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Task Force Purpose. To reduce infant sleep-related deaths by promoting safe sleep and SIDS risk reduction techniques, and by educating about safe sleep environments to all individuals who are responsible for caring for infants . Objectives. To educate healthcare professionals about infant safe sleep
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1. Karen Gray, M.S., C.H.E.S.
Columbus Public Health
Maternal and Child Health Division
Franklin County Infant Safe Sleep and SIDS Risk Reduction Initiative
2. Task Force Purpose To reduce infant sleep-related deaths by promoting safe sleep and SIDS risk reduction techniques, and by educating about safe sleep environments to all individuals who are responsible for caring for infants Our strategies were strongly linked to recommendations provided through the Child Fatality Review (CFR) processOur strategies were strongly linked to recommendations provided through the Child Fatality Review (CFR) process
3. Objectives To educate healthcare professionals about infant safe sleep and the risks associated with SIDS through implementation of a standardized hospital-based infant safe sleep curriculum (Phase I);
To provide educational materials to the community about infant safe sleep; and
To conduct 3 trainings on infant safe sleep that will target childcare providers, home day care providers, home health care professionals, and staff of public OB and pediatric clinics (Phase II)
4. Significant Findings In Franklin County in 2003, the rate of SIDS for Black infants was 3 times higher than the rate for White infants
In 2004, SIDS deaths among male infants (63%) and among Black infants (53%) were high relative to their representation in Franklin County’s population*
*According to the U.S. Census Bureau, 23% of children in Franklin County are Black and 51% are male (2000). Why? Don’t know for certain, but could be related to LBW & VLBW babies (higher incidence among African Americans); moms who smoke during pregnancy, moms with medical conditions; or can it be attributed to environmental factors and risky behaviors… (unsafe sleep environment, unsafe sleep position)…are these conditions higher among African Americans; I don’t have evidence to confirm or denyWhy? Don’t know for certain, but could be related to LBW & VLBW babies (higher incidence among African Americans); moms who smoke during pregnancy, moms with medical conditions; or can it be attributed to environmental factors and risky behaviors… (unsafe sleep environment, unsafe sleep position)…are these conditions higher among African Americans; I don’t have evidence to confirm or deny
5. Environmental Conditions Franklin County Child Fatality Review statistics about SIDS deaths in 2000-2003 indicate*:
46% had moms who smoked during pregnancy
88% had been exposed to ETS
38% were not sleeping alone at the time of death
47% were not on a firm sleeping surface
41% were found in areas with heavy bedding/ pillows For instances where this information is known, but often it is not known; through CFR process, we’ve identified that we need to do a better job with collecting this information (too many unknowns and blanks); a huge “gray area” exists when it comes to SIDS and SUID; back in the early 2000s, there wasn’t consensus on how to classify deaths, medical community wasn’t in tune with how to distinguish between SIDS, positional asphyxia, parental overlay, accidents; our task force tries not to get bogged down with the clinical diagnosis, but rather we work to reduce risk factors proven to be associated with infant sleep related deaths
Firm sleeping surface- of 57 deaths, 19 yes firm surface; 17 were not, 21 were unknown or blankFor instances where this information is known, but often it is not known; through CFR process, we’ve identified that we need to do a better job with collecting this information (too many unknowns and blanks); a huge “gray area” exists when it comes to SIDS and SUID; back in the early 2000s, there wasn’t consensus on how to classify deaths, medical community wasn’t in tune with how to distinguish between SIDS, positional asphyxia, parental overlay, accidents; our task force tries not to get bogged down with the clinical diagnosis, but rather we work to reduce risk factors proven to be associated with infant sleep related deaths
Firm sleeping surface- of 57 deaths, 19 yes firm surface; 17 were not, 21 were unknown or blank
6. SIDS Risks Among Franklin County SIDS deaths in 2004*:
42% were found on their stomach or side at time of death
32% were found sleeping on same surface with an adult
58% of the mothers smoked during pregnancy
63% were exposed to 2nd hand smoke
7. SIDS Risks – Sleep Location Of all SIDS deaths in 2004, 26% occurred in a crib or bassinette, while 69% of SIDS deaths occurred in locations considered unsafe, i.e., in other beds, on couches and other locations Proportion of SIDS Fatality Reviews by Incident Sleep Place, 2004 (N=19)
Conditions of the cribs/bassinets were not known in most casesConditions of the cribs/bassinets were not known in most cases
8. Conclusions from Child Fatality Review Process Data highlight unsafe sleep practices
Back sleep position, by itself, is not protective when other unsafe factors are present
Too many babies are dying in unsafe sleep environments
These deaths are PREVENTABLE
9. Shifting The Focus toInfant Safe Sleep Funding Provided By…
Columbus Public Health to the
Council on Healthy Mothers and Babies
Ohio Department of Health/Federal Government, Bureau of Child and Family Health Services, Child and Family Health Services Program Also, Columbus’ Healthy Start Project, called Caring For 2, also provides significant funding to the COHMAB to address system and capacity issues relating to our local health system action plan, one component of which is to decrease risk factors for and deaths caused by SIDS
Also, Columbus’ Healthy Start Project, called Caring For 2, also provides significant funding to the COHMAB to address system and capacity issues relating to our local health system action plan, one component of which is to decrease risk factors for and deaths caused by SIDS
10. Member Organizations Columbus Public Health
Communities in Schools
Council on Healthy Mothers and Babies
Doctor’s Hospital
Grant Medical Center
Help Me Grow
March of Dimes
Mount Carmel Health System
Nationwide Children’s Hospital
Northwest Counseling Services
Ohio Dept. of Health
Ohio Dept. of Jobs and Family Services
OSU Medical Center
Region IV Perinatal Center
Riverside Methodist Hospital
St. Ann’s Hospital We’re proud that all Franklin County birthing hospitals are represented; hospitals joined at different timesWe’re proud that all Franklin County birthing hospitals are represented; hospitals joined at different times
11. Why Focus on Hospitals? Findings from several studies indicate:
most nurses aware of back sleep recommendation
most nurses afraid of aspiration
preference for side position
parent preference influenced by nurse behavior FC averages over 18,000 births/yr, so hospitals provide logical venue to reach parents
TC conducted workshop for task force and hospital staff sharing info about their hospital based initiative and programs components: audits, policy development, adherence to policy; back to sleep isn’t enough; hospital policies and education need to include safe sleep environment; TC had grant, we didn’t
FC averages over 18,000 births/yr, so hospitals provide logical venue to reach parents
TC conducted workshop for task force and hospital staff sharing info about their hospital based initiative and programs components: audits, policy development, adherence to policy; back to sleep isn’t enough; hospital policies and education need to include safe sleep environment; TC had grant, we didn’t
12. Franklin County Program Components
Hospital observational audits
Pre/post surveys for hospitals, OB clinics and pediatric clinics assessing staff knowledge, beliefs and behaviors
Education component – includes power point presentation for health professionals (i.e. nurses and patient educators) Pre/post surveys developed by staff in Office of Assessment & Surveillance with expertise in survey development; tool enables us to assess knowledge, attitudes, beliefs and behaviors of health professionals; Findings revealed from the observational audits and hospital staff surveys confirmed the critical need for an infant safe sleep educational intervention targeting healthcare professionals in the hospital setting. Hospital staff surveys also indicated that current education regarding infant safe sleep is often lacking information on ways to reduce critical risk factors, namely exposure to tobacco smoke.Pre/post surveys developed by staff in Office of Assessment & Surveillance with expertise in survey development; tool enables us to assess knowledge, attitudes, beliefs and behaviors of health professionals; Findings revealed from the observational audits and hospital staff surveys confirmed the critical need for an infant safe sleep educational intervention targeting healthcare professionals in the hospital setting. Hospital staff surveys also indicated that current education regarding infant safe sleep is often lacking information on ways to reduce critical risk factors, namely exposure to tobacco smoke.
13. Observational Audit Tool Location (hospital)
Shift
Location of infant (nursery, mom’s room)
Position of infant (back, side, stomach)
Condition of crib (blankets, stuffed animals, toys, loose items, etc.)
General comments section
14. Hospital Staff Survey Assessment Discipline
Length of employment
Responsibility for safe sleep education
When education occurs
Components of safe sleep education
Hospital policy
5 questions about beliefs/attitudes regarding infant safe sleep
15. Curriculum Content Definition of SIDS
Introduce concept of sleep-related death
Franklin County and national statistics
Reducing SIDS risks
Obstacles to complying with AAP guidelines
Role of the RN
Hospital safe sleep recommendations
Hospital staff
Parents
What to teach new parents
2005 AAP guidelines
Resources
16. Educational Intervention Success was dependent on…
Hospitals having flexibility to determine method of implementation
Examples of methods selected include:
- grand rounds
- staff in-service trainings
- computer-based education with test Educational intervention was standardized tool that ALL birthing hospitals agreed to useEducational intervention was standardized tool that ALL birthing hospitals agreed to use
17. Beginning Steps – Hospital A Met with management
“Back to sleep” already in newborn policy
How to enforce compliance
Need to change policy to include 2005 AAP recommendations
Task force involvement
Identified safe sleep champions for each shift
Acquired photographic evidence
18. Pre-Audit Photographic Evidence
19. Safe Sleep Champion Recommendations Interview staff
#1 reason for continuing to place infants on their side was fear of aspiration
Revise newborn policy
Change verbage on clinical pathway and discharge summary to reflect safe sleep practices
Re-educate staff
20. Revision of Newborn Policy Infant is to be placed on back while in the crib
Instruct parents not to position infant on stomach or side
Toys, stuffed animals, and extra blankets are not allowed in the crib
Parents will receive education on SIDS/safe sleep practices
21. Staff Education Open house with free food from Thurs 0600 - Sat 0800
Invited all women’s health staff
Continuous PowerPoint presentation
Placed resource manuals on each unit
Education posters on every women’s health unit
22. Position of Baby
23. Non-Essential Items in Crib
24. Outcomes
25. Ongoing Plans Continue with safe sleep audits
Continue with safe sleep champions
Safe sleep education incorporated into new staff orientation
26. Hospital B Guidelines reviewed at Staff Meetings
In-services offered
Online Education with post-test Poor attendance at in-services. Excellent (100%) compliance with online education, as it is offered 24/7 and staff can complete during down time at work. This education is MANDATORY for all RNs and UAP. Poor attendance at in-services. Excellent (100%) compliance with online education, as it is offered 24/7 and staff can complete during down time at work. This education is MANDATORY for all RNs and UAP.
27. Crib Cards – placed on all infant cribs, designed as a reminder for staff and parents & families. Parents can take them home. Crib Cards – placed on all infant cribs, designed as a reminder for staff and parents & families. Parents can take them home.
28. Future Education Plans Infant safe sleep online education will continue to be a requirement for all Perinatal staff to complete at initial hire and annually
An Infant Safe Sleep Station was part of Mandatory OB Education Days last fall
Audits will be conducted as requested by the Franklin County Infant Safe Sleep and SIDS Risk Reduction Task Force to confirm that AAP Guidelines are being followed Annual audit due May 2008Annual audit due May 2008
29. Hospital Staff Survey Within Franklin County Birthing Hospitals
97% of staff recommend back sleeping position
Education typically occurs during hospitalization
65% of staff haven’t received formal training on safe sleep in past 3 years
42% of staff don’t feel they’ve received enough training
Less than half (49%) of staff indicated their hospital has a safe sleep policy; 6% said no; 45% didn’t know Interesting note: despite 97% of staff indicating they recommend back sleeping position, the audits revealed that only 50% of babies in nurseries were being placed to sleep on their backs; this suggests a disconnect between knowledge and behavior; reminder - the overwhelming belief is that parents will mirror behaviors they witness in the hospital setting; therefore, if a nurse places an infant to sleep on its side, parents will do the same
Interesting note: despite 97% of staff indicating they recommend back sleeping position, the audits revealed that only 50% of babies in nurseries were being placed to sleep on their backs; this suggests a disconnect between knowledge and behavior; reminder - the overwhelming belief is that parents will mirror behaviors they witness in the hospital setting; therefore, if a nurse places an infant to sleep on its side, parents will do the same
30. Position of Baby
31. Non-Essential Items in Crib
32. Summary Points Addressing infant safe sleep in the hospital setting positively influenced staff behaviors
Positive behavior change has been maintained 12-months post-intervention
The Initiative demonstrates that there’s an important role for health department leadership in group facilitation, coordination of intervention, and outcome evaluation
The Initiative has been recognized nationally Honorable STAR award at 2007 CityMatCH conference and 2008 NACCHO model practice award recipientHonorable STAR award at 2007 CityMatCH conference and 2008 NACCHO model practice award recipient
33. Safe Sleep Symposium April 12, 2008
94 nurses, social workers, and childcare providers attended
Grant through CJ Foundation for SIDS
Highlighted infant sleep-related death data and safe sleep recommendations
34. Next Steps…Phase II Development of childcare provider educational PowerPoint
Conduct 3 county-wide trainings (secured March of Dimes funding)
Continue monitoring hospital-based safe sleep initiative
Strengthen public information on infant safe sleep group
35. Contact Information Karen Gray, MS, CHES
Columbus Public Health
Public Health Program Manager
614-645-2134
kareng@columbus.gov