The perinatal care bundle has been developed in collaboration between University Hospitals Bristol NHS Foundation Trust (UHB) and Great Western Hospitals NHS Foundation Trust (GWH).
It follows the merger of two Evidence Into Practice applications, both focused on managing the risk of brain injury and death in preterm babies. The programme aims to roll-out the perinatal care bundle to all eligible maternity units in the West of England that care for women in preterm labour to administer the bundle.
An evidence-based, preterm neuroprotection care bundle has the potential to reduce severe preterm brain injury and death. We developed PReCePT (Prevention of Cerebral Palsy in PreTerm Labour), into a programme, now being rolled out nationally, that is reducing Cerebral Palsy cases due to pre-term brain injury. This project will build on that work and aim to tackle a wider range of causes of infant mortality and brain injury in preterm babies.
New born brain injury is highlighted in the NHS Long Term Plan, with targetted reductions of 25% by 2020, and 50% by 2025. Currently the NHS is not on track to meet these targets. So far a large amount of work has focused only on term babies. This initiative is aimed at reducing mortality for preterm babies by increasing the number of very preterm babies who survive free of severe brain injury and will contribute to meeting the Long Term Plan targets.
The proposed bundle consists of a number of elements, all of which have an evidence base showing improvements in infant mortality and brain injury rates. Some of elements are currently common practice, for instance the administration of Magnesium Sulphate under PReCePT, but there is variability in uptake of other elements across the region.
All maternity units across the West of England will collaborate to co-design, co-produce, implement and adopt the bundle, with the aim to reduce variability in outcomes for babies delivered below 32 weeks gestation. This project will build on the lessons of PReCePT and take a quaity improvement approach. This will upskill unit teams to design effective and innovative interventions and foster culture change around preterm bith.
The work carried across the West of England on the perinatal care bundle will inform future perinatal quality improvement and will form a basis for roll out at scale.
All maternity units across the West of England will be supported to optimise compliance with the complete bundle for all eligible mothers who deliver their babies at less than 32 weeks gestation to 70% or more by October 2020.
Each intervention will be monitored individually with more specific targets (e.g. antenatal steroids – 90% compliance), allowing units to celebrate successes even before reaching the overall compliance target.