Annual Report 2018/19
In England, pre-term birth is increasing, and due to advances in care, more babies born preterm are surviving. However, they are at a greater risk of having cerebral palsy, a condition characterised by impaired movement and coordination. The impact to the baby and their family’s quality of life are significant.
Magnesium sulphate has been demonstrated as an effective neuroprotectant for babies delivered prematurely. At the cost of just £1 per dose, antenatal administration reduces the risk of cerebral palsy by around 30 percent. However, in the UK, uptake has been significantly lower than other countries. In 2016, the National Neonatal Audit Programme reported only 43 percent of women who delivered at less than 30 weeks’ gestation were given magnesium sulphate in the UK.
PReCePT was developed in the west of England, with the Academic Health Science Network (AHSN) in collaboration local trusts, staff and patients. It is a quality improvement project, which sought to raise awareness of the evidence and improve uptake of magnesium sulphate in preterm labour, embedding it as a routine part of patient pathways, so that all women and babies would benefit.
In April 2018, PReCePT became one of the seven local ASHN programmes selected for adoption and spread across the national AHSN Network. We therefore began to adopt, adapt and build on the work of the PReCePT project to improve the uptake of magnesium sulphate in all the maternity units across south London.
We launched PReCePT in south London in two waves, starting in October 2018 in south east London and February 2019 in south west, recruiting Midwife Champions in each unit to drive uptake locally. Creating local collaboratives and using quality improvement learning, we coached the Champions to lead change and improve outcomes locally. By the end of the year, women and babies in all south London maternity units were benefiting from the programme. By April 2019, approximately 79 percent of women who delivered before 30 weeks gestation received magnesium sulphate as a neuroprotectant, significantly reducing the risk of cerebral palsy. The significant increase in the use of magnesium sulphate is estimated to have prevented at least four cases of Cerebral Palsy in south London during 2018/19.
Midwife Champions in south London
The Midwife Champions, with the backing of the local Maternity System, will ensure that this programme continues, as a result of their commitment to improving care for mothers and babies. By creating a space for all of the people involved to work together as part of a collaborative, practical support, vital information and shared experiences can inform the implementation and maximise its success. Midwife Champions are a key driving force delivering this implementation to maximise its success.