“For me as a clinical midwife, I’ve learnt so much stuff. It was a real steep learning curve. It was a real collaboration, certainly I couldn’t have done it on my own.”
Project midwife

Overview

PReCePTThe PReCePT initiative has so far prevented around seven cases of cerebral palsy in the West of England, representing potential lifetime healthcare savings in the region of £5 million – and substantially more when including loss of productivity and social care costs over a lifetime.

PReCePT was developed by the West of England AHSN in collaboration with University Hospitals Bristol NHS Foundation Trust, and involved both patients and staff.

This evidence-based, cost-effective project was designed to help reduce cerebral palsy in babies through the increased antenatal administration of magnesium sulphate (MgSO4) to mothers during preterm labour, costing from £1 per individual dose.

The intervention was adopted by all five maternity units in the West of England. Projection modelling indicates that since the launch of the project in August 2014, phase one of PReCePT has prevented seven cases of cerebral palsy across the region.

Between 4,000 and 5,000 babies are born before 30 weeks’ gestation in England per year and stand to benefit from full national roll-out of the PReCePT programme. Successful scaling up of PReCePT is likely to prevent several hundred cases of cerebral palsy per year, based on highest grade evidence1.

Following the successful rollout of PReCePT to all five acute trusts in the West of England in 2016, the project is now benefitting from £0.5 million in ‘Scaling Up’ funding from the Health Foundation so that implementation  of the PReCePT quality improvement (QI) intervention can be studied in a further 10 hospital trusts across England. Read more here.

Funded by NHS England, PReCePT is also one of the seven local AHSN programmes to have been selected for adoption and spread across the national AHSN Network during 2018-2020. This work will be led by the West of England AHSN. Find out more here.

This work will bring together 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 magnesium sulphate to preterm babies in all maternity units in England, with a stretch target of 95% by 2020.

1. Crowther et al. 2017; PLoS Med 14(10): e1002398 https://doi.org/10.1371/journal.pmed.1002398

Challenge/ problem identified

PReCePT.jpg 2Cerebral palsy affects approximately 2.5 in every 1,000 babies.It is estimated that the lifetime cost per patient with cerebral palsy, including health care, productivity and social costs, is in the region of €830,000 (1).

NICE (NG25), recommends administration of magnesium sulphate (MgSO4) in very preterm deliveries as a core part of maternity care to substantially reduce the risk of cerebral palsy by 30%, based on accumulating evidence in support of its brain protective potential (2).

However, the uptake of MgSO4 in the UK remains relatively low, compared with the rest of the developed world, and this problem applies nationwide (with the exception of a few well-performing maternity units). The National Neonatal Audit programmes report on 2016 data demonstrated an uptake of 43.9% for eligible babies in England (3).

Sources:

  1. Kruse M, Michelsen SI, Flachs EM, Bronnum-Hansen H, Madsen M, Uldall P. Lifetime costs of cerebral palsy. Developmental Medicine and Child Neurology. 2009;51(8):622-8.
  2. 2015 NICE Guideline 25: Preterm labour and birth. National Institute for Health and Care Excellence (Available from: https://www.nice.org.uk/Guidance/NG25)
  3. National Neonatal Audit programme (NNAP) 2017 [Available from: http://www.rcpch.ac.uk/improving-child-health/quality-improvement-and-clinicalaudit/national-neonatal-audit-programme-nn-3)

Actions taken

The West of England AHSN developed PReCePT in collaboration with University Hospitals Bristol to help reduce cerebral palsy in preterm babies by optimising administration of magnesium sulphate (MgSO4) to women in preterm labour.

Co-designed with a wide range of stakeholders, including patients, clinicians and management, PReCePT provided a supported quality improvement (QI) toolkit, information materials as well as practical tools and training to raise awareness of evidence-based practice on use of MgSO4 compliance, supporting staff to consider MgSO4 in eligible pregnancies.

Consultant neonatologist Dr Karen Luyt initially led the pilot at St Michael’s Hospital in Bristol, which demonstrated an increase in uptake: from 4% of eligible mothers in 2012 to 65% in 2013).

Between March 2014 and March 2015 with Dr Luyt as the clinical lead, the West of England AHSN coordinated the introduction and supported the adoption of PReCePT in all five maternity units (1) in the region, identifying lead midwives in each trust to champion the initiative.

PReCePT is now embedded in five NHS Trusts in the West of England, and was independently evaluated by NIHR CLAHRC West. This was published in the British Medical Journal Open Quality (2017; 6).

  1. Gloucestershire Hospitals NHS Trust, Great Western Hospitals NHS Foundation Trust, North Bristol NHS Trust, RUH Bath NHS Foundation Trust, and University Hospitals Bristol NHS Trust.

Impacts/ outcomes

PReCePT has led to improved compliance with NICE guidance, (NG25), through its publicity campaign to increase awareness about the use of magnesium sulphate (MgSO4) as a neuroprotector, developing care pathways and a range of tools to spread and embed this message.

  • 664 staff across five trusts were trained in the West of England in 12 weeks as part of the first phase of PReCePT.
  • 89 eligible women in the region were identified, in line with NICE guidance.
  • Of these, 76 women received the recommended intervention; an overall compliance of 85%. Further quantitative evaluation of the project in late 2016 indicated that uptake of the recommended intervention remained consistent at 89% across the participating units.
  • Modelling indicates that a total of 322 eligible births will have received the intervention since the start of the project. This is projected to have prevented seven cases of cerebral palsy across the West of England, representing a potential lifetime financial saving of up to £5.1 million (as of February 2017), including health care, productivity and social costs.
  • It is estimated that up to 700 low birthweight babies could benefit from this intervention each year if rolled out across England.
  • The project involved strong partnership working with five NHS Trusts and engaged a wide range of stakeholders in the co-design of information materials, including patient representatives and clinical partners. Parent engagement was key; there was significant involvement from the charity BLISS, and parent representatives were core steering group members throughout the project.

From a non-clinical perspective, I hadn’t heard that you could do anything to prevent cerebral palsy. so I came into it through the Academic Health Science Network. I just met the project lead to see if I could offer her any project support, but actually all the project materials and the collateral from the AHSN was there. I didn’t really have to do anything because it was all there. From my perspective it was evidence-based, it was a good thing to do… so now we’re just rolling it out. For me it was just a no-brainer to do”
Member of staff, maternity unit

Plans for the future

Health Foundation’s Scaling Up Improvement Programme

Following the successful rollout of PReCePT to all five acute trusts in the West of England in 2016, the project is now benefitting from £0.5 million in ‘Scaling Up’ funding from the Health Foundation so that it can be introduced to a further 10 hospital trusts in the South, North West and South West of England, Midlands, Wales and London.

University Hospitals Bristol NHS Foundation Trust is leading this project, working in partnership with NIHR CLAHRC WestPeople in Health West of England, the West of England AHSN, and the Innovation Agency – AHSN for the North West CoastRead more here.

AHSN Network’s national programme

Funded by NHS England, PReCePT is also one of the seven local AHSN programmes to have been selected for adoption and spread across the national AHSN Network during 2018-2020. This work will be led by the West of England AHSN.

This work will bring together 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 magnesium sulphate to preterm babies in all maternity units in England, with a stretch target of 95% by 2020.

Which national clinical or policy priorities does this example address?

  • NICE Guidance (NG25) Pre-term labour and birth
  • NHS England Better Births – Maternity Transformation Programme
  • NHS England’s Five Year Forward View – the triple aim of bridging the health, quality and funding gap recognising the “Quadruple Aim” of improving the experience of providing care.

Where did the innovation originate from?

  • NHS
  • Third sector

Start and end dates

  • West of England: March 2014 – March 2015 (with care pathways embedded in all participating trusts)
  • Health Foundation ‘Scaling Up’ project: April 2018 – November 2020
  • AHSN Network adoption and spread: April 2018 – March 2020

Contact for help and advice

Download PReCePT resources here.  For more information on PReCePT, email PReCePT@weahsn.net.

Media contact for further information
Vanesther Rees, Communications Manager
E: vanesther.rees@weahsn.net