Evidence based QUality Improvement for Prescribing Stewardship in ICU (EQUIPS-ICU): protocol for type III hybrid...

Area of Science:

• Global Health
• Infectious Diseases
• Implementation Science

Background:

• Inappropriate antimicrobial prescribing in intensive care units (ICUs) is common, estimated at 50% of prescriptions.
• This practice leads to increased healthcare costs, patient side effects, and the critical issue of antimicrobial resistance (AMR), particularly in low- and middle-income countries (LMICs).
• Variability in implementing interventions to improve antimicrobial prescribing necessitates further investigation.

Purpose of the Study:

• To evaluate a structured antimicrobial prescription review intervention in LMIC ICUs.
• To assess the implementation effectiveness, including fidelity, reach, and adoption of the intervention.
• To understand factors influencing the success of antimicrobial stewardship interventions in diverse healthcare settings.

Main Methods:

• A hybrid type III implementation/effectiveness cohort trial involving 35 ICUs across up to 11 LMICs.
• Intervention includes World Health Organization-recommended structured prescription reviews, local protocol development, audit/feedback, and education.
• Evaluation utilizes RE-AIM and the Consolidated Framework for Implementation Research (CFIR), with qualitative interviews and a baseline survey on stewardship structures.

Main Results:

• The primary outcome will be a composite measure of intervention fidelity, reach, and adoption.
• Secondary outcomes will assess the intervention's effectiveness in improving antimicrobial prescribing patterns.
• Qualitative data will explore acceptability, adaptations, and maintenance of the intervention.

Conclusions:

• This study addresses global health priorities by researching antimicrobial stewardship implementation in LMIC ICUs.
• It aims to strengthen healthcare professional competencies and understand how existing stewardship structures influence intervention success.
• Findings will enhance strategies for overcoming implementation barriers in resource-limited settings.