kelli Benson, Erin Burnette, Lena Caison, Hannah Edens, Shantay Harris, Heather Hill, Kim Novak-Jones, Jennifer Patterson, Kimberly Spence, Teri Wallace

Background
Current nursing practice to uphold the Safe Sleep
practices has inconsistent in the Maternity Care Center.
As expressed from direct staff feedback, there is a need
for updated Safe Sleep education and guidelines on
expectations based on current AAP and NANN
guidelines.

Results
The safe sleep recommendations provided to
patients by staff have been updated according to
AAP and NANN as follows:
Room sharing without bed sharing is
recommended.

Goals

Infants placed on their stomach or side for sleep

have an increased risk for SIDS, hypercapnia,
and hypoxia due to rebreathing of exhaled CO2,
overheating, and diminished sleep wake cycles.

100% Compliance with Random Observations of Safe Sleep

Practices Tool to be developed
100% Compliance with Documented Patient Education

Methods
December 2014: Invitation to all staff seeking involvement
in this project
January 2015: Formulate team initiatives, accountabilities,
and time-table
February April 2015: Literature review and develop
training materials

May 2015: Begin roll out of education

June 2015: Complete staff education
July 2015: Begin random observations and chart audits
each month through December
December 2015: Project completion with notable
changed practices

The following patient education handout for the NC

Healthy Start foundation has been approved and
incorporated into infant discharge teaching.

Infants should sleep in his or her own sleep area.

Sudden Infant Death Syndrome (SIDS) is any sudden

and unexpected death of an infant younger than one
year of age. The AAP released recommendations to
follow. Health Care Providers educate and role model
practices to be used in the home environment, thus the
importance of using good practices that will reduce the
risk when families are discharged. Since 2009, the
number of infant deaths in North Carolina due to
accidental suffocation and strangulation in bed have
slowly increased, thus it has become a local concern.

100% Compliance with Staff Education Requirements

Conclusions & Next Steps

Co-bedding of twins should be avoided if

possible.
The flat, supine sleep position is recommended
for infants.
Side sleeping is not safe. It increases the risk of
infants rolling to a prone position.

Crib mattresses should be firm and able to

maintain its shape.
Soft objects such as pillows, quilts, comforters,
and toys should be kept out of the infants sleep
environment.

At this time, all staff in the Maternity Care Center

have completed education on the most recent
recommendations and guidelines. Visual and chart
audits remain ongoing through December 2015.
Employee compliance data will be compiled at that
time.

Wedges and positioners should not be used.

Elevating the head of the bassinet is not

recommended. It is not effective in the reduction
of GERD.
Pacifier use should be delayed until
breastfeeding is well established.

Next steps include:

Extending staff education to Labor and Delivery,

Antepartum, and the Neonatal Critical Care Center

Finalizing policy changes

Applying for NC Health Start Foundations Infant

Safe Sleep Hospital Model of Excellence Award
Program

Preliminary Audit Results

Infants should be loosely swaddled with hands

remaining close to the face.
Bumper pads can increase the risk of SIDS and
are not recommended.

The main changes emphasized in the Maternity Care

Center are as follows:
Infants should be swaddled loosely with hands near
their face as opposed to a tight burrito-like
swaddle with their arms positioned to their sides.
It is no longer thought that raising the head of the
bassinet is beneficial in the prevention of GERD.
Raising the head of the bassinet can lead to the
infant sliding to the end of the bassinet with the
potential for an occluded airway.
Infant should not be sleep in beds where decorative
objects such as pillows, quilts, comforters and toys
are placed.

Contact Information

100.00%
90.00%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%

July, 2015
Aug,201
Sep, 2015

CRIB

INFANT
POSITION

OTHER

Teri Wallace, Patient Services Manager

Maternity Care Center
UNC Womens Hospital
101 Manning Drive, Chapel Hill, NC 27514
ph (984) 974-9252 pager (919) 521-2445
teri.wallace@unchealth.unc.edu