Improving Hospital Infant Safe Sleep Compliance by Using Safety Prevention Bundle Methodology

BACKGROUND AND OBJECTIVES Sudden unexpected infant death often results from unsafe sleep environments and is the leading cause of postneonatal mortality in the United States. Standardization of infant sleep environment education has been revealed to impact such deaths. This standardized approach is similar to safety prevention bundles typically used to monitor and improve health outcomes, such as those related to hospital-acquired conditions (HACs). We sought to use the HAC model to measure and improve adherence to safe sleep guidelines in an entire children’s hospital. METHODS A hospital-wide safe sleep bundle was implemented on September 15, 2017. A safe sleep performance improvement team met monthly to review data and discuss ideas for improvement through the use of iterative plan-do-study-act cycles. Audits were performed monthly from March 2017 to October 2019 and monitored safe sleep parameters. Adherence was measured and reviewed through the use of statistical process control charts (p-charts). RESULTS Overall compliance improved from 9% to 72%. Head of bed flat increased from 62% to 93%, sleep space free of extra items increased from 52% to 81%, and caregiver education completed increased from 10% to 84%. The centerline for infant in supine position remained stable at 81%. CONCLUSIONS Using an HAC bundle safety prevention model to improve adherence to infant safe sleep guidelines is a feasible and effective method to improve the sleep environment for infants in all areas of a children’s hospital.

O020 What helped you and what prevented you from getting good sleep? Contribution of daily facilitators and barriers to adolescent sleep

Introduction This intense longitudinal study examined factors that facilitate and hinder sufficient and good quality sleep in adolescents’ everyday life. Methods 205 (54.2% female, 64.4% non-white) Year 10–12 adolescents (Mage = 16.9 ± 0.9) completed daily morning surveys and wore actigraphy over 2 school-weeks and 2 subsequent vacation-weeks. Morning surveys assessed self-reported sleep and the usage of 8 facilitators and 6 barriers of sleep from the previous night. Linear mixed-effects models examined contribution of facilitators/barriers to actigraphy and self-reported total sleep time (TST) and sleep onset latency (SOL), controlled for age, sex, race, place of birth, and study day. Schooldays/non-schooldays was included as a moderator. Results Seven facilitators and two barriers were endorsed by high proportions (>30%) of adolescents as frequently (≥50% days) helping/preventing them from achieving good sleep. Facilitators predicting longer TST and shorter SOL, were: “follow body cues”, “manage thoughts and emotions”, “create good sleep environment”, “avoid activities interfering with sleep” and “plan bedtime and go to bed as planned” (only TST on schooldays). Barriers predicting shorter TST and longer SOL, were: “pre-bedtime thoughts and emotions”, “unconducive sleep environment”, “activities interfering with sleep”, “inconsistent routines” and “other household members’ activities”. Overall, facilitators or barriers explained an additional 1–5% (p-values < .001) of variance beyond the covariates. Discussion Adolescents perceive a range of factors as facilitating and as preventing sufficient and good quality sleep in everyday life. These factors are predictive of their sleep duration and onset latency, and need further research to understand their functions and clinical implications.

P107 Patient self-reported sleep quality, noise and light levels in a tertiary ICU: a prospective observational study

Introduction Sleep is poor in intensive care units (ICU). However, there is limited research examining the causes from the patient perspective, especially in an Australian population. The current study investigated the factors that patients perceive as affecting their sleep in a major Australian tertiary ICU. Methods Patients (n=138, 51F; aged 58.1±16.8 years) completed a survey assessing sleep before and during their ICU stay, factors contributing to poor sleep, and factors that may have improved their sleep in the ICU. Night-time sound (16 nights) and light (28 nights) levels in rooms were also measured. Results Most patients reported good (38%) to very good (25%) sleep quality before their ICU stay, and poor (28%) to very poor (32%) sleep quality in the ICU. Over half (56%) reported an abnormal sleep-wake cycle and most (60%) felt as though they did not obtain sufficient sleep. Noise (54%), pain (50%) and lights (48%) were the top reasons for self-reported poor sleep. Patients felt as though their sleep would have been improved with dimmed lights (64%), a sleeping pill (57%) and closing door/blinds at night (46%). Median (IQR) overnight noise and light levels were 52.8 (51.4–54.6) dB and 39.9 (8.2–90.9) lux respectively. Discussion Of the top three factors that patients perceive to be the primary reasons for poor sleep, two are modifiable (noise and lights). Night-time sound levels exceed standard recommendations and light levels, while mostly low, were higher than indicated for a healthy sleep environment, suggesting that these could be modified to improve patients sleep.

Infant fatality patterns in shared sleep: keys to intervention strategies?

This study examines infant fatalities that occurred while sharing a sleep surface. Fatality data reported to the U.S. Consumer Product Safety Commission (CPSC) during the time period January, 2013 through December, 2017 and involving infants through age 10 months were reviewed. 1,587 Cases were analyzed on the following variables: infant age and sex; sleep environment by product; cause of death; fatality pattern; and breastfeeding, where it was mentioned. 97% Of deaths were due to some form of asphyxia. Adult beds were associated with 78% of shared sleep fatalities, and the primary fatality pattern was overlay (35.4%)/probable overlay (8.8%). Infants <3 months made up 65% of fatalities. The data reflect that bedsharing continues, despite AAP guidelines to the contrary, and that overlay is the primary hazard pattern to be addressed. This paper discusses potential risk reduction strategies that may reduce the potential for overlay fatalities.

Sleep in Adolescents Attending Australian Boarding Schools: A Review and Interim Recommendations

Boarding schools, by definition, house students in residence either on campus or close by in residential facilities - where the sleep environment is likely to differ from their home environment. For boarders, being in the boarding environment occurs alongside a convergence of psychosocial and physiological factors likely to impact adolescent sleep. This paper comprises a review of the literature on sleep and boarding students in the Australian context. We also propose recommendations aligned with the scientific evidence base that can be used to promote healthy sleep in Australian boarding school students, focusing on staff training and sleep knowledge, daily routines, sleeping arrangements, and student mental health and wellbeing. It must be noted that these recommendations should be considered interim recommendations until further research is performed in the area. Further, we suggest the development of standardised practice guidelines, to ensure that student sleep is supported appropriately within the Australian boarding context.

Implementation of Safe Sleep Practices by Mothers with 0-1 Year-Old Infants

Aim: The sleep environment of an infant affects the likelihood of sudden infant death syndrome and other sleep-related infant deaths. This study was performed to determine the safe sleep practices of mothers with 0–1 year-old infants. Methods: This descriptive study included 204 mothers with 0–1 year-old infants who visited family health centers between October 30 and December 28, 2018. The data were collected using a questionnaire form and evaluated using the number, percentage, mean, standard deviation, and chi-squared test. Results: The mean age of the mothers was 28.48 ±5.83 years; 43.1% were primary school graduates and 84.8% were housewives; 53.9% of the infants were girls and 39.2% were 0–3 months old. It was found that 47.5% of the mothers put their infant to sleep in the supine position, 46.1% in the non-supine position, 70.1% on a soft bed, and 76.5% by using a pillow. In addition, 41.2% of the mothers stated that they used pacifiers while putting their infant to sleep, 9.8% stated that they slept in the same bed with their infant, and 92.9% stated that they slept in the same room. Conclusion: It was determined that the mothers performed certain risky practices related to the sleep environment, particularly regarding soft beds’ use, sleeping positions, pillow use, and bed-sharing. It may be recommended that healthcare professionals play an active role and take responsibility in increasing the level of knowledge and awareness of parents regarding safe sleep. Keywords: sleep, infant, mothers, family practice