Increasing Safe Sleep Practices in the Neonatal Intensive Care Unit

Eveline Treiber Paul, Pamela A. Harris-Haman

Research output: Contribution to journalArticlepeer-review


Background: The American Academy of Pediatrics (AAP) encourages healthcare providers to practice and model safe sleep practices (SSPs) in the neonatal intensive care unit (NICU) when it is developmentally and medically appropriate for the infant. Preintervention data were collected as a baseline prior to the quality improvement (QI) initiative and revealed that 87% of eligible infants were in unsafe sleep environments (n = 331/379). This data revealed the need for an improvement project to help increase the percentage of infants placed in safe sleep in this NICU. Purpose: The purpose of this QI initiative was to increase the percentage of eligible infants being placed in safe sleep environments by registered nurses in a NICU. Methods: The development of an evidence-based safe sleep bundle was implemented in a level IV NICU at an academic medical center in the Southeastern United States. Data were subsequently collected for 5 months via bi weekly crib audits. Results: Of the 744 infants audited in the QI period, 604 were observed in a safe sleep environment. From the pre- to postintervention period, SSPs increased by 68% (preintervention: 13%, postintervention: 81%, P value <.001). Adherence to the varying components of SSPs also reflected statistically significant improvements. Implications for Practice: SSPs should be endorsed and modeled in all NICUs. Introducing proper SSPs in the hospital setting may lead to better compliance at home by the infants' caregivers.

Original languageEnglish (US)
Pages (from-to)384-390
Number of pages7
JournalAdvances in Neonatal Care
Issue number5
StatePublished - Oct 1 2022
Externally publishedYes


  • neonatal intensive care unit (NICU)
  • premature infant
  • quality improvement (QI)
  • safe sleep practices (SSPs)
  • sudden infant death syndrome (SIDS)

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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