Date on Paper


Document Type

Doctoral Paper

Degree Name




Committee Chair

Baker, Leann

Committee Member

Knott, Kimberly

Author's Keywords

safe sleep; neonatal intensive care unit; sudden infant death syndrome; sudden unexplained infant death; premature


Significance: The American Academy of Pediatrics (AAP) recommends safe sleep practices (SSP) to reduce infant sleep-related deaths. Annually 3,500 babies die due to improper sleeping conditions, and Kentucky is among the lower-performing states for infant sleep safety. The AAP recommends initiating SSP with infants in neonatal intensive care units (NICU) and recently expanded recommendations in 2022. Presently, there is no regulation of healthcare clinician education regarding SSP or role-modeling behavior in the in-patient setting.

Purpose: This scholarly project aimed to improve knowledge and awareness of SSP by improving clinician knowledge and behavior of SSP use in NICU and improving parent education on SSP.

Methods: This Quality improvement project followed the Plan-Do-Study-Act cycle framework in a Level III NICU.

Interventions: Provision of clinician education on the AAP’s recommendations for SSP, pre/post-education assessment to evaluate NICU clinician knowledge and behavior of SSP. Implementation of a process for determining infant eligibility to initiate SSP, staff documentation of SSP initiation, and educational enhancements provided to parents.

Results: From February 2023 to April 2023, 41 NICU clinicians participated in a pre-and post-education assessment. Statistical analysis of the assessment did not indicate significance. However, assessment scores improved. Additionally, 25 chart audits were conducted to evaluate improvements in placing infants in SSP and parent receipt of education. Chart audits revealed improvement in parent education from 33% to 70% and implementing SSP from 18% to 100%.

Discussion: This initiative has shown that educating clinicians improves their knowledge and behavior surrounding SSP implementation.

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