Usher Institute


Development and evaluation of a complex ePrescribing-based Antimicrobial Stewardship (ePAMS+) intervention for hospitals.

A multidisciplinary collaboration to develop and evaluate a multifaceted intervention (ePAMS+) that incorporates technical, behavioural and organisational components to safely reduce inappropriate antibiotic use in adult medical in-patients.

epams logo

Summary (Research in a nutshell)

Increasingly, bacteria (germs) no longer respond to antibiotics. This means antibiotics have begun to stop working as well as they should. This can result in patients experiencing more severe infections, lasting longer than they previously did, and may, in some cases, lead to an increased risk of dying from infections.

This is due to too much inappropriate use of antibiotics. The UK Government and World Health Organization believe this is an extremely important issue to tackle.

To improve antibiotic prescribing, "6Rs" should be followed; patients should be given:

  1. the Right antibiotic;
  2. at the Right dose;
  3. by the Right route;
  4. for the Right infection;
  5. at the Right time; and
  6. for the Right duration.

The reasons for overuse of antibiotics include doctors not having relevant information (e.g. on resistance patterns) when prescribing antibiotics, concerns about missing possibly serious infections, and time pressures/lack of continuity of care, limiting opportunities for doctors to review diagnoses and stop antibiotics if no longer needed. Our literature review and discussions with experts found that hospital electronic prescribing (ePrescribing) systems can be used as a type of software that can be used to support new ways of working designed to safely reduce inappropriate antibiotic prescribing. Most of this work however comes from the United States. There is very little UK experience of developing such interventions to achieve the 6Rs.

We will build on our recently completed NIHR-funded research, which developed an ePrescribing Toolkit. This has promoted the use of hospital ePrescribing systems across NHS England. As ePrescribing systems become more widely available, we want to see if they can be used to safely reduce antibiotic prescribing with no change in mortality.

ePrescribing Toolkit website

We will begin by carefully planning all the elements a new intervention (ePAMS+) needs to help hospitals achieve the 6R's. From our preliminary work, we anticipate that ePAMS+ will incorporate two closely related parts: i) a training package, clinical team processes and patient leaflet to help everyone involved understand the importance of reducing antibiotic use and how this can be done safely and effectively; ii) an online computer software system that works with the existing ePrescribing system, gathering information relevant to making antibiotic prescribing decisions, presenting this to clinicians at the time and in the format it is needed, and monitoring/providing feedback to clinical teams on the appropriateness of their antibiotic use.

We will investigate how best to deliver ePAMS+ to hospitals by testing it on a small scale before undertaking a larger study. This will allow us to measure the clinical effects of ePAMS+ on antibiotic use and assess whether ePAMS+ is a good use of NHS resources. We will do this by comparing antibiotic prescribing/administration before and after introducing ePAMS+.

Key people

Name Role
Professor Aziz Sheikh Principal Investigator
Professor Jamie Coleman (University Hospitals Birmingham NHS Foundation Trust) Principal Investigator
Rinku Rajan Research Manager



ePAMS+ project website


The Newcastle Upon Tyne Hospitals NHS Foundation Trust

Royal Free London NHS Foundation Trust

NHS England

University of Bristol

University of Birmingham

Newcastle University

University of Warwick

Brigham and Women's Hospital

NIHR logo


This programme is funded by the National Institute for Health Research (Programme Grants for Applied Research, Development and evaluation of a complex ePrescribing-based Antimicrobial Stewardship (ePAMS+) Intervention for hospitals, RP-PG-0617-20009).


Feb 2019 - July 2024 (66 months)