NICE guidelines recommend that the neuroprotector magnesium sulphate should be given prenatally to women at risk of preterm birth, and there is clear evidence that this significantly reduces the risk of cerebral palsy and other disabilities in pre-term deliveries. Administering magnesium sulphate is clinically effective and cost-effective, yet uptake in UK maternity units remains relatively low and highly variable. CLAHRC West evaluated a quality improvement (QI) intervention PreCePT (Prevention of Cerebral Palsy in Pre-Term Labour) developed by the West of England Academic Health Science Network (WEAHSN) to increase the uptake of magnesium sulphate in five local maternity units. Evaluation results showed that PreCePT improved uptake overall, with indications of sustained use in some centres.
WEAHSN and CLAHRC West were then successful in obtaining funding through Health Foundation ‘scaling-up improvement’ stream to optimise the intervention to prepare for a national roll-out. The cluster randomized trial aimed to compare the full QI model with a ‘self-engaged’ version and controls. The aim of the intervention is to increase knowledge of and compliance with NICE guidelines on the use of magnesium sulphate, leading in turn to improved quality of care and benefits to neonatal and infant health as well as reducing costs associated with cerebral palsy and other neurological impairments.
CLAHRC West are in consultation with the Heath Foundation and the AHSN network to reconfigure the study to try to evaluate the national ‘top-down’ roll-out of the adapted QI intervention, and compare the effectiveness of this with a full, intensive QI approach
Contribution of CLAHRC West
NIHR CLAHRC West designed and led the evaluation and undertook the statistical analyses of the routinely collected data on preterm deliveries obtained via the neonatal registry. Results showed that the PreCePT QI intervention increased the uptake of magnesium sulphate. A paper has been submitted to Implementation Science. CLAHRC West and WEAHSN jointly applied to the Health Foundation ‘scaling-up improvement’ funding stream and were successful in being awarded funding for a larger and more comprehensive evaluation of two types of QI intervention. CLAHRC West staff will lead on the evaluation.
What happened next?
Just at the point when an application to the HRA for the PreCePT trial protocol was about to be submitted, the AHSN network and NHS England decided to expedite the roll-out of an adaptation of the QI intervention across the 15 AHSNs in two waves, in May and September 2018. CLAHRC West are in consultation with the Heath Foundation and the AHSN network to reconfigure the study to try to evaluate the national ‘top-down’ roll-out of the adapted QI intervention, and compare the effectiveness of this with a full, intensive QI approach. Negotiations continue.