The development of a complex digital and behavioural Antimicrobial Stewardship intervention for hospitals in England

Abstract

Abstract Background Computerised prescribing systems, which are becoming widely adopted, have the potential to improve antimicrobial stewardship, but often lack relevant in-built components to optimally facilitate good antimicrobial stewardship practices. Objectives To co-develop with stakeholders, a complex ePrescribing antimicrobial stewardship intervention (ePAMS+) comprising multiple technological and non-technological components, designed to integrate with commercial computerised prescribing (ePrescribing) systems and work processes in hospitals in England. Methods ePAMS+’s development was informed by a qualitative person-based approach. This involved literature reviews, structured stakeholder workshops and interviews with policymakers, practitioner and patient representatives, vendors and international experts. Engagements and interviews focused on identifying key barriers to and facilitators of appropriate prescribing and post-prescription reviewing of antimicrobial therapy by users of ePrescribing systems in hospitals. Qualitative data were thematically analysed and, where feasible, used to inform the design ePAMS + features . Results Several barriers exist to the implementation of appropriate prescribing and post-prescription review of antimicrobial therapy for users of computerised prescribing systems. These mainly relate to beliefs about what constitutes appropriate antimicrobial use and the inaccessibility of information within ePrescribing systems that would facilitate appropriate prescribing and review. ePAMS + addresses these barriers by making relevant information and tools accessible from within the ePrescribing system. Conclusions ePrescribing systems have the potential to facilitate good antimicrobial prescribing and review practice if they incorporate features that make relevant informational resources accessible to healthcare practitioners within ePrescribing systems. Such features can be determined through iterative and structured stakeholder engagement, which can be effective in eliciting requirements for developing interventions, although further adaptations may be necessary after evaluation of early implementation.