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INFANTS 0- 12 MONTHS OF AGE Safe Sleep at ACH. Objectives Upon completion staff will be able to:  Define SIDS.  List the critical SIDS risk reduction.

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Presentation on theme: "INFANTS 0- 12 MONTHS OF AGE Safe Sleep at ACH. Objectives Upon completion staff will be able to:  Define SIDS.  List the critical SIDS risk reduction."— Presentation transcript:

1 INFANTS MONTHS OF AGE Safe Sleep at ACH

2 Objectives Upon completion staff will be able to:  Define SIDS.  List the critical SIDS risk reduction messages for parents and caregivers.  Describe their key role as educators to parents and caregivers about SIDS.  Demonstrate how to document Safe Sleep Environment assessment and education

3 SIDS: What is it?? The leading cause of death in infants from one month to one year of age. A sudden and silent disorder that can happen to a healthy infant. A death often associated with sleep and little or no signs of suffering. Determined only after an autopsy and a thorough death scene investigation. A diagnosis of exclusion.

4 SIDS: What is it??? Expanding recognition of complex nature of SIDS risk  The baby’s vulnerability is undetected;  The infant is in a critical developmental period that can temporarily destabilize his or her systems; and  The infant is exposed to one or more outside stressors that he or she cannot overcome because of the fist two factors.

5 Infant Mortality by Country Despite being a “developed” nation, the United States still has a high infant mortality rate as compared with other countries.

6 How Does Arkansas Compare??? As you can see, Arkansas’ infant mortality rate is higher than the national average

7 Infant Mortality Rate by County

8 What is being done to prevent SIDS?? 1992  the American Academy of Pediatrics (AAP) recommends that all healthy infants younger than 1 year age be placed to sleep on their backs or sides to reduce SIDS  “Back to Sleep” campaign launched  AAP recommends that infants be placed “wholly” on their backs, the position associated with the lowest SIDS risk. October 2011  AAP Policy Statement shifts “safe sleep” focus to include sleep position AND environment

9 2011 AAP Recommendations Supine with Head of Bed flat Environment  Firm surface  Fitted sheet  No loose blankets/bedding  No toys/stuffed animals  No positioners No Bed Sharing/Co-sleeping No tight swaddling  Baby should be able to move legs while swaddled

10 Supine (on their back) ALWAYS place the baby on his/her back to sleep for naps and at night. Supine does not increase risk of choking, even in infants with Gastroesophageal Reflux (GER) (except in very rare anatomic abnormalities) Elevating head of crib is not recommended (does not help GER and infant can slide down in crib) Side and prone(stomach) sleeping is not safe and is not advised  Once the infant can roll themselves if they roll onto their side or prone you DO NOT need to reposition them.

11 How sleep position effects the airway

12 Safe Sleep Environment Firm sleep surface that is covered by a snug fitted sheet. No pillows, soft items (stuffed animals), or loose bedding/blankets in crib Do not use bumper pads If mobiles are used, hang them out of baby’s reach and remove them once baby can sit up. Do not use sitting devices (car seat, bouncy chair, etc.) for sleep. Sleep positioners are not safe or recommended

13 Room Share – Don’t Bed Share Bed sharing/co-sleeping  Keep the baby’s sleep area close to but separate from where parents and others sleep. Dangers of bed sharing/co-sleeping include:  Suffocation  Falls  Entrapment/Strangulation Refer to the Bed Sharing Policy in Policy Box!!!

14 Other Interventions to Reduce the Risk of SIDS Breastfeeding  Avoiding smoking, alcohol, illicit drug use during and after pregnancy  **Smokers should consider changing their clothing before handling the infant. Using a clean dry pacifier when placing the baby down to sleep. Not letting the baby overheat during sleep. Do not rely on home monitors and other products that claim to reduce the risk of SIDS.

15 Swaddling Tight swaddling can put baby at risk for developmental dysplasia of the hip.  Babies should be able to move legs and hips when swaddled. Also consider usage of a wearable swaddle blanket.  Halo swaddle blankets are utilized in ITU and NICU. May see usage hospital-wide in the future.

16 Tummy Time!!!! Provide Tummy Time when the baby is awake and supervised to reduce the chance of flat spots developing on the infant’s head.

17 How do YOU make a difference??? Hospital Staff can help parents by:  providing education  identifying resources  demonstrating desired behaviors Model safe behaviors  Parents who see their baby supine are nearly twice as likely to continue the practice at home Reinforce safe sleep messages for parents, medical professionals, and other caregivers

18 How do YOU make a difference??? Parent/Caregiver/Family Education about the SIDS risk reduction recommendations is vitally important. Teach them to teach others.  About 1 in 5 infant SIDS deaths occur while an infant is in the care of someone else.  Parents should teach child care providers, grandparents, babysitters, and everyone who cares for the baby!

19 Changes to ACH Some patients may not be able to have all components of Safe Sleep in place secondary to their medical condition. complete It is important that nursing judgment is utilized and that patients transition to a complete Safe Sleep environment before discharge. Don’t forget to refer to the Infant Positioning Policy in Policy Box!!

20 Changes to ACH This is a list of conditions that may have portions of Safe Sleep than cannot be implemented. Exclusion CriteriaPiece of Safe Sleep Excluded From When to Transition to Safe Sleep Respiratory DistressHOB flat; positioning supine Patient no longer experiencing respiratory distress Spinal cord DefectsPositioning supine Wt < 1500g or Post Conceptual < 32All componentsReady for open crib Patient being Ventilated (intubated) HOB flat; positioning aids; blankets for positioning Extubated and no longer in respiratory distress Head Injury; Increased Intracranial Pressure; neuro defects HOB flat; positioning aids; possible need for blankets Out of acute phase; may still need help with positioning Post-op Cardiac PatientsHOB flat; positioning devices Extubated and/or move to East (step- down) if not defect dependent Trauma, Congenital Abnormalities, and other Dependent on diagnosis and patient condition Dependent on diagnosis and patient condition.

21 Education for Parents/Caregivers, and Families Education for Parents and Families  Handout  Located as an addendum to the Infant Positioning Policy Available in English and Spanish  Video  Link on the Team ACH Page Link under “Training and Education Videos”  Also available on CareHub

22 Documentation of Safe Sleep Safe Sleep Environment Assessment  Completed every shift  Clocks will populate at the beginning of each shift for documentation to occur  Will auto populate on all patients 0-12 months of age  Can also be added to the worklist as “Safe Sleep”.

23 Document “yes” if all components listed are in place. This portion will “grey out”. No other documentation needed. Hit “Save” and you are finished.

24 If portions of Safe Sleep are not in place, document “No”. If “No” is documented, the Components not in place/Exclusions section must be documented on as well. Check which components are not in place. A comment can also be documented.

25 no “N/A” is to only be used when no components of Safe Sleep are in place. This will mainly be seen in the premature population. Exclusion criteria must be documented if “N/A is chosen. A comment can also be documented.

26 Documentation of Education Added to General Teaching and NICU Teaching Select “Safe Sleep Components”  Document what teaching was completed, response, and whom was instructed.

27 Acknowledgements Cribs for Kids  Hospital Initiative Toolkit  Injury Prevention Center

28 References American Academy of Pediatrics. (2011). Policy Statement SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment. Gelfer, P., Cameron, R., Masters, K., & Kennedy, K. A. (2013). Integrating “Back to Sleep” Recommendations Into Neonatal ICU Practice. Pediatrics, online March 4, 2013; DOI /peds Price, C. T. & Schwend, R. M. (2011). Improper swaddling a risk factor for developmental dysplasia of hip. AAP News, 32 (11).


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