PReCePT2: Reducing brain injury through improving uptake of magnesium sulphate in preterm deliveries University Hospitals Bristol and Weston NHS Foundation Trust

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Led by University Hospitals Bristol and Weston NHS Foundation Trust, in partnership with NIHR ARC West, West of England AHSN and People in Health West of England.
Scaled up a successful quality improvement package to 40 maternity units across the UK.
PReCePT2 aims to increase uptake of magnesium sulphate to protect babies’ brains during premature births.
Project ran from December 2018 to December 2020.

Premature birth is the leading cause of brain injury and cerebral palsy in babies. Evidence shows that babies can be protected from brain injury by giving women who are at risk of having a premature delivery magnesium sulphate. This reduces the risk of cerebral palsy in a third of cases. Despite this, more than half of premature babies in the UK do not receive this highly cost-effective treatment (approximately £1 per dose).

To increase uptake, a quality improvement package, PReCePT1, was designed to increase awareness and knowledge about use of magnesium sulphate as a treatment during premature delivery. It provided practical tools and training to staff in acute clinical settings, and quality improvement training at learning events. PReCePT1 was successfully implemented in five maternity units in the West of England. The proportion of women at these units receiving magnesium sulphate increased from an average of 21% before the intervention to around 88% after the intervention.

This Scaling Up Improvement project, PReCePT2, was a research trial in 40 maternity units across England. The trial was embedded in a national roll-out of PReCePT across all maternity units in England. The trial assessed which is the best method of implementation to improve and sustain magnesium sulphate uptake in maternity units, by comparing two different quality improvement approaches: a fully supported model with dedicated quality improvement coaching, versus a self-engaged, national-level implementation with less support.

The trial ran until December 2019 and the follow-up period ended in June 2020. Results of the trial’s primary and secondary outcome measures will be published at the conclusion of the trial evaluation period (May 2021). The evaluation will make use of primary and secondary data sources and will cover three aspects: effectiveness, implementation (process) and cost-effectiveness.