Cargando…

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+ i...

Descripción completa

Detalles Bibliográficos
Autores principales: Weir, Christopher J., Adamestam, Imad, Sharp, Rona, Ennis, Holly, Heed, Andrew, Williams, Robin, Cresswell, Kathrin, Dogar, Omara, Pontefract, Sarah, Coleman, Jamie, Lilford, Richard, Watson, Neil, Slee, Ann, Chuter, Antony, Beggs, Jillian, Slight, Sarah, Mason, James, Yardley, Lucy, Sheikh, Aziz
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9883604/
https://www.ncbi.nlm.nih.gov/pubmed/36709308
http://dx.doi.org/10.1186/s40814-022-01230-w
_version_ 1784879543929012224
author Weir, Christopher J.
Adamestam, Imad
Sharp, Rona
Ennis, Holly
Heed, Andrew
Williams, Robin
Cresswell, Kathrin
Dogar, Omara
Pontefract, Sarah
Coleman, Jamie
Lilford, Richard
Watson, Neil
Slee, Ann
Chuter, Antony
Beggs, Jillian
Slight, Sarah
Mason, James
Yardley, Lucy
Sheikh, Aziz
author_facet Weir, Christopher J.
Adamestam, Imad
Sharp, Rona
Ennis, Holly
Heed, Andrew
Williams, Robin
Cresswell, Kathrin
Dogar, Omara
Pontefract, Sarah
Coleman, Jamie
Lilford, Richard
Watson, Neil
Slee, Ann
Chuter, Antony
Beggs, Jillian
Slight, Sarah
Mason, James
Yardley, Lucy
Sheikh, Aziz
author_sort Weir, Christopher J.
collection PubMed
description 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 SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40814-022-01230-w.
format Online
Article
Text
id pubmed-9883604
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-98836042023-01-29 A complex ePrescribing-based Anti-Microbial Stewardship (ePAMS+) intervention for hospitals combining technological and behavioural components: protocol for a feasibility trial Weir, Christopher J. Adamestam, Imad Sharp, Rona Ennis, Holly Heed, Andrew Williams, Robin Cresswell, Kathrin Dogar, Omara Pontefract, Sarah Coleman, Jamie Lilford, Richard Watson, Neil Slee, Ann Chuter, Antony Beggs, Jillian Slight, Sarah Mason, James Yardley, Lucy Sheikh, Aziz Pilot Feasibility Stud Study Protocol 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 SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40814-022-01230-w. BioMed Central 2023-01-28 /pmc/articles/PMC9883604/ /pubmed/36709308 http://dx.doi.org/10.1186/s40814-022-01230-w Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Study Protocol
Weir, Christopher J.
Adamestam, Imad
Sharp, Rona
Ennis, Holly
Heed, Andrew
Williams, Robin
Cresswell, Kathrin
Dogar, Omara
Pontefract, Sarah
Coleman, Jamie
Lilford, Richard
Watson, Neil
Slee, Ann
Chuter, Antony
Beggs, Jillian
Slight, Sarah
Mason, James
Yardley, Lucy
Sheikh, Aziz
A complex ePrescribing-based Anti-Microbial Stewardship (ePAMS+) intervention for hospitals combining technological and behavioural components: protocol for a feasibility trial
title A complex ePrescribing-based Anti-Microbial Stewardship (ePAMS+) intervention for hospitals combining technological and behavioural components: protocol for a feasibility trial
title_full A complex ePrescribing-based Anti-Microbial Stewardship (ePAMS+) intervention for hospitals combining technological and behavioural components: protocol for a feasibility trial
title_fullStr A complex ePrescribing-based Anti-Microbial Stewardship (ePAMS+) intervention for hospitals combining technological and behavioural components: protocol for a feasibility trial
title_full_unstemmed A complex ePrescribing-based Anti-Microbial Stewardship (ePAMS+) intervention for hospitals combining technological and behavioural components: protocol for a feasibility trial
title_short A complex ePrescribing-based Anti-Microbial Stewardship (ePAMS+) intervention for hospitals combining technological and behavioural components: protocol for a feasibility trial
title_sort complex eprescribing-based anti-microbial stewardship (epams+) intervention for hospitals combining technological and behavioural components: protocol for a feasibility trial
topic Study Protocol
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9883604/
https://www.ncbi.nlm.nih.gov/pubmed/36709308
http://dx.doi.org/10.1186/s40814-022-01230-w
work_keys_str_mv AT weirchristopherj acomplexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT adamestamimad acomplexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT sharprona acomplexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT ennisholly acomplexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT heedandrew acomplexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT williamsrobin acomplexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT cresswellkathrin acomplexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT dogaromara acomplexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT pontefractsarah acomplexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT colemanjamie acomplexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT lilfordrichard acomplexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT watsonneil acomplexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT sleeann acomplexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT chuterantony acomplexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT beggsjillian acomplexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT slightsarah acomplexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT masonjames acomplexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT yardleylucy acomplexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT sheikhaziz acomplexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT weirchristopherj complexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT adamestamimad complexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT sharprona complexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT ennisholly complexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT heedandrew complexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT williamsrobin complexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT cresswellkathrin complexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT dogaromara complexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT pontefractsarah complexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT colemanjamie complexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT lilfordrichard complexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT watsonneil complexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT sleeann complexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT chuterantony complexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT beggsjillian complexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT slightsarah complexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT masonjames complexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT yardleylucy complexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial
AT sheikhaziz complexeprescribingbasedantimicrobialstewardshipepamsinterventionforhospitalscombiningtechnologicalandbehaviouralcomponentsprotocolforafeasibilitytrial