Improving maternity care – lessons from scaling up the PReCePT programme

Enhanced quality improvement (QI) programmes may be necessary to support the adoption of best practice in maternity units with less developed integrated working practices, a new paper published in the journal Implementation Science suggests. The research builds on an evaluation of the AHSN Network’s national PReCePT (Preventing Cerebral Palsy in Pre-Term Labour) programme, which the South West Academic Health Science Network delivered in the South West across 2018-20, and the conduct of the nested PReCePT study.

Magnesium sulphate is a low-cost medicine given to women going into early labour to protect their babies’ brains. It reduces the risk of cerebral palsy by a third.

To increase uptake of magnesium sulphate, the PReCePT programme was developed by the West of England Academic Health Science Network with University Hospitals Bristol and Weston NHS Foundation Trust. As a result of its regional impact, PReCePT was selected as an AHSN Network national adoption and spread programme from 2018 to 2020 to support maternity units in England to increase their use of magnesium sulphate for women in early labour.

PReCePT was the first ever perinatal quality improvement (QI) programme delivered at scale across the whole country, bringing together midwives, obstetricians and neonatologists. In the South West, the South West Academic Health Science Network supported the implementation of PReCePT in maternity units in seven NHS Trusts across our region.

By March 2020 all 152 maternity units in England had adopted PReCePT, significantly reducing variation in administration rates of magnesium sulphate and achieving the national target of 85% uptake. An estimated 48 cases of cerebral palsy were avoided as a result of PReCePT, saving around £38.4 million in lifetime health and social care costs.

The recent paper in Implementation Science compares the implementation outcomes from scaling up the PReCePT programme with either the standard QI package or an enhanced package, tested via the PReCePT study.

The researchers found that all units, irrespective of whether they received a standard or enhanced QI package, succeeded in restructuring their ways of working to enable them to administer magnesium sulphate.

However, sustaining the changes once resources such as the support offered through the PReCePT programme had been withdrawn, required additional implementation work.

The findings suggest that to sustain the benefits from such programmes, ‘relational restructuring’ was needed. This means that doctors and midwives had to work and communicate as a team and support each other to accommodate new workflows and facilitate the sharing of responsibilities and tasks in daily practice.

Relational restructuring was more likely to have been achieved in units receiving enhanced QI support but also happened in units with standard QI support, especially in those where perinatal team working was already well established.

These findings emphasise the importance of working beyond siloes and across teams in maternity units, chiming with the findings of the Ockenden report. Enhanced QI initiatives, modelled on PReCePT, could be one way of improving teamwork in maternity units where more multidisciplinary working is needed.

Karen Luyt, Professor of Neonatal Medicine at the University of Bristol and PReCePT clinical lead, said:

In this large national qualitative study we identified that collaborative multi-professional/perinatal team working is the key factor in implementing and sustaining new maternity treatments to protect babies.

“The PReCePT enhanced QI model was effective in supporting multi-professional teams, challenged by division/weak collaboration, to sustain improved care. These findings are widely applicable to maternity units invested in improving outcomes for mothers and babies, providing an evidence base for future programmes bringing new treatments into routine clinical practice.

Read the paper published in the Journal Implementation Science here.

Learn more about the PReCePT programme on our website.

This article was originally published on the West of England AHSN website on June 28, 2023.