Inglés

In‑situ Nudges for Guidelines, Local resistance, Estimated Susceptibility

In‑situ Nudges for Guidelines, Local resistance, Estimated Susceptibility

Linear

https://linear.app/safehr/issue/RAD-232

The Inglés trials are layered randomised controlled trials working to improve the quality of antibiotic prescribing through point of care decision support (PoC-DS). The layering allows us to safely and efficiently introduce an increasingly complex intervention. In each layer, the trial targets the same population, and works to improve the same overarching outcome, but as the decision support becomes more sophisticated then the design adapts.

We provide a worked example focusing on antibiotic prescribing in patients with urinary tract infections. The three layers are described below.

Layer	Layer name	Point of care information
1	Inglés-Guidelines	A hospital antibiotic guideline reminder
2	Inglés-Resistance	Historical antibiotic resistance profile
3	Inglés-Estimated Susceptibility	Predicted antibiotic resistance

The overarching patient centred outcome is a reduction in patient morbidity and mortality by reducing bug-drug mismatches, antibiotic side-effects (e.g. diarrhoea), and the risk of future antibiotic resistance (by reducing exposure to antibiotics on the watch or reserve lists). The primary endpoints depend on the layer.

Layer	Intervention	Outcome
1	Interruptive alert when prescribing off the hospital guideline	Improved compliance with hospital antibiotic guidelines
2	Bug-drug mismatch alert based on historical antimicrobial resistance	Reduced bug-drug mismatch against historical samples
3	Bug-drug mismatch alert based on predicted antimicrobial resistance	Reduced bug-drug mismatch against current samples