Lewisham and Greenwich NHS Trust

Increasing neuroprotection for pre-term births

Context

The Lewisham and Greenwich NHS Trust was formed in 2013 after the merger of the Lewisham Healthcare NHS Trusts and Queen Elizabeth Hospital. Its most recent CQC rating was requires improvement.

The PReCEPT programme was launched in 2014 by the West of England AHSN, following initial work in Bristol. It is a quality improvement programme that aims to reduce the incidence of cerebral palsy by encouraging administration of magnesium sulphate to eligible mothers in pre-term labour, in line with NICE guidance. The programme is now a national AHSN programme aiming to achieve administration of magnesium sulphate to 85% of eligible mothers across England by April 2020.

Approach

The national PReCEPT programme provides a number of resources to support the adoption of magnesium sulphate administration for neuroprotection, including: a quality improvement toolkit; implementation guide; training presentations; patient record proformas; management information dashboard templates; promotional materials, such as posters; magnets and leaflets; and programme staff role profiles. Typically, this is made available through each AHSN and providers can use or adapt the resources as suits them.

At the trust, the local AHSN (Health Innovation Network) funded a midwifery champion at each of the two maternity units (Queen Elizabeth Hospital and University Hospital Lewisham) for one day per week for three months. This was protected time from clinical work, enabling the champions to undertake training themselves, plan and train others in the PReCEPT process, collect data and monitor progress, as well as develop local improvements.

Training provided by the champions focused on embedding the process to administer magnesium sulphate and its benefits. The champions targeted staff on night shifts or at the beginning of new rotations. To support them, champions received training in teaching principles, how to identify and manage different personalities, and the psychology of change.

While PReCePT is a national initiative, local staff adapted it to improve outcomes. The midwives developed their own PReCEPT ‘grab box’ that contained all elements needed for magnesium sulphate administration. This was available for easy access in each delivery room.

Successes

Through participation in the PReCEPT programme the midwifery champions reported feeling more confident about leading quality improvement projects and have consequently got involved with other aspects of the trusts’ Better Births programme.

The trust achieved a 100% compliance rate within three months for magnesium sulphate administration, from a baseline of 33% (Lewisham) and 55% (Queen Elizabeth). Modelling indicates that this has the potential to prevent several hundred cases of cerebral palsy per year.

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