ePAMS+ Feasibility
Research type
Research Study
Full title
Complex ePrescribing-based Antimicrobial Stewardship intervention for Hospitals (ePAMS+) Feasibility Trial
IRAS ID
307085
Contact name
Aziz Sheikh
Contact email
Sponsor organisation
The University of Edinburgh
ISRCTN Number
ISRCTN13429325
Duration of Study in the UK
0 years, 5 months, 31 days
Research summary
RESEARCH SUMMARY:
Antibiotics fight infections caused by bacteria, but not all infections are caused by bacteria. When patients first come to hospital, often it is too early to be sure of what is causing their illness so doctors may prescribe antibiotics ‘just in case’. The more antibiotics a person takes the more likely they are to carry antibiotic resistant bacteria in their body and to have antibiotic resistant infections in the future. The ePAMS+ intervention is designed to manage antibiotic use within hospital settings by placing patients prescribed antibiotics on active review:Under ePAMS+ the progress of a patient prescribed antibiotics will be reviewed in line with the national 'Start Smart - Then Focus' guidelines:
• Patients on review will have their antibiotics stopped if their doctors decide that their illness is not caused by bacteria
• When doctors have a patients test results they can decide on how long they need antibiotics, and which ones they need
• Doctors may decide a patient will need to carry on with antibiotics because they are right for their illnessLAY SUMMARY OF STUDY RESULTS:
Increasingly, bacteria (germs) no longer respond to antibiotics. This means antibiotics have begun to stop working as well as they should. This can result in patients experiencing more severe infections, lasting longer than they previously did, and may, in some cases, lead to an increased risk of dying from infections.
This is due to too much inappropriate use of antibiotics. The UK Government and World Health Organization believe this is an extremely important issue to tackle.To improve antibiotic prescribing, "6Rs" should be followed; patients should be given:
the Right antibiotic;
at the Right dose;
by the Right route;
for the Right infection;
at the Right time; and
for the Right duration.The reasons for overuse of antibiotics include doctors not having relevant information (e.g. on resistance patterns) when prescribing antibiotics, concerns about missing possibly serious infections, and time pressures/lack of continuity of care that limit opportunities for doctors to review diagnoses and stop antibiotics if no longer needed. Our literature review and discussions with experts found that hospital electronic prescribing (ePrescribing) systems can be used as a type of software to support new ways of working, designed to safely reduce inappropriate antibiotic prescribing.
We built on our recently completed NIHR-funded research, which developed an ePrescribing Toolkit to promote the use of hospital ePrescribing systems across NHS England. As ePrescribing systems become more widely available, we want to see if they can be used to safely reduce antibiotic prescribing with no change in mortality.
We carefully planned all the elements a new intervention (ePAMS+) would need to help hospitals achieve the “6Rs”. ePAMS+ incorporates two closely related parts: i) a training package, clinical team processes and patient leaflet to help everyone involved understand the importance of reducing antibiotic use and how this can be done safely and effectively; ii) an online computer software system that works with the existing ePrescribing system, gathering information relevant to making antibiotic prescribing decisions, and presenting this to clinicians at the time and in the format it is needed.
Feasibility trial
We carried out a special type of trial to see how well ePAMS+ will work – researchers call this a feasibility study. The feasibility study investigated how best to deliver ePAMS+ to hospitals, by testing it on a small scale before undertaking a larger study.We introduced ePAMS+ in two English hospitals, studying several wards that treat people with a variety of conditions to investigate how ePAMS+ could be used in different contexts. We aimed to assess how acceptable ePAMS+ was to prescribers. We investigated how acceptable the processes of our research were, to guide plans for future research on this topic. We also wanted to find out how feasible it was to implement ePAMS+ in a real hospital setting, and how best to record the impact of this on measures that are important to patients and to the National Health Service. We interviewed doctors, nurses and pharmacists to find out their views on ePAMS+, and observed their work prescribing antibiotics. We analysed the quantity of antibiotics prescribed to help us plan the design of a future, larger-scale, research study which would confirm whether ePAMS+ helps prescribers follow the “6Rs” and benefits people when they need antibiotics in hospital.
Our research took place during the COVID-19 pandemic, from April 2021 to November 2022. We interviewed 57 healthcare professionals and collected data on antibiotic prescribing from 1,958 hospital admissions (1,358 before ePAMS+ was introduced and 600 afterwards).
The interviews confirmed that some aspects of ePAMS+ are acceptable, while other features need to be improved. Our analysis of the variability in the amount of antibiotics prescribed to patients will help us design a future trial investigating whether ePAMS+ is beneficial. It was not possible to collect all of the outcome measures directly from the ePrescribing system: we’ll need to look into other ways of gathering this information.
The COVID-19 pandemic disrupted this research, and also affected the hospital services where we were introducing ePAMS+. This showed us that we need to adapt our plans carefully to take account of local circumstances when implementing ePAMS+ in future. We identified key refinements to ePAMS+ that would support its wider adoption in clinical practice. These updates will need further testing before we start a large-scale trial of the effectiveness of ePAMS+.
REC name
London - South East Research Ethics Committee
REC reference
22/LO/0204
Date of REC Opinion
16 Mar 2022
REC opinion
Favourable Opinion