PReCePT – preventing Cerebral Palsy in preterm babies

A simple £1 injection can significantly reduce the risk of cerebral palsy (CP) in pre-term babies, but before ICHP launched the PReCePT programme in north west London only 60% of eligible mothers were receiving the intervention.

Just over a year after launch this figure is being sustained at over 90%. 90 expectant mothers identified to be at risk were treated with magnesium sulphate resulting in at least three cases of CP prevented, and an estimated £2.4M saved across the NHS and unquantifiable costs to the individual and their family.

PReCePT is a national programme, launched in north west London by ICHP in October 2018, working in collaboration with six hospital sites across north west London; Chelsea and Westminster, West Middlesex, Northwick Park, Hillingdon, St Mary’s and Queen Charlotte and Chelsea.

The programme is aimed at delivering a simple injection of magnesium sulphate (MgSO4) to mothers who go into preterm labour (less than 30 week’s gestation). This injection costs just £1, and research shows that for every 37 women who receive it, one case of CP is prevented.

With a baseline of just 60% of eligible patients receiving the intervention and wide variation across units, ICHP used a centrally-coordinated locally-led approach to  build awareness, provide support and enable leadership around PReCePT. Delivery was led through a highly motivated team which included a Regional Clinical Lead and 6 Local Clinical Leads.

Other key enablers to the programme’s success included securing PReCePT as a North West London Local Maternity System (LMS) priority and Local Clinical Leads efforts to strengthen multidisciplinary team collaboration.

Our Innovation Delivery Lead Shakti Dookeran and Regional Clinical Lead Miss Mandish Dhanjal provided quality improvement coaching and training on administering magnesium sulphate to clinical leads,  who in turn trained up  wider teams. This helped to bring about a consistent approach to administering MgSO4 to eligible women across all units.After the first year of national funding, ICHP directly funded a second-year training refresher, to help maintain momentum.]

Shakti said: “As a team we have established a robust relationship.

“Local Clinical Leads share their data monthly which I centrally collate and share to drive and sustain improvement, and we meet quarterly to share learning, overcome challenges and celebrate success.”

Within three months of starting the programme our compliance increased by 23% to 88% and we achieved the national programme’s ambition of 85% which we have sustained over the lifetime of the programme. Additionally, we successfully met the stretch target of 95% in 2 quarters over the last year and our average for 2019 was 95.2%

We have continued to sustain this high uptake achieving 92% in the first quarter of the 2020 financial year, which was following the completion of the programme.

As a result, unit-led improvements included;

• Updated Prematurity guideline.
• Increased staff awareness about prompt administration of MgSO4 to reduce risk of CP.
• Inclusion of MgSO4 in prematurity care bundle.
• Introduction of pre-filled MgSO4 syringes to reduce the administration time.
• Regular data presentation at the Perinatal meeting.

Every case of Cerebral Palsy is estimated to cost the NHS £800,000 over the patient’s lifetime. Since the launch of PReCePT in north west London data suggests that we have prevented two babies being born with CP, saving the NHS £1.6 million.