Nurse-Led Evidence-Based Sleep Program Helps Hospitals and New Mothers Keep Babies Safe

Photo © Associated Press.

Photo © Associated Press.

I can remember, when I was pregnant, reading everything I could get my hands on about every mother’s fear—sudden infant death syndrome (SIDS). My mother, who followed the norms of her time when I was born, was surprised that my son’s crib was bare—no blankets, pillows, toys, or bumpers. He wore a sleep sack and was placed on his back to sleep until he began to roll over by himself.

To add to what I learned from my preparatory reading, the nurses at the hospital I gave birth in set a standard for how to care for my newborn—explaining the abovementioned safe sleep tips, and much more. After all, nurses are probably a mom’s first stop for this information, helping new mothers navigate the choppy waters of caring for their newborns.

This month’s Cultivating Quality article, “An Evidence-Based Infant Safe Sleep Program to Reduce Sudden Unexplained Infant Deaths,” from the Hospital of the University of Pennsylvania, describes a nurse-led community program begun after two infants were lost to sleep-related deaths following discharge from the hospital’s neonatal ICU (NICU).

To develop the program, an interdisciplinary team made up of nurses, a physician, an occupational therapist, and a respiratory therapist examined the literature on sleep-related deaths and safe sleep practices, consulted with colleagues from nearby NICUs, and conducted an audit of practices related to putting infants to sleep in the NICU. Some of the initiatives implemented through the program included making sleep sacks available for mothers to take home after discharge, developing a clinical practice guideline on safe sleep, and offering safe sleep classes to expectant mothers and caregivers in the community.

The program appears to have been successful. Random unit audits showed that NICU nurses followed safe sleep practices 90% of the time after implementation, compared with 20% before the initiative.

Some of the practices listed in the article are familiar to those involved in infant care: babies should sleep on their backs in an open crib, open cribs should be level and flat, and soft materials such as blankets and stuffed toys should not be placed in the crib. Others were new to me—for example, that hats can place an infant at risk for overheating and should not be used if the infant is normothermic. To read more on this program and the full safe sleep guidelines developed, click here.

2016-11-21T13:00:48+00:00 November 18th, 2016|Nursing, patient safety, pediatrics|11 Comments
Managing editor, American Journal of Nursing


  1. Lisa-Dawn Maloney November 29, 2016 at 6:16 pm

    As I read this article, I couldn’t help but think how simple this program initiative was.. yet it more likely will save more lives than could’ve ever been imagined. It’s extremely coincidental that my eldest cousin- a new mom, and a nurse for 3+ years was telling me the main cause of infants dying in Utah right now is due to SIDS. She expressed how she attended infant care classes prior to the birth of her baby, and met many moms who were very surprised that babies were so vulnerable sleeping face-down. It’s something that I, as a future nurse, and she as a nurse are well aware of- however, many first time moms out there are shocked when they hear this news. I think it is a great idea to not only run through this information to these future parents, but to actually implement some sort of program to help it cement in their brains. The fact that this idea was nurse led is amazing! It shows just how much nurses can make a difference as advocates for their patients and in their communities. I believe that globally, more programs are needed like this so that mothers and fathers could be properly educated on such an important issue.

  2. Melanie Espient November 29, 2016 at 5:19 pm

    As a student nurse currently taking clinical in labor and delivery and in the NICU, I have had the chance to observe these guidelines being implemented. I had the opportunity to see vaginal deliveries and how the nurses take care of newborns in the nursery and in the NICU, and the teaching nurses implement to the mother/family regarding this topic in the postpartum unit. Families are cautioned to not bring their own blankets and to not leave the newborn with toys and baby hats. Unfortunately, many parents still bring blankets and toys and leave it in the crib with the baby. Fortunately, I have seen nurse caught that and provided the necessary education. The positive side of this is that the nurses gets to see this and intervene before the baby and mother is discharged. They are also taught how to swaddle the baby to avoid suffocation and they are educated about placing the baby in the back instead of the belly. According to this blog, the Back to Sleep guidelines implementation from nurses in the NICU have been proven to be 90% effective. As the article states, Sudden Infant Death Syndrome (SIDS) is a very important topic in which many family fear and unfortunately not all know how to avoid it. I am happy to have seen nurses teach the mother and families ways to avoids SIDS and to use the blanket hospital instead of their own. They are continuously teaching the mothers to have the baby’s crib empty. This topic is important to me because I am interested in working in the NICU in the future.

  3. Dianelys Pineira November 28, 2016 at 10:28 pm

    I was intrigued by the issue on sudden infant death syndrome (SIDS) because it has been my number one fear. I have heard about a few preventative measures taken at the hospital but having a thorough education on just sudden infant death syndrome is helpful for at home purposes as well. Furthermore, having a program that increased the usage percentage by 70% is a great success in decreasing SIDS. Also, many of my family members still believe that placing infants on their tummy is the way to prevent SIDS. This program should be available globally to educate everyone because just educating the parents and professionals is not enough. We have babysitter, daycare centers, family members and etc, who should be educated on these preventative measures. Implementing this to the community will commence a standardization of safe sleep program all around.

  4. Lourdes Bazan November 28, 2016 at 9:58 am

    As a nursing student attending both pediatric and labor and delivery clinical rotations, I have been given the opportunity to experience two different neonatal intensive care unit settings. In both level II and level III NICU’s, I have seen how these new guidelines are not being implemented. I have observed how the parents of the newborns bring their own blankets and toys from home. This may be due to the fact that they are not aware of the guidelines the Back to Sleep Program wishes to implement in all NICU settings globally. Sudden unexplained infant deaths (SUID’s) can arise due to the presence of all of these materials surrounding the neonate. Placing the patient in a prone position can also lead to SUID’s according to evidence-based research. According to this nursing blog, the implementation of these evidence-based Back to Sleep guidelines have proven to be 90% effective among nurses working in NICU settings. The task of nurses working in these pediatric care settings as well as with future mothers should be to educate parents on these evidence-based guidelines in order to minimize risks and ultimately reduce the occurrence of SUID’s on a global level. Losing an infant due to a sleep-related death is every mother’s worst fear, as stated in the article, and the proper teaching should be implemented. Nurses are the health professionals primarily by the infants’ side in the hospital setting and it is essential for them to be aware of new evidence-based research to ensure the highest quality form of care possible.

  5. Alexandra Cernuda November 26, 2016 at 3:02 pm

    As a student nurse interested in working in the NICU in the nearby future, it is nice to see the nursing community working to improve outcomes for these babies at risk of developing SIDS. Sudden Infant Death Syndrome is something that we student nurses are heavily cautioned about, with instructors teaching us about new guidelines such as Back-to-Sleep that help prevent such tragedies. As this blog mentions, it was not uncommon for newborns to not only be placed on their bellies for sleep, but also to have comforting items such as toys or mobiles in their cribs, which we now know to be hazardous. For this reason, I feel we as new nurses in the community have the responsibility to carry out precautions and implement programs such as this one to improve statistics and reduce mortality rates. It greatly pleased me to see that this nurse-implemented program has already helped save the lives of so many newborns, and I hope to one day be a part of a major community program such as this one to improve a large global health issue such as SIDS.

  6. Kiara Simmons November 25, 2016 at 11:16 pm

    Sudden infant death syndrome (SIDS) is a tragic phenomenon that claims the lives of many infants every year. SIDS is an unpredictable and unexplainable tragedy, however, with the right education an infant’s risk for SIDS can be reduced significantly. This is a very interesting blog that helps clarify some of the misconceptions of newborn care. Nurses from the Hospital of the University of Pennsylvania developed a safe-sleep program after they lost two infants to sleep related deaths following their discharge from the NICU. Some nursing interventions that are implemented in this program are the use of infant sleep sacks and discharge teaching for the infants’ caregivers. During my time on the post-partum unit for clinical rotation, I’ve had the privilege of attending a few discharge teaching classes. Majority of the mothers were really engaged in the discharge teaching and I could tell by their facial expressions that they gained new information from the class. Placing an infant on their back in an open crib with no blankets or stuffed animals promotes safe sleeping and reduces an infant’s risk for SIDS. It is crucial for nurses to demonstrate and educate parents about the importance of these safe sleeping practices.

  7. Dora Cawley November 25, 2016 at 6:20 pm

    The first item that caught my attention in this article was the fact that, the discharge nurse was giving information on sleep education to caregivers, approximately three days before patient was being discharged from the NICU. Given the fact that they were handouts, the caregivers would have a chance to read, and ask any questions. The caregivers were held responsible when they signed that they had received “safe sleep education”. That didn’t necessarily mean they understood everything. Standardizing the “safe sleep” message by having the caregivers watch a short video, showing ways to reduce the risk of sudden unexplained infant deaths (SUIDs), helps to reiterate the spoken and written education information given to them. Even though this information may still be given to the caregivers 72 hours prior to discharge, the NICU nurses are now accountable to sign, and date when they received the signed documents, and to assess caregivers as they practice placing their infant in the crib, and provide caregiver or family member, with real time feedback.I have floated to our NICU area. It is not my favorite place to be, and, just the opposite of what I have read in this article is practiced.

  8. Karina Elizondo Haft November 23, 2016 at 11:30 am

    With initiatives such as those from the article, it is no wonder why Philadelphia is a hub of nation’s pediatric healthcare standards. By identifying modifiable risk factors and creating new clinical practice guidelines that save lives is how nurses can go beyond the bedside and help countless patients globally. Sudden unexplained infant deaths (SUIDs) is a global issue and the guidelines outlined in, An Evidence-Based Infant Safe Sleep Program to Reduce Sudden Unexplained Infant Deaths, can help ensure NICU patients globally continue to improve after discharge. This term as a nursing student I have spent a lot of time in level III NICUs and see how these new guidelines are not being implemented. Patient’s parents may feel the environment is sterile and compensate by adorning the cribs with plush blankets and toys. Changing the unit’s culture and changing parents’ cultures requires thorough education and an understanding of why the changes must be made in order for nurses and parents to accept and implement the new practice changes. I admire the nurses and healthcare team that sought out find a way to reduce SUIDs and are proving that the new guidelines can positively impact the lives of so many. I hope to find these guidelines and classes quickly make their way down to South Florida NICUs.

  9. Vianney R November 22, 2016 at 11:44 pm

    This is a huge change for many nurses that work with infants especially in the NICU. The hospital I currently work at is implementing Back to Sleep initiative. In the last couple of months children arrived to our ER because of SUID’s therefore we saw the necessity for this initiative. Parents and family members do mimic what they see being done in the hospital. We use to allow toys, extra blankets, placing the babies prone and even covering the cribs with blankets. This has now come to a complete halt. We educate parents on placing their child on their backs on a flat surface with no barriers or toys and why this is done for their children safety. We now follow the Back to Sleep initiative based on research done for safe infant sleeping.

  10. Vina Travero November 22, 2016 at 5:28 pm

    I really liked reading this blog post because the subject addresses what every new mother fears the most. Sudden infant death syndrome is a scary phenomenon that no mother should ever go through. This blog talks about a nurse-led evidence based sleep program to try to prevent sudden infant death syndrome. This program is created from the Hospital of the University of Pennsylvania and was started when the hospital’s NICU lost two babies from sleep-related disorders. Some of the initiatives in this program includes giving away sleep sacks for mothers to take home, creating a clinical practice guideline on safe sleep and offering safe sleep classes to mothers and caregivers in the community. There were also some practices mentioned that were not new such as babies should sleep supine and that open cribs should be level and flat with no soft materials placed on it. After this program was implemented, there was a success rate of 90% of NICU nurses who followed the safe sleep practices. I think this program is great because as mentioned in the article, nurses are often the mom’s first stop of information when caring for their newborns. Nurses should first follow safe sleeping practices before they can teach the mother on what they should do to prevent sudden infant death syndrome.

  11. Monica L November 19, 2016 at 1:49 am

    As a former nursery nurse, this was a very interesting read. I completely agree with the implementation of safe sleep guidelines to be used during the hospital stay and even when infants go home with their family. I believe these guidelines, classes, and sleep sacks being provided for these infants to nurses and families can be a great prevention of accidental deaths of infants due to SIDS. I found it very interesting to learn about the use of hates for normothermic infants could put them at risk for overheating. That new fact is something I will definitely use to teach new parents of my patients.

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