Keeping Infants Safe for Sleep What Can Nursing Do?

Keeping Infants Safe for Sleep
What Can Nursing Do?
Donna M. Flook, MSN, RN, CPN
Durae L. Vincze, MSN, RN
Disclosures
• All research studies discussed are
appropriately cited
• All pictures are in either public domain
or permissions have been obtained and
are on file
• There are no conflicts of interests to
disclose
Objectives
• Define SIDS
• Summarize history of Sudden Infant Death
Syndrome (SIDS)
• Discuss rationale and importance of SIDS risk
reduction compliance and role modeling
• Describe strategies that can be implemented
to improve safe sleep education and
compliance
What exactly is
SIDS?
Definition
• SUID: Sudden death of an infant less than 1
year of age whose cause of death is not
immediately known (CDC, 2011)
• SIDS: Sudden death of an infant less than 1
year of age that remains unexplained after a
thorough case investigation, autopsy,
examination of death scene and review of
clinical history (Willinger, James, & Catz, 1991)
The Centuries
Old Story of
SIDS
The Story of Solomon
• Reign began approximately 967BC
• Judgment by King Solomon
Sudden Infant Deaths
•
•
•
•
14th century
Crib death
Infanticide viewed as a sin
Punishments given
Ballad of Moll Magee – William
Butler Yeats
• 1889
• A poem describing an
overlay
Sudden Infant Death
Syndrome Act of 1974
• Charged the National Institute of Child Health
and Human Development (NICHD) with
leading research on SIDS
• Charged the NICHD with providing
information to the public on SIDS education
and risk reduction strategies
Recent History
• American Academy of Pediatrics (AAP)
recommendations on safe sleep in 1992
• Back to Sleep Campaign in 1994
• Updated recommendations from AAP in 2000
and 2005
• Latest recommendations from AAP 2011
July 2012
Still exists today
• 2012
• Cases of co-sleeping still exist
• Infant mortality due to suffocation/SIDS
Causes of Sudden
Unexplained Infant Death
CDC.gov
Background
• 4,500 infants die annually in the U.S. of no
apparent cause (CDC, 2011)
• SIDs remains one of the 3 leading causes of
infant deaths and accounts for 8% of all infant
deaths (Matthews & MacDorman, 2011)
Causes of Resident Infant
Mortality, Allegheny County, PA
2005 -2009
CODE
2005
2006
2007
2008
2009
TOTAL
Cause
R95
10
7
7
14
12
50
Sudden Infant Death
Syndrome
R99
3
5
6
2
2
18
Other Unspecified
Cause
This data is provided by the Allegheny County Health Department, Office of Epidemiology and Biostatistics through a
cooperative agreement with the Pennsylvania Department of Health which requires the following disclaimer: "These data
were supplied by the State Health Data Center, Pennsylvania Department of Health, Harrisburg, Pennsylvania. The
Pennsylvania Department of Health specifically disclaims responsibility for any analyses, interpretations or conclusions."
Allegheny County
• Medical Examiner’s Office conducts
investigation after infant unexpected death
• Meets with family at hospital and/or visits
home
• Reports to Centers for Disease Control (CDC)
• Medical Examiner determines cause of death
SUIDI Reporting Form
Investigation data (demographic)
Witness interview
Infant medical history
Pregnancy history
Incident scene investigation
Investigation summary including scene
diagrams
• Summary of pathologist
•
•
•
•
•
•
Child Death Review Team
• Multidisciplinary team
• Meets once a month in Allegheny County
• National program
• Examines trends and preventative measures
Causes of SIDS
• Causes are unknown
• Many Theories and Hypotheses
•
•
•
•
•
1614 Felix Platter Thymus Theory
1972 Apnea Theory (Steinscheider, A)
1992 Triple Risk Model for SIDS (Fillano, & Kinney)
1993 Rebreathing expired gases (Kemp, et.al.)
2010 Serotonin link (Kinney, et. Al)
Articles listed in references
Statistics
• 90% of SIDS cases occur before age 6
months
• Peaks between 1 and 4 months of age
• Seasonality no longer apparent
American Academy of Pediatrics, 2011. SIDS and other sleep-related infant deaths: expansion of
recommendations for a safe Infant sleeping environment. Pediatrics, 128(5), e1-e27. Retrieved
October 19, 2011.
SIDS Rates
• American Indians/Alaskan Native 112 per
100,000 live births
• Non- Hispanic Black 99 per 100,000 live
births
• Non-Hispanic White infants 55 per 100,000
live births
• Asian or Pacific Islander 24 per 100,000 live
births
American Academy of Pediatrics, 2011. SIDS and other sleep-related infant deaths: expansion of
recommendations for a safe Infant sleeping environment. Pediatrics, 128(5), e1-e27. Retrieved
October 19, 2011.
Risk Factors
• Prone sleep position
• Late or no prenatal care
• Sleeping on soft surface
• Young maternal age
• Maternal smoking during
pregnancy
• Preterm birth and/or low
birth weight
• Overheating
• Male gender
• Alaskan Native
• African American
Back to Sleep Campaign
• 1994
• This campaign is sponsored by the Eunice Kennedy
Shriver National Institute of Child Health and Human
Development (NICHD), the Maternal and Child
Health Bureau of the Health Resources and Services
Administration, the American Academy of Pediatrics
(AAP), First Candle/SIDS Alliance, and the
Association of SIDS and Infant Mortality Programs
• Since the Back to Sleep campaign, there has been a
50% decrease in SIDS
Eunice Kennedy Shriver National Institute of Child Health & Human Development (2012).
Back to sleep public education campaign. Retrieved from http://www.nichd.nih.gov/sids/
SIDS Deaths
American Academy of
Pediatrics
View full listing of 2011 AAP
recommendations
http://pediatrics.aappublications.org/content/128
/5/1030.abstract
Back to Sleep
• Do not recommend
elevating head of bed
(HOB)
• Rare risk of reflux
outweighs risk
for SIDS
• Preterm infants placed on
back as soon as possible
American Academy of Pediatrics, 2011. SIDS and other sleep-related infant deaths: expansion of recommendations for a safe
Infant sleeping environment. Pediatrics, 128(5), e1-e27. Retrieved October 19, 2011.
Correct position
Incorrect Position
Nursing Urban Legend
• To elevate head of bed or not elevate?
• Total 699 infants audited between November
2010 and April 2012
• 251 had HOB elevated without an physician
order
Additional Recommendations
•
•
•
•
Pacifier use
Avoid overheating
Immunizations up to date
Avoid wedges & positioning devices
American Academy of Pediatrics, 2011. SIDS and other sleep-related infant deaths: expansion of recommendations for a
safe Infant sleeping environment. Pediatrics, 128(5), e1-e27. Retrieved October 19, 2011.
ROLE MODELING
More Action is Needed
• Grazel, Phalen, and Polomano (2010)
• Moon, R., & Omron, R. (2002)
Role of Media in Social Modeling
Joyner, Bailey, & Moon (2009)
Better Messages
• Encourage pictures of normal sleep
environment
• Started with education and progressively
becoming more powerful
• Local and national ads making harsh
messages
YOUR BABY
BELONGS IN A CRIB,
NOT A CASKET
Every day babies suffocate in
adult beds and on couches.
RIP
Used with permission from SIDS of PA/Cribs for Kids
For safest sleep, put your baby
on its back in a crib.
888-721-CRIB www.cribsforkids.org
City of Milwaukee Health
Department
Used with permission from City of Milwaukee Heath Department
Expand National Campaign
• National Conference of State Legislators at
http://www.ncsl.org/issues-research/health/sudden-infant-death-syndromelaws.aspx
How is Children’s Hospital of
Pittsburgh of UPMC doing
with implementation of risk
reduction strategies?
Journey Began in 2008
• Allegheny County Department of Health and
SIDS of Western Pennsylvania
• Reviewed current safe sleep practices
• Developed Infant Safe Sleep Environment
Policy in September 2008
Safe Sleep Committee
August 2010
Charter
Members
Look at internal practices first before
educating families
• Revised current policy
•
•
•
•
Audits
Patient Sleep Postion:
Room # Age
one
Circle
Toys in
HOB
Loose
Other Items Postioning
Crib Circle Elevated Blankets Circle in Crib
Devices
one
Circle one
one
Circle one
Circle one
Back
Side
Prone
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Back
Side
Prone
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Back
Side
Prone
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Back
Side
Prone
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Back
Side
Prone
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Back
Side
Prone
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Back
Side
Prone
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Back
Side
Prone
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Back
Side
Prone
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Back
Side
Prone
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Back
Side
Prone
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Back
Side
Prone
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Back
Side
Prone
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Back
Side
Prone
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Back
Side
Prone
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Back
Side
Prone
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Back
Side
Prone
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Back
Side
Prone
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Back
Side
Prone
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Back
Side
Prone
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
If yes is checked for HOB Elevated, Prone/Side Position, or Positioning Devices, please verify if
there is a physician order. Please note this in the comment section.
Comment
Act 73 of 2010 (HB47)
• Requires education of SIDS and SUIDS
• Acknowledgement signature not required at
CHP
• Electronic education given to every family
with prompts on printing welcome document
and discharge instructions
• Video available
Automated Prompt
Other Committee Initiatives
• Eliminate Crib Wavier
• Cribs for rooming in families
• Department of Health (DOH) pamphlets
available on units
• Eliminate positioning devices
• Sleep sacks for infants
• Fitted crib sheets
• Eliminate conflicting information on interactive
media for parents
Dawn at Wheel
Bundling Station
Beth Mastrangelo
Electronic Nursing Grand Rounds
• Available February 15, 2012 to May 1, 2012
• 1 nursing contact offered
• 74 participants
Online Education Module
• Safe Sleep module launched February 2012
• 937 Staff (RNs and PCTs) completed module by
March 31, 2012
Timeline
•
•
•
•
•
•
•
August 2010 Safe Sleep Committee formed
November 2010 audits started
Winter 2010 policy revised
August 2011 Safe Sleep Fair
January 2012 Nursing Grand Rounds
February 2012 Nursing Grand Rounds online
March 2012 required online learning module
Results
Overall Compliance
November 2010 - May 2012
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Supine
HOB without Orders
Loose Blankets
Other Items
Devices
Supine Sleeping
94%
92%
90%
88%
86%
84%
82%
80%
Pre Education
Post Fair
Post Education
HOB Elevated without MD Orders
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Pre Education
Post Fair
Post Education
Loose Blankets
100%
95%
90%
85%
80%
75%
70%
65%
60%
55%
50%
Pre Education
Post Fair
Post Education
Other Items in Cribs
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Pre Education
Post Fair
Post Education
What kind of other items?
40
35
30
25
20
15
10
5
0
Wipes
Diapers
Stuffed Animals
Pillows
Bulb Syringe
Positioning Devices (nests, bendies,
wedges)
12%
10%
8%
6%
4%
2%
0%
Pre Education
Post Fair
Post Education
Cribs for Kids® Program
• Provides Pack ‘N Play® for infants with unsafe
sleep environment
• Secure funding
• Screening question added to admission data
base
Community Involvement
Used with permission from Cribs for Kids®.
Next Steps
•
•
•
•
Algorithm for transitioning infants
Staff education
Safe Sleep Champions
Increase community involvement
So why is all of this important?
• Our patients and families deserve the best
care possible
• Our role modeling can set an example for
parents
Saving Infant Lives
Its up to all of us!
Questions?
References
American Academy of Pediatrics, 2011. SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping
environment. Pediatrics, 128(5), e1-e27. Retrieved October 19, 2011.
American Academy of Pediatrics, 2011. SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping
environment. Pediatrics, 128, 1030 -1039.
Centers for Disease Control and Prevention (2011). Sudden unexpected infant death and sudden infant death syndrome. Retrieved from
http://www.cdc.gov/SIDS/index.htm.
Eunice Kennedy Shriver National Institute of Child Health & Human Development (2012). Back to sleep public education campaign. Retrieved
from http://www.nichd.nih.gov/sids/
Filano, J., Kinney, HC. (1994). A perspective on neuropathologic findings in victims of the sudden infant death syndrome: the triple-risk model.
Bilo Neonate, 65(3-4), 194-197.
Flook, D., & Vincze, D. (2012). Infant safe sleep: efforts to improve education and awareness. Journal of Pediatric Nursing, 27(2), 186-188.
Grazel, R., Phalen, A.G., & Polomano, R. (2010). Implementation of the American Academy of Pediatrics recommendations to reduce sudden
infant death syndrome risk in neonatal intensive care units. Advances in Neonatal Care, 10, 332-342
Joyner, B., Gill-Bailey, C., and Moon, R. (2009). Infant sleep environments depicted in magazines targeted to women of
childbearing age. Pediatrics. 124(3), 425-431.
Kemp, J., Kowalski, R., Burch, P., Graham, M., & Thach, B. (1993). Unintential suffocation by rebreathing: a death scene and physiologic
investigation of a possible cause of sudden infant death.
Kinney, H., Duncan, J., Paterson, D., Hoffman, J., Mokler, D., Borenstein, N., Bellilveau, R., Krous, H., Haas, E., Stanley, C., Nattie, E., &
Trachtenberg, F. (2010). Brainstem serotonergic deficiency in sudden infant death syndrome. JAMA , 303 (5), 430-437.
Mathwes, T.J. & MacDorman, M.F. (2011). Infant mortality statisitics from the 2007 period linked birth/infant death set. National Vital Statisitics
Reports, 59, 1-31.
Moon, R., & Omron, R. (2002) Determinants of infant sleep position in an urban population. Clinical Pediatrics, 41(8), 569-573.
Steinschneider, A. (1972). Prolonged apnea and the sudden infant death syndrome: clinical and laboratory observations. Pediatrics, 50(4),
646-653.
Whitehurst, L. (2012). Appeals court won’t dismiss charges in deadly ‘co-sleeping’ case. The Salt Lake Tribune. Retrieved on May 7, 2102 from
http://www.sltrib.com/sltrib/news/53248734-78/sleeping-appeals-court-nielsen.html.csp
Willinger, M., James, L.S., & Catz, C. (1991). Defining the sudden infant death syndrome (SIDS): deliberations of an expert panel convened by
the National Institute of Child Health and Human Development. Pediatric Pathology, 11, 677-684.