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Exploring two distinct gentamicin prescribing protocols in UK hospitals: a mixed-methods realist evaluation
Nadine Dyar1, Karen Mattick2, Rob Bethune3
1Medical Sciences, University of Exeter, Exeter, UK nadinedyar@gmail.com.
BMJ Open
|December 24, 2021
Summary
A simplified gentamicin prescribing protocol improved accuracy and adherence. This approach is better accepted by healthcare professionals, leading to safer patient care.
Area of Science:
- Pharmacology and Therapeutics
- Health Services Research
- Clinical Pharmacy Practice
Background:
- Gentamicin, a critical aminoglycoside antibiotic, has a narrow therapeutic index, posing risks of underdosing (inefficacy) and overdosing (nephrotoxicity, ototoxicity).
- Hospital protocols for gentamicin prescription vary in complexity, impacting patient safety and treatment outcomes.
Purpose of the Study:
- To evaluate and compare two distinct gentamicin prescribing protocols in hospital settings.
- To understand the mechanisms triggered by different protocols and their resulting patient outcomes.
Main Methods:
- A mixed-methods realist evaluation was conducted in two surgical admissions units over eight months.
- Data collection involved semi-structured interviews with 30 healthcare professionals (HCPs) and a clinical audit of 100 gentamicin prescriptions.
- The study employed a three-phase approach: initial programme theory generation, testing, and refinement.
Main Results:
- Prescribing accuracy was significantly higher with the simplified protocol (78.79%) compared to the complex one (65.67%).
- Key contextual factors influencing protocol adherence included prescriptiveness, HCP experience, and patient information availability.
- Mechanisms like uncertainty, fear, confidence, and frustration were triggered, leading to both intended and unintended outcomes, including protocol deviations.
Conclusions:
- A simplified gentamicin prescribing protocol demonstrates superior acceptance among prescribers.
- Simplified protocols lead to enhanced adherence and more accurate gentamicin prescribing, ultimately improving patient safety.
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