TY  - JOUR
AU  - Cresswell, Kathrin
AU  - Hinder, Susan
AU  - Sheikh, Aziz
AU  - Watson, Neil
AU  - Price, David
AU  - Heed, Andrew
AU  - Pontefract, Sarah Katie
AU  - Coleman, Jamie
AU  - Beggs, Jillian
AU  - Chuter, Antony
AU  - Slee, Ann
AU  - Williams, Robin
PY  - 2024
DA  - 2024/7/26
TI  - Complex Hospital-Based Electronic Prescribing–Based Intervention to Support Antimicrobial Stewardship: Qualitative Study
JO  - JMIR Form Res
SP  - e54458
VL  - 8
KW  - antimicrobial stewardship
KW  - electronic prescribing
KW  - evaluation
KW  - healthcare
KW  - qualitative study
KW  - hospital-based
KW  - e-prescribing
KW  - prescribing
KW  - prescription
KW  - ePAMS+
KW  - antimicrobial resistance
KW  - AMR
KW  - complex intervention
KW  - complex interventions
KW  - educational
KW  - behavioral
KW  - technological
KW  - public health
KW  - implementation
KW  - AMS
KW  - hospital
KW  - hospitals
KW  - development
KW  - in-depth
KW  - interview
KW  - interviews
KW  - observation
KW  - observations
KW  - prescriber
KW  - prescribers
KW  - nurse
KW  - nurses
KW  - pharmacist
KW  - pharmacists
KW  - microbiologist
KW  - microbiologists
KW  - thematic analysis
KW  - antimicrobial
KW  - antimicrobials
AB  - Background: Antimicrobial resistance (AMR) represents a growing concern for public health. Objective: We sought to explore the challenges associated with development and implementation of a complex intervention designed to improve AMS in hospitals. Methods: We conducted a qualitative evaluation of a complex AMS intervention with educational, behavioral, and technological components in 5 wards of an English hospital. At 2 weeks and 7 weeks after initiating the intervention, we interviewed 25 users of the intervention, including senior and junior prescribers, a senior nurse, a pharmacist, and a microbiologist. Topics discussed included perceived impacts of different elements of the intervention and facilitators and barriers to effective use. Interviews were supplemented by 2 observations of ward rounds to gain insights into AMS practices. Data were audio-recorded, transcribed, and inductively and deductively analyzed thematically using NVivo12. Results: Tracing the adoption and impact of the various components of the intervention was difficult, as it had been introduced into a setting with competing pressures. These particularly affected behavioral and educational components (eg, training, awareness-building activities), which were often delivered ad hoc. We found that the participatory intervention design had addressed typical use cases but had not catered for edge cases that only became visible when the intervention was delivered in real-world settings (eg, variations in prescribing workflows across different specialties and conditions). Conclusions: Effective user-focused design of complex interventions to promote AMS can support acceptance and use. However, not all requirements and potential barriers to use can be fully anticipated or tested in advance of full implementation in real-world settings. 
SN  - 2561-326X
UR  - https://formative.jmir.org/2024/1/e54458
UR  - https://doi.org/10.2196/54458
DO  - 10.2196/54458
ID  - info:doi/10.2196/54458
ER  -