Quality improvement interventions to increase the uptake of magnesium sulphate in preterm deliveries for the prevention of cerebral palsy (PReCePT study): a cluster randomised controlled trial

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Abstract

Objective:
Compare two Quality Improvement (QI) interventions to improve antenatal magnesium sulfate (MgSO4) uptake in preterm births for prevention of Cerebral Palsy.

Design:
Unblinded cluster randomised controlled trial.

Setting:
England, Academic Health Sciences Network, 2018.

Participants:
Maternity units with ≥10 preterm deliveries annually and MgSO4 uptake ≤70%. 40 (27 NPP, 13 enhanced support) were included (randomisation stratified by MgSO4 uptake).

Interventions:
The National PReCePT Programme (NPP) gave maternity units QI materials (clinical guidance, training), regional support, and midwife backfill funding. Enhanced support units received this plus extra backfill funding and unit-level QI coaching.

Outcome measures:
MgSO4 uptake was compared using routine data and multivariable linear regression. Net monetary benefit was estimated, based on implementation costs, lifetime quality-adjusted life-years and societal costs. Implementation process was assessed through qualitative interviews.

Results:
MgSO4 uptake increased in all units, with no evidence of difference between groups (0.84 percentage points lower uptake in the enhanced group, 95% CI -5.03 to 3.35). The probability of enhanced support being cost-effective was <30%. NPP midwives gave more than their funded hours to implementation. Units varied in their support needs. Enhanced support units reported better understanding, engagement, and perinatal teamwork.

Conclusion:
PReCePT improved MgSO4 uptake in all maternity units. Enhanced support did not further improve uptake but may improve teamwork, and more accurately represented the time needed for implementation. Targeted enhanced support, sustainability of improvements and the possible indirect benefits of stronger teamwork associated with enhanced support should be explored further.
Original languageEnglish
Pages (from-to)256-266
Number of pages11
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume131
Issue number3
Early online date10 Sept 2023
DOIs
Publication statusPublished - 12 Jan 2024

Bibliographical note

Funding Information:
KL, BO and JD conceptualised the trial; KL and BO led the funding application to the Health Foundation supported by JD; KL is Chief Investigator and BO is Co‐Chief Investigator. TP, MTR, SR, WH and HM led the design and analysis plan. ET advised on methodology. PC and EMH were trial managers. HE, MTR, RM, CSR and PC acquired NNRD and questionnaire data. HE, MTR and RM conducted the effectiveness analysis. CSR, HM and WH conducted the cost‐effectiveness analysis. CPM, TS and SR conducted qualitative data collection and analysis. HE, MTR, CSR, CPM and RM wrote the original article and contributed equally to the work. All authors reviewed and edited the article and approved the submission. KL is the guarantor.

Funding Information:
Public and patient involvement for this trial built on the involvement work in the PReCePT pilot study.10 This used a co-design and co-production approach, including a partnership with BLISS, a support organisation for mothers experiencing preterm births, and two mothers who had experienced preterm births, Elly Salisbury and Monica Bridge, who were involved in trial design and delivery (at the learning events) and were part of the Trial Steering Committee. Their input was invaluable in ensuring that the project, interpretation/communication of findings and considerations of next steps remained centred on the ultimate aim of improving care for mothers and babies. We also acknowledge: The Health Foundation and the West of England Academic Health Science Network, in particular Natasha Swinscoe and Ellie Wetz, for their support and guidance; the AHSN Network, in particular Gary Ford, for leadership and guidance; Anna Burhouse, for her continued input and inspiration; QI Coaches Noshin Menzies, Vardeep Deogan and Hannah Bailey; Jo Bangoura for producing the PReCePT QI toolkit; and all local champions who were instrumental in applying the QI training from learning events to their local perinatal teams.

Publisher Copyright:
© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.

Structured keywords

  • HEHP@Bristol
  • NIHR ARC West

Keywords

  • Obstetrics
  • Midwifery
  • Pregnancy
  • Infant
  • Premature
  • Extremely Premature
  • Cerebral Palsy
  • Magnesium Sulfate
  • Quality Improvement
  • Randomized Controlled Trials

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