Exploring two distinct gentamicin prescribing protocols in UK hospitals: a mixed-methods realist evaluation.
dc.contributor.author | Dyar, N | |
dc.contributor.author | Mattick, K | |
dc.contributor.author | Bethune, R | |
dc.date.accessioned | 2022-09-16T14:14:38Z | |
dc.date.issued | 2021-12-23 | |
dc.date.updated | 2022-09-16T13:47:36Z | |
dc.description.abstract | OBJECTIVES: Gentamicin is the aminoglycoside antibiotic of choice in the UK. It has a narrow therapeutic index: underdosing results in inefficacy while overdosing is characterised by nephrotoxicity and ototoxicity. To improve patient safety, hospitals have protocols for the prescription of gentamicin, which vary in complexity and approach. This study aimed to explore two distinct protocols for prescribing gentamicin in hospital settings, in order to understand the mechanisms they trigger and the outcomes they achieve. SETTING: A mixed-methods realist evaluation explored gentamicin prescribing protocols in two hospital surgical admissions units in South West England between January and August 2018. Site 1 had a traditional, complex protocol, while site 2 took a simplified protocol. PARTICIPANTS: Testing the initial programme theory (IPT) involved semi-structured audio-recorded interviews of a volunteer sample of healthcare professionals (HCPs) involved in the prescribing and administering process, alongside a clinical audit reviewing accuracy of gentamicin prescribing. OUTCOME MEASURES: Three sequential phases were used to identify factors in a successful protocol: IPT generation; testing; refinement of the IPT. The IPT was generated by literature search and analysis of existing protocols of sites 1 and 2. Refinement of the IPT synthesised the results of the quantitative and qualitative research to identify the key characteristics of a successful protocol. RESULTS: One hundred gentamicin prescriptions were reviewed, with a mean accuracy of gentamicin prescribing at site 1 of 65.67% and at site 2 of 78.79% (p<0.01). Thirty HCPs were interviewed. Key contexts were identified including prescriptiveness, experience and availability of patient information. These triggered hidden mechanisms including uncertainty, fear, confidence and frustration leading to both intended outcomes but also unintended outcomes such as deviation from protocol and unnecessary gentamicin levels. CONCLUSIONS: A simplified prescribing protocol for gentamicin is better accepted by prescribers, leading to better adherence to protocol and more accurate prescribing. | en_GB |
dc.format.extent | e052697- | |
dc.format.medium | Electronic | |
dc.identifier.citation | Vol. 11, no. 12, article e052697 | en_GB |
dc.identifier.doi | https://doi.org/10.1136/bmjopen-2021-052697 | |
dc.identifier.uri | http://hdl.handle.net/10871/130872 | |
dc.identifier | ORCID: 0000-0003-1800-773X (Mattick, Karen) | |
dc.identifier | ScopusID: 56723888400 | 57130622400 | 6701773218 (Mattick, Karen) | |
dc.identifier | ORCID: 0000-0002-1855-0639 (Bethune, Rob) | |
dc.language.iso | en | en_GB |
dc.publisher | BMJ | en_GB |
dc.relation.url | https://www.ncbi.nlm.nih.gov/pubmed/34949620 | en_GB |
dc.rights | © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. | en_GB |
dc.subject | clinical audit | en_GB |
dc.subject | education & training (see medical education & training) | en_GB |
dc.subject | microbiology | en_GB |
dc.subject | protocols & guidelines | en_GB |
dc.subject | qualitative research | en_GB |
dc.title | Exploring two distinct gentamicin prescribing protocols in UK hospitals: a mixed-methods realist evaluation. | en_GB |
dc.type | Article | en_GB |
dc.date.available | 2022-09-16T14:14:38Z | |
dc.identifier.issn | 2044-6055 | |
exeter.article-number | ARTN e052697 | |
exeter.place-of-publication | England | |
dc.description | This is the final version. Available from BMJ Publishing via the DOI in this record. | en_GB |
dc.description | Data availability statement: Data are available upon reasonable request. The raw data cannot be made freely available to share, given the nature of the consents given by participants. However, the corresponding author (ND ORCID ID: 0000-0002-8797-3467) can be contacted to discuss possible secondary analyses of deidentified participant data. | en_GB |
dc.identifier.journal | BMJ Open | en_GB |
dc.relation.ispartof | BMJ Open, 11(12) | |
dc.rights.uri | http://creativecommons.org/licenses/by-nc/4.0/ | en_GB |
dcterms.dateAccepted | 2021-11-24 | |
dc.rights.license | CC BY-NC | |
rioxxterms.version | VoR | en_GB |
rioxxterms.licenseref.startdate | 2021-12-23 | |
rioxxterms.type | Journal Article/Review | en_GB |
refterms.dateFCD | 2022-09-16T14:12:36Z | |
refterms.versionFCD | VoR | |
refterms.dateFOA | 2022-09-16T14:14:50Z | |
refterms.panel | A | en_GB |
refterms.dateFirstOnline | 2021-12-23 |
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Except where otherwise noted, this item's licence is described as © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.