Table 1 Feasibility trial objectives and summary findings
Objective | Methodology | Completed | Key findings |
|---|---|---|---|
1. Explore acceptability to users of the content and any barriers to uptake of the ePAMS+ technical component | Qualitative | Yes | Users reported difficulty in finding review documentation |
2. Investigate whether ePAMS+ Antibiotic Order Plans can be used as intended in clinical practice and the reasons why this may not happen | Qualitative | Yes | Used correctly, but infrequently due to it being non-compulsory. ePAMS+ did not cover non-standard cases such as combinations of antibiotics |
3. Assess acceptability to healthcare professionals of the ePAMS+ intervention organisational and educational components | Qualitative | Yes | Champion appointed and led training. No regular, formalised meetings undertaken; generally low awareness among staff Online training – reduce duration by removing video content; staff welcomed “at elbow” on the job support and training |
4. Establish how ePAMS+ may best be implemented in various care contexts and health information systems | Qualitative | Yes | Assessment Suite ward at start of many patients’ admission journey identified as a key point for implementing ePAMS+ . Recognised importance of use in general medical wards, not just those in which specialist microbiology input is available |
5. Confirm whether the processes used to implement ePAMS+ are acceptable and feasible | Qualitative | Yes | Found not to be acceptable or feasible; points towards opportunities for greater communication and improvements to the implementation plan |
6. Create a Fidelity Index to measure the extent to which the core ePAMS+ intervention themes are delivered in antibiotic prescribing and test usability of the Fidelity Index | Quantitative | Partially | The routine data extract can inform whether critical decision-making points (or core ePAMS+ intervention themes) were adhered to when delivering ePAMS+ intervention. Insufficient antibiotic review data to progress further with Fidelity Index development |
7. Explore hypothesised mechanisms of action, refine programme theory and select appropriate process analysis measures to be used a future trial evaluating ePAMS+ | Qualitative | Yes | The trial generated hypotheses which will require further testing, for example regarding alternative delivery of education component |
8. Confirm whether ePAMS+ can be integrated successfully into hospitals to facilitate prescribing behaviour changes | Qualitative / Quantitative | Yes | Full integration not achieved, evidenced by low uptake of online training and small number of reviews undertaken. Importance of intervention being optional rather than mandatory |
9. Build processes of collecting outcome data from EPMA systems before and after introduction of the ePAMS+ ePrescribing tools | Quantitative | Partially | Some outcomes could be successfully extracted and derived from EPMA system. Some process measures could only be recorded after ePAMS+ had been implemented. Lack of availability of indication data meant that a number of outcomes could not be derived |
10. Quantify between-patient variability in total antibiotic consumption, confirming the sample size required for a full-scale trial evaluating the ePAMS+ intervention | Quantitative | Yes | Antibiotic consumption data modelled and residual variance used to inform sample size calculations for future ePAMS+ evaluation studies |