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

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. DevallI. Gallos, A. Merriel, M. Bonet, J. P. Souza, A. Coomarasamy

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

6 Citations (Scopus)

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.

Original language	English
Pages (from-to)	416-423
Number of pages	8
Journal	BJOG: An International Journal of Obstetrics and Gynaecology
Volume	127
Issue number	3
DOIs	https://doi.org/10.1111/1471-0528.16005
Publication status	Published - 1 Feb 2020

Bibliographical note

Funding Information:
University of Birmingham (RG_16-150) and Ammalife (1120236).

Funding Information:
Research funding was provided by University of Birmingham and the charity Ammalife. Several authors are, or have recently been, employed by the University of Birmingham. D.L., A.C., J.C., and C.D. all work with the charity Ammalife as volunteers. Those engaged in the work were excluded from the funding decision‐making by Ammalife. Neither funder had input into the study design, data collection, data analysis, data interpretation or writing of the report.

Publisher Copyright:
© 2019 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists

Keywords

care bundle
Delphi process
low resource setting
maternal sepsis

ASJC Scopus subject areas

Obstetrics and Gynaecology

Access to Document

10.1111/1471-0528.16005

Cite this

Lissauer, D., Cheshire, J., Dunlop, C., Taki, F., Wilson, A., Smith, J. M., Daniels, R., Kissoon, N., Malata, A., Chirwa, T., Lwesha, V. M., Mhango, C., Mhango, E., Makwenda, C., Banda, L., Munthali, L., Nambiar, B., Hussein, J., Williams, H. M., ... Coomarasamy, A. (2020). Development of the FAST-M maternal sepsis bundle for use in low-resource settings: a modified Delphi process. BJOG: An International Journal of Obstetrics and Gynaecology, 127(3), 416-423. https://doi.org/10.1111/1471-0528.16005

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

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 {\textquoteleft}FAST-M{\textquoteright}. 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 = "care bundle, Delphi process, low resource setting, maternal sepsis",

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

note = "Funding Information: University of Birmingham (RG_16-150) and Ammalife (1120236). Funding Information: Research funding was provided by University of Birmingham and the charity Ammalife. Several authors are, or have recently been, employed by the University of Birmingham. D.L., A.C., J.C., and C.D. all work with the charity Ammalife as volunteers. Those engaged in the work were excluded from the funding decision‐making by Ammalife. Neither funder had input into the study design, data collection, data analysis, data interpretation or writing of the report. Publisher Copyright: {\textcopyright} 2019 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists",

year = "2020",

month = feb,

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doi = "10.1111/1471-0528.16005",

language = "English",

volume = "127",

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Lissauer, D, Cheshire, J, Dunlop, C, Taki, F, Wilson, A, Smith, JM, Daniels, R, Kissoon, N, Malata, A, Chirwa, T, Lwesha, VM, Mhango, C, Mhango, E, Makwenda, C, Banda, L, Munthali, L, Nambiar, B, Hussein, J, Williams, HM, Devall, AJ , Gallos, I, Merriel, A, Bonet, M, Souza, JP & Coomarasamy, A 2020, 'Development of the FAST-M maternal sepsis bundle for use in low-resource settings: a modified Delphi process', BJOG: An International Journal of Obstetrics and Gynaecology, vol. 127, no. 3, pp. 416-423. https://doi.org/10.1111/1471-0528.16005

TY - JOUR

T1 - Development of the FAST-M maternal sepsis bundle for use in low-resource settings

T2 - a modified Delphi process

AU - Lissauer, D.

AU - Cheshire, J.

AU - Dunlop, C.

AU - Taki, F.

AU - Wilson, A.

AU - Smith, J. M.

AU - Daniels, R.

AU - Kissoon, N.

AU - Malata, A.

AU - Chirwa, T.

AU - Lwesha, V. M.

AU - Mhango, C.

AU - Mhango, E.

AU - Makwenda, C.

AU - Banda, L.

AU - Munthali, L.

AU - Nambiar, B.

AU - Hussein, J.

AU - Williams, H. M.

AU - Devall, A. J.

AU - Gallos, I.

AU - Merriel, A.

AU - Bonet, M.

AU - Souza, J. P.

AU - Coomarasamy, A.

N1 - Funding Information: University of Birmingham (RG_16-150) and Ammalife (1120236). Funding Information: Research funding was provided by University of Birmingham and the charity Ammalife. Several authors are, or have recently been, employed by the University of Birmingham. D.L., A.C., J.C., and C.D. all work with the charity Ammalife as volunteers. Those engaged in the work were excluded from the funding decision‐making by Ammalife. Neither funder had input into the study design, data collection, data analysis, data interpretation or writing of the report. Publisher Copyright: © 2019 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists

PY - 2020/2/1

Y1 - 2020/2/1

N2 - 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.

AB - 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.

KW - care bundle

KW - Delphi process

KW - low resource setting

KW - maternal sepsis

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DO - 10.1111/1471-0528.16005

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JO - BJOG: An International Journal of Obstetrics and Gynaecology

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ER -

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

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

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