A complex ePrescribing-based Anti-Microbial Stewardship (ePAMS+) intervention for hospitals combining technological and behavioural components: protocol for a feasibility trial

Pilot and Feasibility Studies

Study Protocol

Christopher J. Weir¹  Holly Ennis¹  Imad Adamestam¹  Robin Williams²  Sarah Pontefract³  Jamie Coleman³  Ann Slee⁴  Andrew Heed⁵  Neil Watson⁶  Sarah Slight⁷  Lucy Yardley⁸  Richard Lilford⁹  Rona Sharp^1,10  Aziz Sheikh^1,10  Jillian Beggs^1,10  Kathrin Cresswell^1,10  Antony Chuter^1,10  Omara Dogar^1,11  James Mason^1,12 

[1] Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK;Institute for the Study of Science, Technology and Innovation, University of Edinburgh, Edinburgh, UK;Institute of Clinical Sciences, University of Birmingham, Birmingham, UK;NHS England, London, UK;Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK;Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK;NHS Covid Vaccine North East and North Cumbria, Carlisle, UK;School of Pharmacy, Newcastle University, Newcastle, UK;School of Psychological Science, University of Bristol, Bristol, UK;School of Psychology, University of Southampton, Southampton, UK;University of Birmingham, Birmingham, UK;Usher Institute, University of Edinburgh, Edinburgh, UK;Usher Institute, University of Edinburgh, Edinburgh, UK;Department of Health Sciences, University of York, York, UK;Warwick Medical School, University of Warwick, Coventry, UK;

关键词: Health informatics;    Bacteriology;    Infectious diseases;    Microbiology;    Decision support;   

DOI  :  10.1186/s40814-022-01230-w

 received in 2022-05-23, accepted in 2022-12-16,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundAntimicrobial resistance is a leading global public health threat, with inappropriate use of antimicrobials in healthcare contributing to its development. Given this urgent need, we developed a complex ePrescribing-based Anti-Microbial Stewardship intervention (ePAMS+).MethodsePAMS+ includes educational and organisational behavioural elements, plus guideline-based clinical decision support to aid optimal antimicrobial use in hospital inpatients. ePAMS+ particularly focuses on prompt initiation of antimicrobials, followed by early review once test results are available to facilitate informed decision-making on stopping or switching where appropriate. A mixed-methods feasibility trial of ePAMS+ will take place in two NHS acute hospital care organisations. Qualitative staff interviews and observation of practice will respectively gather staff views on the technical component of ePAMS+ and information on their use of ePAMS+ in routine work. Focus groups will elicit staff and patient views on ePAMS+; one-to-one interviews will discuss antimicrobial stewardship with staff and will record patient experiences of receiving antibiotics and their thoughts on inappropriate prescribing. Qualitative data will be analysed thematically. Fidelity Index development will enable enactment of ePAMS+ to be measured objectively in a subsequent trial assessing the effectiveness of ePAMS+. Quantitative data collection will determine the feasibility of extracting data and deriving key summaries of antimicrobial prescribing; we will quantify variability in the primary outcome, number of antibiotic defined daily doses, to inform the future larger-scale trial design.DiscussionThis trial is essential to determine the feasibility of implementing the ePAMS+ intervention and measuring relevant outcomes, prior to evaluating its clinical and cost-effectiveness in a full scale hybrid cluster-randomised stepped-wedge clinical trial. Findings will be shared with study sites and with qualitative research participants and will be published in peer-reviewed journals and presented at academic conferences.Trial registrationThe qualitative and Fidelity Index research were approved by the Health and Research Authority and the North of Scotland Research Ethics Service (ref: 19/NS/0174). The feasibility trial and quantitative analysis (protocol v1.0, 15 December 2021) were approved by the London South East Research Ethics Committee (ref: 22/LO/0204) and registered with ISRCTN (ISRCTN 13429325) on 24 March 2022

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

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