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Lookup NU author(s): Neil Watson, Professor Sarah Slight
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2024. The Author(s). BACKGROUND: Antibiotic resistant infections cause over 700,000 deaths worldwide annually. As antimicrobial stewardship (AMS) helps minimise the emergence of antibiotic resistance resulting from inappropriate use of antibiotics in healthcare, we developed ePAMS+ (ePrescribing-based Anti-Microbial Stewardship), an ePrescribing and Medicines Administration (EPMA) system decision-support tool complemented by educational, behavioural and organisational elements. METHODS: We conducted a non-randomised before-and-after feasibility trial, implementing ePAMS+ in two English hospitals using the Cerner Millennium EPMA system. Wards of several specialties were included. Patient participants were blinded to whether ePAMS+ was in use; prescribers were not. A mixed-methods evaluation aimed to establish: acceptability and usability of ePAMS+ and trial processes; feasibility of ePAMS+ implementation and quantitative outcome recording; and a Fidelity Index measuring the extent to which ePAMS+ was delivered as intended. Longitudinal semi-structured interviews of doctors, nurses and pharmacists, alongside non-participant observations, gathered qualitative data; we extracted quantitative prescribing data from the EPMA system. Normal linear modelling of the defined daily dose (DDD) of antibiotic per admission quantified its variability, to inform sample size calculations for a future trial of ePAMS+ effectiveness. RESULTS: The research took place during the SARS-CoV-2 pandemic, from April 2021 to November 2022. 60 qualitative interviews were conducted (33 before ePAMS+ implementation, 27 after). 1,958 admissions (1,358 before ePAMS+ implementation; 600 after) included 24,884 antibiotic orders. Qualitative interviews confirmed that some aspects of ePAMS+ , its implementation and training were acceptable, while other features (e.g. enabling combinations of antibiotics to be prescribed) required further development. ePAMS+ uptake was low (28 antibiotic review records from 600 admissions; 0.047 records per admission), preventing full development of a Fidelity Index. Normal linear modelling of antibiotic DDD per admission showed a residual variance of 1.086 (log-transformed scale). Unavailability of indication data prevented measurement of some outcomes (e.g. number of antibiotic courses per indication). CONCLUSIONS: This feasibility trial encountered unforeseen circumstances due to contextual factors and a global pandemic, highlighting the need for careful adaptation of complex intervention implementations to the local setting. We identified key refinements to ePAMS+ to support its wider adoption in clinical practice, requiring further piloting before a confirmatory effectiveness trial. TRIAL REGISTRATION: ISRCTN Registry ISRCTN13429325, 24 March 2022.
Author(s): Weir CJ, Hinder S, Adamestam I, Sharp R, Ennis H, Heed A, Williams R, Cresswell K, Dogar O, Pontefract S, Coleman J, Lilford R, Watson N, Slee A, Chuter A, Beggs J, Slight S, Mason J, Bates DW, Sheikh A
Publication type: Article
Publication status: Published
Journal: BMC Medical Informatics and Decision Making
Year: 2024
Volume: 24
Online publication date: 11/10/2024
Acceptance date: 01/10/2024
Date deposited: 21/10/2024
ISSN (electronic): 1472-6947
Publisher: BioMed Central Ltd
URL: https://doi.org/10.1186/s12911-024-02707-9
DOI: 10.1186/s12911-024-02707-9
Data Access Statement: De-identified quantitative data for this trial are held within the Scottish National Safe Haven, having been obtained from routinely collected health data within the Cerner EPMA system. These data are not appropriate for public sharing, as consent was not sought from eligible admissions in this service-level evaluation of intervention feasibility. The qualitative datasets generated and/or analysed during the current study are not publicly available to protect the anonymity of participants, but are available from co-author KC on reasonable request.
PubMed id: 39394550
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