Background

Aim

Planned Improvement

Conclusions

To improve right care for SIDS prevention in newborns ages 0-

12 months to 80% at wellness visits over a 90-day period

Results

• The project demonstrated that effective screening for SIDS riskin newborns at wellness visits can promote education andreferral for treatment in a rural clinic

• The simplicity and adaptability of using the SDMT andscreening checklist and the minimal time increase needed toimplement made this project easily sustainable, measurable,and replicable in other clinics

• Requirements for sustainability include continued team andadministrative support.

• Limitations include time and parent buy-in.• The project was significant to the Rayville community because

it promoted SIDS prevention.• Next steps include continuing to identify SIDS risk using a

checklist and engaging parents through the SDMT, addition ofthe tools to the electronic medical record, and expansion ofthe project to other clinics in northeast Louisiana

Measures

• Richland Parish has an infant mortality rate 3x that of the United States population as a whole. 3

• Nationally, SIDS is leading cause of death in newborns. 2

• In Louisiana, approximately 100 infants ages 1-12 months die from SIDS annually. 1

• Many SIDS deaths are related to unsafe sleeping environments. 4

• Best practices teach that placing infants to sleep on their backs in the same room but on a separate sleep surface helps to prevent SIDS. 1

• In an effort to address this problem a chart audit was performed identifying practice gaps at the clinic.

• Baseline data showed that only 80% of parents were placing their infants on their backs for sleep, and there was no standardization among providers on teaching safe sleep practices.

• This issue is important because although the Safe to Sleep campaign has cut SIDS rates in half since the 1990’s, SIDS remains the leading cause of death in newborns. 1

A Patient-Centered Right Care Approach to Sudden Infant Death Syndrome Prevention in a Rural ClinicCaroline Carpenter, DNP, APRN, FNP-C, Khara’ Jefferson, DNP, APRN, FNP-C, Terri Sylvestri, APRN,

FNP-C, Cecilia Weaver, APRN, FNP-C, Jessica Berry, LPN

Frontier Nursing University, Hyden, KY

RAMP Process Measure Outcome Measure

Team Engagement

# staff trained/Total # staff on

team

Mean score on Likert each week

Patient Engagement

# tools completed/ # patients qualified

for tool

Mean score on post-test

Screening # checklists/Total # visits

# high risk for SIDS/ total #

screened

Referral to Treatment

# log book entries/ total # high risk for

SIDS patients

# parents receiving call/

total # high risk for SIDS patients

Balancing Measure: Mean visit length Lessons Learned

• Factors that promoted the success of the project:• Team work, buy-in, and participation• Administrative support• SDMT that was easy to read

• Barriers to success included remembering to use the tools and log book as well as overcoming cultural beliefs

• Parents are eager to learn about ways to prevent SIDS • A screening checklist is useful in identifying high risk for SIDS

patients • Staff buy-in and participation was key to implementing

change and applying evidence based guidelines to the practice setting

Acknowledgements

1. Centers for Disease Control and Prevention, HHS. (2018). Sudden infant death syndrome. Washington, DC: Government Printing Office.

2. Murphy, S. L., Xu, J., & Kochanek, K. D. (2013). Deaths: Final report from 2010 (National Vital Statistics Report, vol. 61 no.4). Retrieved from Centers for Disease Control.

3. Plante, L. (2017). Louisiana child death review report. Retrieved from Louisiana Department of Health Office of Public Health.

4. Shapiro-Mendoza, C. K., Camperlengo, L., Ludvigsen, R., Cottengim, C., Anderson, R. N., Andrew, T., ... MacDorman, M. (2014). Classification system for the sudden unexpected infant death case registry and its application. Pediatrics, 134(1), e210-e219.

References

• Khara’ Jefferson, DNP, APRN, FNP-C my FNU faculty for her continued guidance and ongoing support

• Terri Sylvestri, APRN, FNP-C my clinic sponsor for having the confidence in me to carry out this project

• The team members at the Rayville Family Clinic for their support and active teamwork

• My family especially my husband, Lee, for always believing in me and providing encouragement

• Katherine Sandifer for her copy editing

This quality improvement project utilized four Institute for Healthcare Improvement’s plan-

do-study-act (PDSA) cycles implemented over 90-days with small rapid cycle tests of change

with revisions dictated by previous cycle findings and audit

results.

Team Engagement: Kickoff team in-service, weekly team huddles with team

engagement survey, touch point huddles, and wrap up

party

Patient Engagement: Use of shared decision making tool

(SDMT) to assist with conversations regarding SIDS risk and screening,

teach back demonstration, and video played in waiting

room

Screening: Implementation of a checklist to evaluate for SIDS risk, revised checklist,

smoking cessation handout, reinforcement of checklist

by providers

Referral: Implementation of a follow up phone call log

for high risk for SIDS newborns, revised to include all newborns,

reminder posters, gift card incentive, and follow up appointment scheduled prior to patient leaving

clinic

Screening for SIDS risk was implemented using a checklist and had a median of 100% by cycle four with an overall mean of 95% for all four cycles and supported that using a checklist is one way to identify high risk for SIDS patients. Overtime implementation of a checklist reached 100% by staff buy-in.

A median of 90% right care for SIDS at wellness visits was achieved. AIM was measured by combination of patient post-test, screening and referral to treat and reached a mean of 100% by cycle four signaling that an effective change took place.

Patient engagement outcome measure reached a median of 74% with a ten point run above the median in cycles three and four signaling an effective change. Use of a shared decision making tool helped initiate conversations about safe sleep practices between parents and providers.

Teamwork played a key role and increased through the use of a kickoff in-service, weekly meetings and a wrap-up party. Staff competency increased from a mean of 22% to 90%. Weekly team huddles were effective.