Hospital Outreach and Partnerships for Educating about Infant Safe Sleep (HOPES)

The HOPES initiative addresses two significant infant mortality problems. Sudden Infant Death Syndrome (SIDS) and the growing number of accidental suffocation/strangulation infant deaths associated with the sleep environment.

Harsh realities that surround these infant deaths in North Carolina include:

• 100 infants dies of SIDS each year
• N.C. SIDS rates have stagnated and exceed the national average (0.8 per 1,000 live births and 0.5, respectively)
• Accidental infant suffocation/strangulation deaths associated with the sleep environment have dramatically increased by more than 100% over the past three years
• Practices within hospitals and different units are often inconsistent and contradictory to infant sleep safety best practices
• N.C. hospitals have varying levels of knowledge of evidence-based practices about infant safe sleep training, policies and parent education
• Key hospital staff have not received adequate training or tools to put safe sleep practices and policies in place

Purpose

Nationally, hospitals have been identified as key in the fight to reduce SIDS. Inconsistent modeling of infant sleep practices by hospital nurses for parent/parents and their families (other infant caregivers) perpetuates unsafe infant sleep practices that may be adopted.

The purpose of HOPES is to increase the capacity of hospitals to develop and institutionalize evidence-based infant safe sleep practices in newborn nurseries and neonatal intensive care units (NICUs). HOPES promotes staff training, policy development and parent education on infant safe sleep best practices in the hope that North Carolina's newborns will live to celebrate their first birthday.

HOPES builds on groundwork started by the N.C. Healthy Start Foundation and provides training and resources for hospitals wanting to assess and strengthen infant sleep policies, implement staff in-service training and/or provide quality parent education for new mothers and their families.

HOPES focuses on counties with high SIDS rates/number and/or high numbers of accidental suffocation/strangulation infant deaths. In 2005, 54 of the 100 N.C. counties reported SIDS deaths.

Objectives

• Increase the number of N.C. hospitals who evaluate their in-house policies, practices and parent education with the goal of implementing (or strengthening) infant safe sleep practices and education
• Codify infant safe sleep best practice standards in written guidelines or policies
• Improve the capacity of N.C. hospitals to provide evidence-based, infant safe sleep training for well-baby nursery and/or NICU nursing staff by adapting national nursing curriculums to the needs of N.C. hospitals
• Provide training to the Foundation's two hospital advisory groups (current membership includes representation from 25 hospitals and 4 health-related associations)
• Increase patient and caregiver education on infant sleep safety provided by hospital nursing staff by offering educational materials
• Increase education and outreach in the African American community by offering and providing training to nurses who are members of the African American community and who also practice at area hospitals, health departments and clinics

HOPES strengthens the N. C. Back to Sleep Campaign's efforts to address the disparity among African American families/communities disproportionately affected by SIDS/ It expands existing partnerships with medical organizations like the Central North Carolina Black Nurses Council, Chi Eti Phi and African American nursing sorority, the Old North State Medical Society (a N.C. African American Medical Society) and the N.C. Pediatric Society.

Hospital Advisory Group Meetings

Outreach to hospitals in 2006-2007 was achieved through two regional Hospital Advisory Group meetings and through the provision of in-service education. A curricula developed by the National Institutes of Child Health and Human Development was adapted to N.C. and piloted with NICU nurses at two hospitals and to 50 nurses at the regional Perinatal Health Conference sponsored by Eastern Carolina University, School of Medicine's Area Health Education Center (AHEC).

The Hospital Advisory Group Meetings (December 2006 and January 2007) shed light on current hospital practices and awareness of the American Academy of Pediatrics 2005 SIDS risk reduction and infant sleep-related safety recommendations. Participants identified resources and potential partners to continue the initiative. Interest, suggested "next steps" for involvement and identified needs needs include:

• Staff training
• Parent/patient education
• Technical assistance in developing standardized materials
• Requests for sample model policies
• Initiate an achievable plan of action
• Promote information sharing including lessons learned and strategies

Advisory Meeting Attendee Profile

• 47 participants from 25 hospitals representing urban and rural locations, teaching and community hospitals and administrators, physicians, nursing supervisors and nursing staff from Neonatal Intensive Care Units (NICU) and well-baby nurseries
• 4 professional associations: the N.C. Association of Women, Obstetric and Neonatal Nurses; the N.C. Pediatric Society, the Central North Carolina Black Nurses Association and the Area Health Education Center for Region lll - southwestern N.C.
• 16 counties with high SIDS rates and/or high numbers of accidental infant suffocation and strangulation deaths

Call to Action

Participants completed a Call to Action worksheet and listed ways to voluntarily promote and engage in infant safe sleep education and practices in their hospitals or professional associations. Responses included:

• Help facilitate staff in-service education
• Develop or strengthen staff, patient or membership education efforts
• Serve on a Hospital Advisory Group
• Occasionally review educational materials being developed
• Facilitate discussions with hospital or association
• Assist with a staff or membership survey or needs assessment
• Pilot a hospital initiative with staff training, safe sleep policy development and parent education
• Focus on Latino outreach, develop or strengthen Latino staff, patient or membership education efforts on infant safe sleep and SIDS

Recipe for Successful Hospital Outreach on Infant Safe Sleep

Convening the two Hospital Advisory Group meetings was strategically orchestrated in order to recruit key gatekeepers, engage expertise on SIDS and accidental asphyxiation infant deaths and involve SIDS parents who could speak to the tragedy of SIDS.

The following "recipe" lists essential ingredients that may aid in your program's successful hospital outreach.

Prepare 2-4 months ahead of time.

• Arrange logistics. Assemble necessary ingredients
  • Do not start from scratch but tap into existing partnerships. These partners can help identify key contacts and assist with regional logistics.
  • Locate list of hospitals with well-baby nursery and/or Neonatal Intensive Care Unit (NICU). Begin telephone calls and assemble resource list of invitees.
• Recruit speakers
  • Include 1 death scene investigator/researcher from the Office of the Chief Medical Examiner who knows the SIDS and accidental suffocation/strangulation infant death cases intimately.
  • Stir in 1 SIDS Program/Campaign manager who will add one pinch of your own state's epidemiological SIDS trends and place the data in context by stirring in a dash of national trends.
  • Add 2-3 SIDS parents of different backgrounds to share their stories. Consult with the SIDS parents ahead. Ask them to be prepared to tell healthcare professionals what they wished they had known and how the healthcare folks can educate parents and caregivers now.
    Set aside until the meeting, but check-in periodically. Offer assistance, as needed.
• Recruit Hospital Advisory participants
  • Select low-hanging fruit such as representatives from counties with the highest SIDS rates and/or accidental asphyxiation infant deaths associated with sleeping.
  • Explain why their county has been selected to participate.
  • Be prepared to provide infant death date by county.
  • For good measure, inform them about these infant deaths in other counties their hospital system serves.
• Optional, but recommended - be informed of media coverage about recent SIDS and/or accidental asphyxiation infant deaths in communities. Interest and participation from these counties is likely to be high.
  Set aside until the meeting, but continue to stir in keystakeholders and follow-up on leads.
  

On meeting day combine all ingredients.

Convene regional meetings. Travel to your partners.

• In a comfortable, well-lit and easily accessible room mix together representatives from large medical systems, teaching hospitals, smaller rural hospitals, you local pediatric society, 3-4 professional nurses associations and child fatality prevention review teams.
• Blend in compelling presentations by presenters.
• Check temperature.
• Allow 1.5 to 2 hours for facilitated discussion.
• Serve additional state and national resources.
• Dish out Q&A response sheets and a Call to Action interest survey.
• Gauge participant's willingness to participate in an advisory capacity in the coming months/year and identify specific skills they can contribute.

For more information contact
Marta Pirzadeh
NC Healthy Start Foundation

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Last updated: January 2008