Table 1.

Local PReCePT PDSA cycles

Theme	What situation was observed?	What change was tested?	Was this change successful, and was it evidenced?
Awareness raising and promotion	Midwives on the unit were not routinely aware of which mothers were eligible for the intervention.	A set of stickers depicting the project logo were developed and attached to relevant sets of notes on admission.	Each mother with the sticker on the notes received the intervention. It also had the unintended consequence of making notes easier to find for the purpose of continually monitoring uptake and providing performance feedback to unit staff.
Awareness raising and promotion	Based on previous experience on the unit, it was known that simple and accessible protocols aided uptake of new practice and promoted consistency in administration.	The lead midwife asked the intended audience what they would find helpful as an aide memoire. As a result, credit card-sized cards depicting the clinical protocol were designed to be attached to identification lanyards already worn by clinical staff.	During project implementation, staff were observed referring to the cards on a daily basis. When the test batch was depleted, unit staff requested additional stock and suggested amendments and improvements for subsequent iterations. This was the most successful of all the materials in promoting awareness among staff in this unit.
Awareness raising and promotion	The original PReCePT patient leaflets were tested and found to be suitable for those women who were expected to encounter a preterm birth and could be given them in advance. However, the leaflets were found to be too long for use by mothers in a stressful emergency premature labour.	The unit lead developed an A5 leaflet containing just the key points for mothers in emergency labour.	Direct feedback from patients in this unit was not evaluated in real time, as the leaflet was used at a highly stressful moment in labour. However, unit staff requested more leaflets when the initial stock was depleted, indicating the countermeasure was valued by staff through use and feedback from women after birthsaid they had valued it.
Equipment and environment	The clinical supplies needed to support administration were stored in separate locations and required additional time to collate in a time-critical situation.	A brightly coloured and clearly marked ‘PReCePT’ box was created containing all necessary materials and stored in a prominent position behind the nurses’ station.	Unit staff were observed to use the box and request that other staff do so when admitting patients. Also, unit staff commented directly to the project lead on its ease of use and visibility.
Training and knowledge mobilisation	Difficulties were noted in accessing some staff groups for training either due to time constraints or because of rostering conflicts (particularly night staff).	The training presentation was sent out to staff by email, with the request for automatic confirmation of the email being opened and understood by the recipient being included.	Numbers of staff opening the email was tracked, with 52 staff members in a single unit using the automated response function. Furthermore, the unit’s project lead did not note any variation in uptake between day and night shifts. In another unit the research midwife spent several night shifts educating staff through a ’micro-training' approach.
Training and knowledge mobilisation	Difficulties were noted in accessing some staff groups for training through traditional mechanisms (such as large scale training sessions).	The project midwife adapted the first iteration of the training presentation to suit a 7-inch tablet screen. This was then used to support opportunistic ‘micro training’ sessions (with as few as a single participant) that could be completed to suit the ebb and flow of clinical demands on the ward.	The rate of numbers trained increased following the introduction of a ‘micro training’ approach. This approach was used in addition to existing, larger scale training opportunities. It also helped to train people on night shifts, when traditional training sessions are not available.
Training and knowledge mobilisation	The numbers of staff initially targeted for phase 1 of the training was too large to be manageable within the constraints of the project.	A review of the staff group was undertaken to find those most able to influence uptake. Efforts were then directed to ensuring that these key staff received the relevant training and could cascade.	The trend of missed opportunities for giving the intervention was towards zero during the project timeframe, and there were no missed opportunities during the whole of 2015/2016 (after the conclusion of the project).

PDSA, Plan, Do, Study, Act; PReCePT, PReventing Cerebral palsy in Pre Term labour.