Development of the FAST-M maternal sepsis bundle for use in low-resource settings: a modified Delphi process

D Lissauer; J Cheshire; C Dunlop; F Taki; A Wilson; J M Smith; R Daniels; N Kissoon; A Malata; T Chirwa; V M Lwesha; C Mhango; E Mhango; C Makwenda; L Banda; L Munthali; B Nambiar; J Hussein; H M Williams; A J Devall; I Gallos; A Merriel; M Bonet; J P Souza; A Coomarasamy

doi:10.1111/1471-0528.16005

Development of the FAST-M maternal sepsis bundle for use in low-resource settings: a modified Delphi process

BJOG. 2020 Feb;127(3):416-423. doi: 10.1111/1471-0528.16005. Epub 2019 Dec 5.

Authors

D Lissauer^{1

2}, J Cheshire^{3

4}, C Dunlop^{3

4}, F Taki⁵, A Wilson^{4

6}, J M Smith⁷, R Daniels⁸, N Kissoon⁹, A Malata¹⁰, T Chirwa¹¹, V M Lwesha¹², C Mhango¹³, E Mhango¹¹, C Makwenda¹⁴, L Banda¹⁴, L Munthali¹⁴, B Nambiar¹⁵, J Hussein¹⁶, H M Williams^{4

17}, A J Devall^{3

4}, I Gallos^{3

4}, A Merriel¹⁸, M Bonet¹⁹, J P Souza²⁰, A Coomarasamy^{3

4}

Affiliations

¹ Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
² Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, Blantyre, Malawi.
³ Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
⁴ World Health Organization Collaborating Centre for Global Women's Health Research, University of Birmingham, Birmingham, UK.
⁵ The Hillingdon Hospitals NHS Foundation Trust, London, UK.
⁶ Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
⁷ The Bill & Melinda Gates Foundation's Maternal, Newborn & Child Health Team, Seattle, WA, USA.
⁸ University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
⁹ Department of Pediatrics and Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.
¹⁰ Malawi University of Science and Technology, Limbe, Malawi.
¹¹ Chitipa District Hospital, Chitipa, Malawi.
¹² Save the Children Norway, Lilongwe, Malawi.
¹³ College of Medicine, University of Malawi, Blantyre, Malawi.
¹⁴ Parent and Child Health Initiative (PACHI) Trust, Lilongwe, Malawi.
¹⁵ Institute for Global Child Health, University College London, London, UK.
¹⁶ Independent Maternal Health Consultant, Aberdeen, UK.
¹⁷ Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
¹⁸ School of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
¹⁹ UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
²⁰ Department of Social Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil.

Abstract

Objective: To develop a sepsis care bundle for the initial management of maternal sepsis in low resource settings.

Design: Modified Delphi process.

Setting: Participants from 34 countries.

Population: Healthcare practitioners working in low resource settings (n = 143; 34 countries), members of an expert panel (n = 11) and consultation with the World Health Organization Global Maternal and Neonatal Sepsis Initiative technical working group.

Methods: We reviewed the literature to identify all potential interventions and practices around the initial management of sepsis that could be bundled together. A modified Delphi process, using an online questionnaire and in-person meetings, was then undertaken to gain consensus on bundle items. Participants ranked potential bundle items in terms of perceived importance and feasibility, considering their use in both hospitals and health centres. Findings from the healthcare practitioners were then triangulated with those of the experts.

Main outcome measure: Consensus on bundle items.

Results: Consensus was reached after three consultation rounds, with the same items deemed most important and feasible by both the healthcare practitioners and expert panel. Final bundle items selected were: (1) Fluids, (2) Antibiotics, (3) Source identification and control, (4) Transfer (to appropriate higher-level care) and (5) Monitoring (of both mother and neonate as appropriate). The bundle was given the acronym 'FAST-M'.

Conclusion: A clinically relevant maternal sepsis bundle for low resource settings has been developed by international consensus.

Tweetable abstract: A maternal sepsis bundle for low resource settings has been developed by international consensus.

Keywords: Delphi process; care bundle; low resource setting; maternal sepsis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Consensus
Delphi Technique
Female
Humans
Infant, Newborn
International Cooperation
Medically Underserved Area
Patient Care Bundles / methods*
Patient Care Management* / methods
Patient Care Management* / organization & administration
Pregnancy
Pregnancy Complications, Infectious* / diagnosis
Pregnancy Complications, Infectious* / therapy
World Health Organization

Abstract

Publication types

MeSH terms

Grants and funding