The PROMPT Maternity Foundation (PMF) is a non-profit charity led by a multi-professional team of clinicians, including midwives, obstetricians and anaesthetists. PROMPT stands for ‘PRactical Obstetric Multi-Professional Training’, and since its inception in 2000, the PMF team has been dedicated to researching and developing the most effective way to train maternity teams, both in the UK and internationally. PMF's aim is to facilitate improvements in care for mothers and families by managing obstetric emergencies effectively and reducing preventable harm.
Why local multi-professional training?
Poor teamworking and human factors have consistently been identified as contributary factors within avoidable harm in maternity care in the UK (Royal College of Obstetricians and Gynaecologists, 2021; Knight et al, 2023).
Research involving some of the PMF team has demonstrated that individuals make fewer errors when working in effective teams and that training within a multi-professional team can improve team working by itself. For training to be effective (ie improve outcomes for mothers and babies) it should be local, multi-professional and include teamworking that is integrated in clinical skills training (Siassakos et al, 2011; Liberati et al, 2021).
Local, multi-professional training was a key recommendation of the NHS England (2016) national maternity services review in 2016, and important national publications such as the Ockenden (2022) and Kirkup (2022) reports identify effective training as a vital contributor to improving unit culture. A government response to the Kirkup report recommended PROMPT training as an important intervention (Department of Health and Social Care, 2023).
An evidence-based approach to multi-professional training is central to PMF's work. The training programmes developed by the charity provide simple clinical algorithms that can be adapted for use locally and encourage multi-professional team management of obstetric emergencies. The training resources are designed to bring together the whole maternity team, including obstetricians, midwives, anaesthetists, maternity support workers, maternity theatre teams, paramedics and other healthcare professionals. The training focuses on hands-on scenarios that simulate real-life childbirth emergencies. Training within their own units, or other local settings, not only provides maternity teams with invaluable experience of managing obstetric emergencies but also the opportunity to test their local systems and processes in a psychologically safe environment.
Improving outcomes
The overall aim of PMF's work is to reduce adverse outcomes during childbirth. Research undertaken by PMF has shown that when PROMPT is authentically embedded and sustained, there are associated improvements in outcomes (Draycott et al, 2006; Crofts et al, 2016). In Bristol, the introduction of PROMPT led to:
- A 50% reduction in hypoxic brain injury
- A 45% reduction in school-aged cerebral palsy
- A 100% reduction in permanent brachial plexus injury
- 40% quicker delivery at emergency caesarean births.
These improvements have also been seen in diverse maternity settings, where the authentic implementation of PROMPT training has led to improved outcomes and safer births for mothers and babies around the world. PROMPT USA at the Kansas University Hospital has seen a 30% reduction in caesarean births, a 30% reduction in Apgar score <7 at 5 minutes and a 100% reduction in permanent brachial plexus injury (Weiner et al, 2014). PROMPT Victoria in Australia has seen a 15% reduction in Apgar score <7 at 1 minute and reduced length of stay for babies, as well as improvements in safety attitudes and culture (Shoushtarian et al, 2014).
Training in low and middle-income settings
Maternal mortality in low- and middle-income countries remains a significant problem, and the PMF team continues to investigate ways in which they can provide training resources free-of-charge to these areas. Funded by research grants, PMF has been able to collaborate with local teams to successfully introduce PROMPT and monitor its effect on outcomes.
PMF has been working with maternity units in Zimbabwe since 2012, supporting the introduction of local PROMPT PMF have an ethos of “making the right way, the easy way” and have always provided tools and resources that are based on national guidance, but that can be easily adapted for use locally courses. The training, which started at Mpilo Hospital in Bulawayo, has resulted in 34% reduced maternal deaths at Mpilo Hospital, and led to the roll-out of PROMPT training in further health facilities, supported by a Tropical Health and Education Trust grant (Crofts et al, 2015; PMF, 2019).
In 2015, Project Hope provided funding for PMF to deliver the PROMPT Train-the-Trainers (T3) programme to multi-professional healthcare staff from eight selected maternity units in the Philippines, with the aim of reducing postpartum haemorrhage through improvements in the quality of hospital-based maternal and child health service delivery. The project required participating teams to rapidly adapt the training resources to reflect the emergency care provided in their maternity units (Ghag et al, 2018).
PMF have an ethos of “making the right way, the easy way” and have always provided tools and resources that are based on national guidance, but that can be easily adapted for use locally
In 2019, PMF supported the introduction of PROMPT training in the Medias Municipal Hospital in Transylvania, Romania. PMF also presented them with a PROMPT Flex® manikin (Limbs and Things, 2023) for shoulder dystocia training. Following the training, the team at Medias translated and adapted the PROMPT algorithms and have produced locally relevant emergency boxes. They are also translating PROMPT's course manual to benefit all maternity staff in Romania. More recently, PMF have begun a collaboration with the Pacific Society for Reproductive Health to support the adaptation and localisation of the new PROMPT Global training resources for use across Pacific Island countries.
Funds for these projects have been supported by specific project grants and fundraising. Additionally, income generated from the sales of PROMPT packages are often directed to supporting the introduction of PROMPT training in low- and middle-income settings. The launch of the PROMPT Global training package will provide additional funding for this initiative.
Authentic PROMPT training
To achieve improvements in outcomes, it is important that PROMPT is authentically implemented within units and institutions. PMF have an ethos of ‘making the right way, the easy way’ and have always provided tools and resources that are based on national guidance, but that can be easily adapted for use locally.
Until recently, units were guided in how to adapt and implement the PROMPT materials locally, by sending a multi-professional team of staff to attend a PROMPT ‘Train-the-Trainers’ day. However, a new model for supporting implementation, called iPROMPT, has now been included in the most recent Annual Update package. iPROMPT can be run as a Train-the-Trainers day ‘in house’ in each maternity unit, so that as many staff can be trained as needed, and as frequently as necessary, to ensure a sustainable local PROMPT training programme.
Research, evidence and innovation
PMF have always placed great importance on demonstrating that PROMPT training is effective in improving outcomes. In addition, research carried out by PMF has contributed to national guidance for the management of shoulder dystocia (Royal College of Obstetricians and Gynaecologists, 2012) and impacted fetal head at caesarean birth (Cornthwaite et al, 2021).
By sustaining a solid research base, PMF can continue to develop innovative and practical training materials that are up-to-date and applicable for maternity teams to implement locally, with the determined aim of making childbirth safer across the world.