Implementation of a Technology-driven Antimicrobial Stewardship Program Steered by Clinicians to Improve Antimicrobial Prescribing: protocol of a multi-centre stepped wedge trial

BackgroundThe World Health Organization (WHO), Centre for disease Control and Prevention (CDC) gives broad guidance on how to establish, implement and evaluate AMSP. However, specific action plans for effective AMSP especially in LMICs is needed, the action plan in India is not uniformly implemented across hospitals because of prevailing issues specific to diverse hospital settings. These include-non-availability of all classes of antimicrobial agents (AMA) in the hospital, lack of in-house antibiotic policy which may lead to irrational prescription and lack of skilled manpower such as clinical pharmacists who are the pillars to prescription audits. Crucial to all this is how clinical teams are constantly engaged in informed AMA prescribing. As per the NAP-AMR strategy, hospitals have been trying to implement AMSP inspite of resource constraints. Ensuring only right drugs are used at the right time, is challenging because, engaging clinical teams has been an important bottleneck. ObjectivesTo explore the key promoters, constraints, and operational feasibility of an integrated m-health intervention program on antimicrobial consumption and AMSP in five tertiary hospitals in south India; To evaluate the effectiveness of an integrated m-health intervention program on antimicrobial consumption and AMSP in five tertiary hospitals in south India; To assess the impact of an integrated AMSP m-health intervention on the incidence of multidrug-resistant organisms in five tertiary hospitals in south India MethodologyStudy will be conducted in four tertiary hospitals across south India. Pre-intervention-A baseline data collection will be done before the delivery of the intervention. Intervention: This includes capacity building of clinicians on AMSP and provision of mobile application for them to use during patient care. Implementation of intervention-A stepped wedge trail will be conducted in the selected units various departments included in the study. This will be done over 24 months. All units receiving the intervention will be followed up for the next eight months periodically. OutcomesOutcome indicators such as consumption of antimicrobial agents, incidence of multi drug resistance organisms and healthcare associated infections will be captured during the follow ups.