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

Wagstaff, Duncan and Amuasi, John and Arfin, Sumaiya and Aryal, Diptesh and Mat Nor, Mohd Basri and Bonney, Joseph and Dondorp, Arjen and Dongelmans, David and Dullawe, Layoni and Fazla, Fathima and Ghose, Aniruddha and Hanciles, Eva and Haniffa, Rashan and Hashmi, Madiha and Smith, Adam Hewitt and Kumar, Bharath and Minh, Yen Lam and Moonesinghe, Ramani and Pisani, Luigi and Sendagire, Cornelius and Hasan, Mohd Shahnaz and Ghalib, Maryam Shamal and Frimpong, Moses Siaw and Ranzani, Otavio and Sultan, Menbeu and Thomson, David and Tripathy, Swagata and Thwaites, Louise and Uddin, Rabiul Alam Md. Erfan and Mazlan, Mohd Zulfakar and Waweru-Siika, Wangari and Beane, Abigail (2025) Evidence based QUality Improvement for Prescribing Stewardship in ICU (EQUIPS-ICU): protocol for type III hybrid implementation-effectiveness study. Implementation Science, 20 (1). pp. 1-12. E-ISSN 1748-5908

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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. © The Author(s) 2025.

Item Type:	Article (Journal)
Uncontrolled Keywords:	Anti-Bacterial Agents; Antimicrobial Stewardship; Humans; Implementation Science; Inappropriate Prescribing; Intensive Care Units; Quality Improvement; antiinfective agent; antimicrobial stewardship; human; implementation science; intensive care unit; organization and management; prescribing error; prevention and control; total quality management
Subjects:	R Medicine > R Medicine (General)
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Medicine Kulliyyah of Medicine > Department of Anaesthesiology & Intensive Care
Depositing User:	Fuziah Arifin
Date Deposited:	22 May 2025 16:26
Last Modified:	22 May 2025 16:26
URI:	http://irep.iium.edu.my/id/eprint/121153

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