Improving maternity care – lessons from scaling up the PReCePT programme

Enhanced Quality Improvement (QI) programmes may be necessary to support the adoption of best practice in maternity units with less developed integrated working practices, a new paper published in the journal Implementation Science suggests. The research builds on ARC West’s evaluation of the PReCePT programme and the conduct of the nested PReCePT study.

Magnesium sulfate is a low-cost medicine given to women going into early labour to protect their babies’ brains. It reduces the risk of cerebral palsy by a third.

The national PReCePT programme supported maternity units in England to increase their use of magnesium sulfate for women in early labour. The programme aimed to increase use of magnesium sulfate by 2020 to 85% of eligible mothers, with a stretch target of 95% for high-performing units.

The paper compares the implementation outcomes from scaling up the PReCePT programme with either the standard QI package or an enhanced package, tested via the PReCePT study.

The researchers found that all units, irrespective of whether they received a standard or enhanced QI package, succeeded in restructuring their ways of working to enable them to administer magnesium sulfate.

However, to sustain the changes once resources such as the support offered through the PReCePT programme had been withdrawn, required additional implementation work.

The findings suggest that to sustain the benefits from such programmes, ‘relational restructuring’ was needed. This means that doctors and midwives had to work and communicate as a team and support each other to accommodate new workflows and facilitate the sharing of responsibilities and tasks in daily practice.

Relational restructuring was more likely to have been achieved in units receiving enhanced QI support but also happened in units with standard QI support, especially in those where perinatal team working was already well established.

These findings emphasise the importance of working beyond siloes and across teams in maternity units, chiming with the findings of the Ockenden report. Enhanced QI initiatives, modelled on PReCePT, could be one way of improving teamwork in maternity units where more multidisciplinary working is needed.

Karen Luyt, Professor of Neonatal Medicine at the University of Bristol and PReCePT clinical lead, said:

“In this large national qualitative study we identified that collaborative multi-professional / perinatal team working is the key factor in implementing and sustaining new maternity treatments to protect babies.

“The PReCePT enhanced QI model was effective in supporting multi-professional teams, challenged by division/weak collaboration, to sustain improved care. These findings are widely applicable to maternity units invested in improving outcomes for mothers and babies, providing an evidence base for future programmes bringing new treatments into routine clinical practice.”