Multifaceted QI Initiative in UH Rainbow NICU Promotes Safe Sleep

Innovations in Pediatrics | Summer 2024

The Neonatal Intensive Care Unit at UH Rainbow Babies & Children’s Hospital has launched a comprehensive, ambitious quality improvement project to boost safe sleep practices among the parents of premature infants cared for in the NICU. Safe sleep is vitally important for these babies, who are at two to three times the risk of SUID/SIDS as are full-term infants.

While many premature or ill babies in the NICU have medical problems precluding safe sleep initially, the goal is to transition all babies to a safe sleep environment when they reach 32 weeks corrected gestational age and are medically stable.

The new effort takes a multifaceted approach to informing parents about the necessity of safe sleep practices, including in-depth safe sleep education with simulation. The intensive safe sleep class is supported by a grant from UH Rainbow Babies & Children’s Foundation, allowing for two swaddle sleep sacks to be given to families participating. A reinforcing board book is also a gift to participating families from Charlie’s Kids Foundation. The class has been very successful to date and is now offered to all NICU families with babies born at less than 32 weeks gestational age.

Mary Nock, MD

“We are doing the classes one-on-one with one of our team and the family at the baby’s bedside,” says UH Rainbow neonatologist Mary Nock, MD. “We encourage families to invite anyone who may care for the baby after discharge and anyone who might question the need for recommended safe sleep practices, such as an older family member, to try to get them all on the same page.”

However, parent education is necessary, but not sufficient, to boost safe sleep compliance rates. The new project also includes enhanced education for the care team as well, in order to model a safe home sleep environment well before discharge, knowing that families will often imitate what they have seen in the hospital. The NICU teams now have a discussion of each baby’s safe sleep status weekly during rounds, and the program includes sleep environment audits of all patients by fellows in the NICU and audits by OT/PT in the NICU stepdown unit.

Although the interventions are many, the main message is singular and clear: The safe place for baby to sleep is alone in their own space, on their backs, and in their own crib or bassinet. The UH Rainbow staff also follows up with families regarding safe sleep at home with a post-discharge questionnaire and phone call.

For more information about this QI initiative at UH Rainbow, please email Peds.Innovations@UHhospitals.org.

Contributing Experts:
Mary Nock, MD
Neonatologist,
UH Rainbow Babies & Children’s Hospital
Professor of Pediatrics
Case Western Reserve University School of Medicine

Sheri E Ricciardi, OTR/L
Neonatal Developmental Clinical Specialist
UH Rainbow Babies & Children’s Hospital