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E-Patient Counseling Trial E-PACO: Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy

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A complex ePrescribing antimicrobial stewardship-based (ePAMS+) intervention for hospitals: mixed-methods feasibility

Christopher J Weir¹, Susan Hinder², Imad Adamestam³

¹Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK. Christopher.Weir@ed.ac.uk.

BMC Medical Informatics and Decision Making

|October 11, 2024

Summary

A new ePrescribing-based Anti-Microbial Stewardship (ePAMS+) tool showed mixed results in a feasibility trial. Further refinements are needed to improve adoption and effectiveness in combating antibiotic resistance.

Keywords:

Bacteriology Decision support Health informatics Infectious diseases Microbiology

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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

Published on: August 30, 2018

Area of Science:

Health Informatics
Infectious Diseases
Clinical Pharmacy

Background:

Antibiotic-resistant infections are a major global health threat, causing over 700,000 deaths annually.
Antimicrobial stewardship (AMS) programs are crucial for minimizing antibiotic resistance.
The ePAMS+ (ePrescribing-based Anti-Microbial Stewardship) tool was developed to support AMS.

Purpose of the Study:

To evaluate the feasibility, acceptability, and usability of the ePAMS+ system.
To assess the implementation processes and quantitative outcome recording for ePAMS+.
To inform sample size calculations for a future trial on ePAMS+ effectiveness.

Main Methods:

A non-randomised before-and-after feasibility trial was conducted in two English hospitals.
A mixed-methods evaluation included qualitative interviews and quantitative prescribing data analysis.
The study utilized the Cerner Millennium ePrescribing and Medicines Administration (EPMA) system.

Main Results:

The trial occurred during the COVID-19 pandemic, impacting implementation.
Qualitative feedback indicated some aspects of ePAMS+ were acceptable, but required further development.
Uptake of ePAMS+ was low, hindering full evaluation and preventing measurement of certain outcomes.

Conclusions:

The feasibility trial highlighted challenges in implementing complex interventions during unforeseen circumstances like a pandemic.
Key refinements for ePAMS+ were identified to enhance clinical practice adoption.
Further piloting is necessary before a confirmatory effectiveness trial can be conducted.