A complex ePrescribing-based Anti-Microbial Stewardship (ePAMS+) intervention for hospitals combining technological and behavioural components: protocol for a feasibility trial
A complex ePrescribing-based Anti-Microbial Stewardship (ePAMS+) intervention for hospitals combining technological and behavioural components: protocol for a feasibility trial
Background: antimicrobial 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+).
Methods: ePAMS+ 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.
Discussion: this 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 registration: the 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.
Decision support, Health informatics, Infectious diseases, Microbiology, bacteriology, Bacteriology
Weir, C.J.
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Adamestan, Imad
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Sharp, Rona
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Ennis, Holly
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Heed, Andrew
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Williams, Robin
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Creswell, Kathrin
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Dogar, Omara
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Pontefract, Sarah
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Coleman, Jamie
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Lilford, Richard
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Watson, Neil
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Slee, Ann
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Chuter, Antony
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Beggs, Jillian
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Slight, Sarah
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Mason, James
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Yardley, Lucy
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Sheikh, Aziz
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28 January 2023
Weir, C.J.
c3d2c5ad-6881-40bc-b36c-88afaa438e00
Adamestan, Imad
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Sharp, Rona
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Ennis, Holly
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Heed, Andrew
37aece8f-2e07-4831-8586-f418a3d31b60
Williams, Robin
ea00ad09-08d8-469c-a776-1c674777be10
Creswell, Kathrin
4d3bb1a3-f5c4-4697-8936-d9ba8570168d
Dogar, Omara
88101044-88d8-40c5-b610-a7ec163ae27d
Pontefract, Sarah
10b5f00a-dbb7-4fc2-be05-b22454fa861a
Coleman, Jamie
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Lilford, Richard
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Watson, Neil
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Slee, Ann
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Chuter, Antony
3cfeec83-e62e-40ff-a502-a38e31c8b6c4
Beggs, Jillian
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Slight, Sarah
0411c037-d8ca-40e1-a8c6-008743f10a7a
Mason, James
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Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Sheikh, Aziz
0ac10790-619a-472f-82fd-9fc77d8e405e
Weir, C.J., Adamestan, Imad, Sharp, Rona, Ennis, Holly, Heed, Andrew, Williams, Robin, Creswell, Kathrin, Dogar, Omara, Pontefract, Sarah, Coleman, Jamie, Lilford, Richard, Watson, Neil, Slee, Ann, Chuter, Antony, Beggs, Jillian, Slight, Sarah, Mason, James, Yardley, Lucy and Sheikh, Aziz
(2023)
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, 9, [18].
(doi:10.1186/s40814-022-01230-w).
Abstract
Background: antimicrobial 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+).
Methods: ePAMS+ 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.
Discussion: this 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 registration: the 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.
Text
s40814-022-01230-w
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Accepted/In Press date: 16 December 2022
Published date: 28 January 2023
Additional Information:
Funding Information:
LY is an NIHR Senior Investigator and her research programme is partly supported by NIHR Applied Research Collaboration (ARC)-West, NIHR Health Protection Research Unit (HPRU) for Behavioural Science and Evaluation, and the NIHR Southampton Biomedical Research Centre (BRC).
Funding Information:
This study is funded by the National Institute for Health and Care Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference number NIHR RP-PG-0617-20009). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising from this submission. The funders and Sponsor have had no role in study design; collection, management, analysis, and interpretation of data; writing of the report; or the decision to publish.
Publisher Copyright:
© 2022, The Author(s).
Keywords:
Decision support, Health informatics, Infectious diseases, Microbiology, bacteriology, Bacteriology
Identifiers
Local EPrints ID: 474941
URI: http://eprints.soton.ac.uk/id/eprint/474941
ISSN: 2055-5784
PURE UUID: 6a197353-9ba0-46f8-aabd-7ee1f57694db
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Date deposited: 07 Mar 2023 17:38
Last modified: 11 May 2024 01:36
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Contributors
Author:
C.J. Weir
Author:
Imad Adamestan
Author:
Rona Sharp
Author:
Holly Ennis
Author:
Andrew Heed
Author:
Robin Williams
Author:
Kathrin Creswell
Author:
Omara Dogar
Author:
Sarah Pontefract
Author:
Jamie Coleman
Author:
Richard Lilford
Author:
Neil Watson
Author:
Ann Slee
Author:
Antony Chuter
Author:
Jillian Beggs
Author:
Sarah Slight
Author:
James Mason
Author:
Aziz Sheikh
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