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

• Published in: BJOG : an international journal of obstetrics and gynaecology Vol. 127; no. 3; pp. 416 - 423
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-02-2020; John Wiley and Sons Inc
• Subjects: Antibiotics; care bundle; Consensus; Delphi method; Delphi process; Delphi Technique; Family counseling; Female; Humans; Infant, Newborn; International Cooperation; low resource setting; Maternal Medicine; maternal sepsis; Medically Underserved Area; Neonates; Patient Care Bundles - methods; Patient Care Management - methods; Patient Care Management - organization & administration; Pregnancy; Pregnancy Complications, Infectious - diagnosis; Pregnancy Complications, Infectious - therapy; Sepsis; World Health Organization; Delphi process; care bundle; maternal sepsis; low resource setting
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/1471-0528.16005

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