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Impact review 2020-21: maternity and neonatal

Seeing my ideas incorporated into the design and rollout of the PERIPrem bundle has been incredibly rewarding. It’s knowing that I have made a personal difference.

Leanna Wakely PERIPrem Parent Partner

The PERIPrem perinatal care bundle

370

babies cared for under PERIPrem to date

12

NHS hospital trusts working together to implement PERIPrem

19

share and learn events attended by the regional PERIPrem community

The enthusiasm of the PERIPrem Team is contagious! The support they have provided us to implement changes in practice that are essentially life changing to our premature babies has been invaluable. Proud to be part of the PERIPrem family.

Pauline Hewitt Gloucestershire Royal Hospitals NHS Foundation Trust

Launched in May 2020, PERIPrem (which stands for Perinatal Excellence to Reduce Injury in Premature Birth) is our new perinatal care bundle, co-designed with parents and clinicians, to improve the outcomes for premature babies.

Working in partnership with the South West AHSN and the South West Neonatal Operational Delivery Network, we have supported 12 hospital trusts across the region to deliver this system level improvement project.

The bundle consists of 11 perinatal interventions, such as delayed cord clamping, early breast milk and prophylactic hydrocortisone. These can have a significant impact on brain injury and mortality rates amongst babies born prematurely.

PERIPrem aims to reduce variation and optimise care by using a novel quality improvement (QI) data tool for recording trust-specific monthly outcomes, by creating a regional perinatal clinical collaborative, and by putting parent partners at the heart of the project.

While formal evaluation of the impact of PERIPrem will be published in September 2021, early findings are extremely positive. So far 370 babies in the South West have been cared for using the PERIPrem bundle.

What is perhaps most impressive about the success of the PERIPrem project to date is that it’s all been coordinated virtually, launching just weeks after national lockdown was announced last year. Read this blog on our PERIPrem journey by Senior Project Manager, Noshin Menzies to find out more.

Developed by people involved in the rollout of the project, the short animation below uses real-life examples to explain how PERIPrem works.

Find out more about PERIPrem

PReCePT – preventing cerebral palsy in preterm labour

As a mother who has gone through pregnancy and preterm birth, it is inconceivable to me that there wouldn’t be a joined up approach across the whole perinatal team. It’s any mother’s expectation that the care she receives during her pregnancy and preterm birth and the subsequent care of her baby are delivered seamlessly.

Monica Bridge Parent Partner, PReCePT

86.5%

of eligible women in England in preterm labour (30 weeks or less) received magnesium sulphate in 2020-21 – the national target is 85%

1,797

additional mothers in England received magnesium sulphate to reduce incidence of cerebral palsy in their preterm babies as a direct result of our national PReCePT programme since April 2018

48

estimated cases of cerebral palsy avoided in England as a direct result of PReCePT since April 2018

£38.4 million

estimated lifetime health and social care costs avoided in England in 2020-21 as a direct result of PReCePT since April 2018

Despite the challenges presented by Covid last year, maternity units across England have managed to sustain the incredible success of our national PReCePT programme, making a huge difference to the lives of very premature babies and their families.

The PReCePT programme supported the use of magnesium sulphate by maternity units. Costing from just £1 a dose, the use of magnesium sulphate in preterm labour reduces the risk of cerebral palsy in unborn babies by 30%.

The West of England AHSN led the national rollout of PReCePT by the AHSN Network from April 2018 to March 2020, working with all maternity hospitals in England to increasingly make magnesium sulphate available to mothers who go into labour at less than 30 weeks. It represents the first ever perinatal quality improvement (QI) programme delivered at scale across the whole country, bringing together midwives, obstetricians and neonatologists.

At the end of the two-year national programme, we were delighted to achieve our target of ensuring at least 85% of eligible women in preterm labour received magnesium sulphate.

But what is perhaps more exciting still is that the maternity and neonatal community have continued to achieve and better this target during one of the most difficult years facing the NHS.

Ellie Wetz, PReCePT Programme Manager at the West of England AHSN, explains:

“During the pandemic, we issued advice on continuing to administer magnesium sulphate where appropriate to maintain this valuable intervention. The AHSN Network has monitored use of magnesium sulphate nationally since the active phase of the programme ended. This period saw unprecedented pressures across all NHS services as they responded to Covid-19.

“This was felt particularly in our maternity and neonatal units due to staff shortages and the challenges this presented. Incredibly, these issues did not impact rates of magnesium sulphate uptake. In 2020-21, magnesium sulphate uptake was a fantastic 86.5% across England, clearly demonstrating that the PReCePT QI work undertaken in units has been fully embedded and sustained.”

Preliminary data shows that since the national programme launch in April 2018  the number of additional eligible women who received magnesium sulphate as a result of our PReCePT programme was 1,797 and the estimated number of cases of cerebral palsy avoided as a result of the programme was 48.

This equates to around £38.4 million of lifetime health and social care costs avoided (approximately £800,000 per case of cerebral palsy).

In March 2021, the PReCePT programme was a finalist in the HSJ Awards in the Workforce Initiative of the Year category. Watch our short film featuring colleagues from around the country explaining why we think PReCePT is a winner.

Read more about PReCePT

Tests to rule out pre-eclampsia in pregnant women

5

hospital trusts in the West of England using PlGF tests to rule out pre-eclampsia in pregnant women

As part of the AHSN Network’s support to the Accelerated Access Collaborative, we are driving adoption of a number of transformative technologies and medicines through the Rapid Uptake Products (RUP) programme.

This includes increasing the use of placental growth factor (PlGF) based tests. These diagnostic tests help accurately rule out pre-eclampsia quickly and assess the risk for associated, sometimes life-threatening, complications, so that pregnant women receive the most appropriate care.

All five hospital trusts in the West of England are now using PlGF based tests.

Read more about our support for Rapid Uptake Products

Maternity and Neonatal Patient Safety Network

We launched our Maternity and Neonatal Patient Safety Network with an event in March attended by members of the maternal and neonatal workforce in the West of England, including frontline doctors, midwives, nurses, support workers, as well as commissioners, and women and their families.

Our Patient Safety Network forms the structure and delivery model for our contribution to the three-year National Maternity and Neonatal Safety Improvement Programme (MatNeoSIP). This programme focusses on three key workstreams: smoke-free pregnancy; early recognition and management of deterioration of women and babies; and optimisation and stabilisation of the preterm infant, which is the vehicle through which we continue to support the PERIPrem perinatal care bundle into a sustainability phase.

Led by NHS England and Improvement, the National MatNeoSIP’s mission is to create and embed the conditions for all staff to improve the safety and outcomes of maternity and neonatal care by reducing unwarranted variation and provide a high quality healthcare experience for all women, babies and families across England.

Read more about our maternity and neonatal safety work