P3.K217: Beyond Bedtime Stories: The Power of Books in Promoting Safe Sleep

Purpose/Objectives: Sleep-related causes of death, including Sudden Infant Death Syndrome and Accidental Suffocation & Strangulation in Bed, represent a leading cause of infant mortality. As such, safe sleep is an essential topic for anticipatory guidance during clinic visits over the first year of life. In a pediatric resident clinic, limitations to providing high-quality counseling on safe sleep practices (SSPs) may include resident physician knowledge base or discomfort with leading discussion. Our project aimed to increase resident knowledge of SSPs while also providing a mechanism to encourage consistent, comfortable discussion of SSPs at each newborn visit in a pediatric resident primary care clinic.

Design/Methods: We obtained a supply of Sleep Baby, Safe and Snug books through a grant from Charlie’s Kids Foundation. Books were given (1 per patient) to facilitate anticipatory guidance during infant visits with emphasis on the newborn visit. A pre-intervention and 6 month follow-up survey were created to assess change in resident knowledge, anticipatory guidance practices and perception of whether giving the book made an impact on safe sleep counseling interactions. The project was introduced to residents at a dedicated morning report where we also reviewed SSPs as recommended by the American Academy of Pediatrics. We continued to promote the project in clinic, and reminders were built into clinic note templates.

Results: Our pre-intervention survey (n=18) demonstrated that 72% of residents knew the ABCs of safe sleep (alone, back, crib) and 81% discussed safe sleep in ≥75% of newborn visits (2 respondents indicated they had not yet seen a newborn in clinic); these percentages increased to 100% and 96% of residents respectively on our follow-up survey approximately 6 months later (n=24) with one resident indicating they had not yet seen a newborn in clinic at that time. Additionally, 88% of residents indicated they were much more or slightly more likely to discuss safe sleep since starting the project, and 52% of those identified themselves as upper-level residents. Residents provided narrative comments illustrating how giving the book provides a “helpful reminder” and offers a “great way to start the conversations.”

Conclusion/Discussion: This QI project indicates that educational baby books such as Sleep Baby, Safe and Snug are a beneficial augmentation to anticipatory guidance counseling in a pediatric resident primary care clinic. The tangible book served as a conversation starter and encouraged more consistent safe sleep counseling. While more robust data are required to further elucidate the effects of book-facilitated safe sleep counseling on resident practice and how that practice translates into caregiver perception and SSPs in the home environment, this low-cost, low-risk intervention was easily implemented with an overall positive response from pediatric resident participants.