Evaluating an enhanced quality improvement intervention in maternity units: PReCePT trial protocol

BMJ Open Quality

article

Hannah Edwards¹  Maria Theresa Redaniel¹  Brent Opmeer¹  Tim Peters²  Ruta Margelyte¹  Carlos Sillero Rejon¹  William Hollingworth¹  Pippa Craggs³  Elizabeth Hill¹  Sabi Redwood¹  Jenny Donovan²  Karen Luyt⁴ 

[1] Applied Research Collaboration West ,(NIHR ARC West) , National Institute for Health Research;Population Health Sciences , University of Bristol;Research and Innovation , University Hospitals Bristol and Weston NHS Foundation Trust;Translational Health Sciences , University of Bristol;Neonatology , University Hospitals Bristol and Weston NHS Foundation Trust

关键词: obstetrics and gynecology;    cerebral palsy;    cluster trials;    maternal health services;    quality improvement;   

DOI  :  10.1136/bmjoq-2020-001204

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

The UK’s National Institute for Health and Care Excellence Preterm labour and birth guideline recommends use of magnesium sulfate (MgSO4) in deliveries below 30 weeks’ gestation to prevent cerebral palsy and other neurological problems associated with preterm delivery. Despite national guidance, the uptake of MgSO4 administration in eligible women has been slow. National Health Service England has rolled out the PReCePT (PRevention of Cerebral Palsy in Pre-Term labour) quality improvement (QI) toolkit to increase uptake of MgSO4 in preterm deliveries. The toolkit is designed to increase maternity staff knowledge about MgSO4 and provides training and practical tools to help staff consider use in eligible women. The PReCePT trial compares the effectiveness of two different methods of implementing the QI toolkit (standard versus enhanced support). The standard support arm (control) receives the QI toolkit and regional-level support for a midwife/obstetric ‘champion’. The enhanced support arm (intervention) receives this plus additional clinical backfill funding and unit-level QI microcoaching. It is funded by The Health Foundation. This is a cluster randomised controlled trial designed to include 48 maternity units randomised (2:1 ratio) to standard or enhanced support. Units are eligible for inclusion if they have 10 or more preterm (<30 weeks’ gestation) deliveries annually and MgSO4 uptake of 70% or less. Randomisation is stratified by previous level of MgSO4 uptake. The QI intervention is implemented over 9 months. All units are followed up for a further 9 months. Blinding is not possible due to the nature of the intervention. The primary outcome is the proportion of MgSO4 uptake among eligible women at follow-up, adjusting for uptake before implementation of the toolkit. The effectiveness of the intervention will be assessed using weighted linear regression on data from the National Neonatal Research Database. Semistructured qualitative staff interviews will inform understanding of the process and outcomes. Economic evaluation will describe total costs and cost-effectiveness.Trial registration number SRCTN 40938673.obstetrics and gynecologycerebral palsycluster trialsmaternal health servicesquality improvementData availability statementAll data relevant to the study will be included in the article or uploaded as supplementary information. This article describes a trial protocol and, as such, data from trial results are not yet available.http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

【 授权许可】

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