Evidence based QUality Improvement for Prescribing Stewardship in ICU (EQUIPS-ICU): protocol for type III hybrid implementation-effectiveness study
Abstract Background Approximately half of all antimicrobial prescriptions in intensive care units (ICUs) may be inappropriate, including those prescribed when not needed, in unnecessary combinations or for longer durations than needed. Inappropriate prescribing is costly, exposes patients to unneces...
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2025-02-01
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| Online Access: | https://doi.org/10.1186/s13012-024-01413-4 |
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| author | Duncan Wagstaff John Amuasi Sumaiya Arfin Diptesh Aryal Mohd Basri Mat Nor Joseph Bonney Arjen Dondorp David Dongelmans Layoni Dullawe Fathima Fazla Aniruddha Ghose Eva Hanciles Rashan Haniffa Madiha Hashmi Adam Hewitt Smith Bharath Kumar Yen Lam Minh Ramani Moonesinghe Luigi Pisani Cornelius Sendagire Mohd Shahnaz Hasan Maryam Shamal Ghalib Moses Siaw Frimpong Otavio Ranzani Menbeu Sultan David Thomson Swagata Tripathy Louise Thwaites Rabiul Alam Md. Erfan Uddin Mohd Zulfakar Mazlan Wangari Waweru-Siika Abigail Beane |
| author_facet | Duncan Wagstaff John Amuasi Sumaiya Arfin Diptesh Aryal Mohd Basri Mat Nor Joseph Bonney Arjen Dondorp David Dongelmans Layoni Dullawe Fathima Fazla Aniruddha Ghose Eva Hanciles Rashan Haniffa Madiha Hashmi Adam Hewitt Smith Bharath Kumar Yen Lam Minh Ramani Moonesinghe Luigi Pisani Cornelius Sendagire Mohd Shahnaz Hasan Maryam Shamal Ghalib Moses Siaw Frimpong Otavio Ranzani Menbeu Sultan David Thomson Swagata Tripathy Louise Thwaites Rabiul Alam Md. Erfan Uddin Mohd Zulfakar Mazlan Wangari Waweru-Siika Abigail Beane |
| author_sort | Duncan Wagstaff |
| collection | DOAJ |
| description | Abstract Background Approximately half of all antimicrobial prescriptions in intensive care units (ICUs) may be inappropriate, including those prescribed when not needed, in unnecessary combinations or for longer durations than needed. Inappropriate prescribing is costly, exposes patients to unnecessary side-effects and drives population-level antimicrobial resistance, the prevalence and consequences of which are greatest in low- and middle-income countries. However, the implementation of interventions to improve the appropriateness of antimicrobial prescribing has been variable and requires further study. Methods We propose a type III hybrid implementation/effectiveness interventional cohort trial in 35 ICUs in up to 11 low- and middle- income countries. The study intervention is a structured review of antimicrobial prescriptions as recommended by the World Health Organisation. Strategies to support stakeholder-led implementation include development of local protocols, registry-enabled audit and feedback, and education. Evaluation of implementation, and the determinants of its success, is informed by the RE-AIM framework and the Consolidated Framework for Implementation Research respectively. The primary outcome is a composite measure of fidelity, reach and adoption. Secondary outcomes describe the effectiveness of the intervention on improving antimicrobial prescribing. Qualitative interviews will assess relevant implementation acceptability, adaptations and maintenance. A baseline survey will investigate ICU-level antimicrobial stewardship structures and processes. Discussion This study addresses global policy priorities by supporting implementation research of antimicrobial stewardship, and strengthening associated healthcare professional competencies. It does this in a setting where improvement is sorely needed: low- and middle- income country ICUs. The study will also describe the influence of pre-existing antimicrobial stewardship structures and processes on implementation and improve understanding about the efficacy of strategies to overcome barriers to implementation in these settings. Trial registration This study protocol has been registered with ClinicalTrials.gov (ref NCT06666738) on 31 Oct 2004. https://clinicaltrials.gov/study/NCT06666738?term=NCT06666738&rank=1 . |
| format | Article |
| id | doaj-art-5a514005fc724e5c9c92ec2bd1e6dce3 |
| institution | DOAJ |
| issn | 1748-5908 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science |
| spelling | doaj-art-5a514005fc724e5c9c92ec2bd1e6dce32025-08-20T03:04:51ZengBMCImplementation Science1748-59082025-02-0120111210.1186/s13012-024-01413-4Evidence based QUality Improvement for Prescribing Stewardship in ICU (EQUIPS-ICU): protocol for type III hybrid implementation-effectiveness studyDuncan Wagstaff0John Amuasi1Sumaiya Arfin2Diptesh Aryal3Mohd Basri Mat Nor4Joseph Bonney5Arjen Dondorp6David Dongelmans7Layoni Dullawe8Fathima Fazla9Aniruddha Ghose10Eva Hanciles11Rashan Haniffa12Madiha Hashmi13Adam Hewitt Smith14Bharath Kumar15Yen Lam Minh16Ramani Moonesinghe17Luigi Pisani18Cornelius Sendagire19Mohd Shahnaz Hasan20Maryam Shamal Ghalib21Moses Siaw Frimpong22Otavio Ranzani23Menbeu Sultan24David Thomson25Swagata Tripathy26Louise Thwaites27Rabiul Alam Md. Erfan Uddin28Mohd Zulfakar Mazlan29Wangari Waweru-Siika30Abigail Beane31Centre for Preoperative Medicine, University College LondonDepartment of Global Health, Kwame Nkrumah University of Science and TechnologyThe George Institute for Global HealthDepartment of Critical Care, Nepal Intensive Care Research FoundationDepartment of Intensive Care Anaesthesiology, International Islamic University MalaysiaEmergency Medicine Department, Komfo Anokye Teaching HospitalMahidol Oxford Tropical Medicine Research UnitNational Intensive Care Evaluation (NICE) FoundationNat-Intensive Care Surveillance, Mahidol Oxford Tropical Medicine Research UnitNat-Intensive Care Surveillance, Mahidol Oxford Tropical Medicine Research UnitDepartment of Medicine, Chittagong Medical College HospitalConnaught HospitalMahidol Oxford Tropical Medicine Research UnitDepartment of Critical Care Medicine, Ziauddin UniversityFaculty of Health Sciences, Busitema UniversityDepartment of Critical Care Medicine, Apollo Hospitals Educational and Research FoundationClinical Research Unit, Oxford University, University of OxfordCentre for Preoperative Medicine, University College LondonMahidol Oxford Tropical Medicine Research UnitD’Or Institute for Research and EducationDepartment of Intensive Care Anaesthesiology, International Islamic University MalaysiaGeneral Surgery, Wazir Akbar Khan HospitalDepartment of Anaesthesiology and Intensive Care, Komfo Anokye Teaching HospitalBarcelona Institute for Global Health, ISGlobalDepartment of Emergency Medicine and Critical Care, St. Paul’s Hospital Millennium Medical CollegeDepartment of Anaesthesia and Perioperative Medicine, University of Cape TownPandemic Sciences Hub and Institute for Regeneration and Repair, University of EdinburghClinical Research Unit, Oxford University, University of OxfordDepartment of Medicine, Chittagong Medical College HospitalHospital Universiti Sains MalaysiaDepartment of Anaesthesia, The Aga Khan UniversityMahidol Oxford Tropical Medicine Research UnitAbstract Background Approximately half of all antimicrobial prescriptions in intensive care units (ICUs) may be inappropriate, including those prescribed when not needed, in unnecessary combinations or for longer durations than needed. Inappropriate prescribing is costly, exposes patients to unnecessary side-effects and drives population-level antimicrobial resistance, the prevalence and consequences of which are greatest in low- and middle-income countries. However, the implementation of interventions to improve the appropriateness of antimicrobial prescribing has been variable and requires further study. Methods We propose a type III hybrid implementation/effectiveness interventional cohort trial in 35 ICUs in up to 11 low- and middle- income countries. The study intervention is a structured review of antimicrobial prescriptions as recommended by the World Health Organisation. Strategies to support stakeholder-led implementation include development of local protocols, registry-enabled audit and feedback, and education. Evaluation of implementation, and the determinants of its success, is informed by the RE-AIM framework and the Consolidated Framework for Implementation Research respectively. The primary outcome is a composite measure of fidelity, reach and adoption. Secondary outcomes describe the effectiveness of the intervention on improving antimicrobial prescribing. Qualitative interviews will assess relevant implementation acceptability, adaptations and maintenance. A baseline survey will investigate ICU-level antimicrobial stewardship structures and processes. Discussion This study addresses global policy priorities by supporting implementation research of antimicrobial stewardship, and strengthening associated healthcare professional competencies. It does this in a setting where improvement is sorely needed: low- and middle- income country ICUs. The study will also describe the influence of pre-existing antimicrobial stewardship structures and processes on implementation and improve understanding about the efficacy of strategies to overcome barriers to implementation in these settings. Trial registration This study protocol has been registered with ClinicalTrials.gov (ref NCT06666738) on 31 Oct 2004. https://clinicaltrials.gov/study/NCT06666738?term=NCT06666738&rank=1 .https://doi.org/10.1186/s13012-024-01413-4Antimicrobial StewardshipAntimicrobial ResistanceImplementationIntensive CareCritical CareLow- and Middle- Income Countries |
| spellingShingle | Duncan Wagstaff John Amuasi Sumaiya Arfin Diptesh Aryal Mohd Basri Mat Nor Joseph Bonney Arjen Dondorp David Dongelmans Layoni Dullawe Fathima Fazla Aniruddha Ghose Eva Hanciles Rashan Haniffa Madiha Hashmi Adam Hewitt Smith Bharath Kumar Yen Lam Minh Ramani Moonesinghe Luigi Pisani Cornelius Sendagire Mohd Shahnaz Hasan Maryam Shamal Ghalib Moses Siaw Frimpong Otavio Ranzani Menbeu Sultan David Thomson Swagata Tripathy Louise Thwaites Rabiul Alam Md. Erfan Uddin Mohd Zulfakar Mazlan Wangari Waweru-Siika Abigail Beane Evidence based QUality Improvement for Prescribing Stewardship in ICU (EQUIPS-ICU): protocol for type III hybrid implementation-effectiveness study Implementation Science Antimicrobial Stewardship Antimicrobial Resistance Implementation Intensive Care Critical Care Low- and Middle- Income Countries |
| title | Evidence based QUality Improvement for Prescribing Stewardship in ICU (EQUIPS-ICU): protocol for type III hybrid implementation-effectiveness study |
| title_full | Evidence based QUality Improvement for Prescribing Stewardship in ICU (EQUIPS-ICU): protocol for type III hybrid implementation-effectiveness study |
| title_fullStr | Evidence based QUality Improvement for Prescribing Stewardship in ICU (EQUIPS-ICU): protocol for type III hybrid implementation-effectiveness study |
| title_full_unstemmed | Evidence based QUality Improvement for Prescribing Stewardship in ICU (EQUIPS-ICU): protocol for type III hybrid implementation-effectiveness study |
| title_short | Evidence based QUality Improvement for Prescribing Stewardship in ICU (EQUIPS-ICU): protocol for type III hybrid implementation-effectiveness study |
| title_sort | evidence based quality improvement for prescribing stewardship in icu equips icu protocol for type iii hybrid implementation effectiveness study |
| topic | Antimicrobial Stewardship Antimicrobial Resistance Implementation Intensive Care Critical Care Low- and Middle- Income Countries |
| url | https://doi.org/10.1186/s13012-024-01413-4 |
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