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evaluation instruments

PA SafeSleep Practice
Analysis Survey

This 10-minute survey is intended to assess the providers knowledge of safe sleep tenets before the implementation of the program.  The survey may also be administered post program implementation to measure change in practices, and is available for use in online platforms or for paper use.

PA SafeSleep PRACTICE
Environment Audit Tool

This 3-minute flow sheet provides a standard method to evaluate the sleeping environment of the infant during their hospital stay after birth.

PA SafeSleep ICN/NICU audit tool

This brief tool can be used to audit for NICU compliance with safe sleep.

PA SafeSleep Medical Record
Chart Audit Tool

This tool can be used to audit medical record documentation for compliance with safe sleep tenets.

Module Evaluations

Module 1 & 2 Evaluations

These surveys are used to evaluate the learners’ perceptions related to content, format, learning process, and overall impressions of the module.  The evaluations are needed for continuing education credit.

"Evidence-Based and Best Practices for Safe Sleep with Newborns"

"Teaching Safe Sleep Practices to Mothers, Families and the Community"

Progress You Made By Completing This Module

This Likert scale survey allows the learner to evaluate their individual progress in acquiring knowledge about S.A.F.E. and the prevention of sudden unexpected infant deaths.

PA SafeSleep Program One Month Telephone OR EMAIL Follow Up
for Birth Parents

Administered at one-month post birth discharge, the follow-up call is intended to gain insight into the mother’s perception of helpfulness of the hospital teaching and use of safe sleep practices at home. 

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