Summary
Every year around 4,000 women in the UK give birth very early because of complications with their pregnancy. Being born too early is the leading cause of cerebral palsy, which has a lifelong impact on children and families.
Magnesium sulphate (MgSO4) given during preterm labour reduces the relative risk of cerebral palsy in very preterm infants by 30% and costs from just £1 a dose. For every 37 women given MgSO4, one case of cerebral palsy is avoided.
"
Cormac’s just turned 5 and he is an amazing little boy and has no signs of Cerebal Palsy at all. I truly believe that the magnesium sulphate was part of that. I feel incredibly lucky to have been given magnesium sulphate at that time.
"
Elly Salisbury, mother to Cormac
What the project involved
The Prevention of Cerebral Palsy in PreTerm Labour (PReCePT) programme was developed by the West of England AHSN in collaboration with University Hospitals Bristol and Weston NHS Foundation Trust and involved both patients and staff.
Selected as an AHSN Network national programme from April 2018 to March 2020, AHSNs worked with maternity hospitals in England to make MgSO4 available to mothers who go into labour at less than 30 weeks. It was the first ever perinatal quality improvement (QI) programme delivered at scale across the whole country, bringing together midwives, obstetricians, and neonatologists.
This work mobilised the 15 AHSNs and the aligned drivers of the Maternal and Neonatal Health Safety Collaborative (MNHSC) and the national Patient Safety Collaboratives (PSCs) to support the aim of achieving 85% uptake of administration of MgSO4 to preterm babies in all maternity units in England.
At the end of the AHSN Network national programme all 152 maternity units in England had adopted PReCePT; the programme aim of 85% uptake had been achieved and variation in administration significantly reduced.
Adoption and spread or improvement methodology
The PReCePT programme took a network approach, delivering it through the 15 AHSNs.
The IHI model for improvement was used, which is based on three core questions and the Plan-Do-Study-Act cycle to test and accelerate improvement.
Co-designed with a range of stakeholders, a quality improvement (QI) toolkit and support materials were provided as well as practical tools and training.
These included toolkits, implementation guides and dashboards in addition to clinical role descriptions, training presentations and promotional collateral.
Midwife champions were funded to deliver PReCePT in each maternity unit and regional clinical leads were employed to support the delivery of the programme across each AHSN geographical area.
Outcomes
Over the course of the programme an estimated 48 cases of cerebral palsy were avoided as a result of PReCePT, saving an estimated £38.4 million in lifetime health and social care costs (figures from 2018-2021).
Next steps
This innovation has been sustained through the Patient Safety Collaboratives Maternity and neonatal Safety Improvement programme. This programme ‘optimisation of the preterm infant’ includes magnesium sulphate as one of seven bundle elements and has been adopted by 100% of trusts across England with an 85% uptake across all units.
