Table 1.

Feasibility trial objectives and summary findings

Objective	Methodology	Completed	Key findings
1. Explore acceptability to users of the content and any barriers to uptake of the ePAMS+ technical component	Qualitative	Yes	Users reported difficulty in finding review documentation
2. Investigate whether ePAMS+ Antibiotic Order Plans can be used as intended in clinical practice and the reasons why this may not happen	Qualitative	Yes	Used correctly, but infrequently due to it being non-compulsory. ePAMS+ did not cover non-standard cases such as combinations of antibiotics
3. Assess acceptability to healthcare professionals of the ePAMS+ intervention organisational and educational components	Qualitative	Yes	Champion appointed and led training. No regular, formalised meetings undertaken; generally low awareness among staff Online training – reduce duration by removing video content; staff welcomed “at elbow” on the job support and training
4. Establish how ePAMS+ may best be implemented in various care contexts and health information systems	Qualitative	Yes	Assessment Suite ward at start of many patients’ admission journey identified as a key point for implementing ePAMS+ . Recognised importance of use in general medical wards, not just those in which specialist microbiology input is available
5. Confirm whether the processes used to implement ePAMS+ are acceptable and feasible	Qualitative	Yes	Found not to be acceptable or feasible; points towards opportunities for greater communication and improvements to the implementation plan
6. Create a Fidelity Index to measure the extent to which the core ePAMS+ intervention themes are delivered in antibiotic prescribing and test usability of the Fidelity Index	Quantitative	Partially	The routine data extract can inform whether critical decision-making points (or core ePAMS+ intervention themes) were adhered to when delivering ePAMS+ intervention. Insufficient antibiotic review data to progress further with Fidelity Index development
7. Explore hypothesised mechanisms of action, refine programme theory and select appropriate process analysis measures to be used a future trial evaluating ePAMS+	Qualitative	Yes	The trial generated hypotheses which will require further testing, for example regarding alternative delivery of education component
8. Confirm whether ePAMS+ can be integrated successfully into hospitals to facilitate prescribing behaviour changes	Qualitative / Quantitative	Yes	Full integration not achieved, evidenced by low uptake of online training and small number of reviews undertaken. Importance of intervention being optional rather than mandatory
9. Build processes of collecting outcome data from EPMA systems before and after introduction of the ePAMS+ ePrescribing tools	Quantitative	Partially	Some outcomes could be successfully extracted and derived from EPMA system. Some process measures could only be recorded after ePAMS+ had been implemented. Lack of availability of indication data meant that a number of outcomes could not be derived
10. Quantify between-patient variability in total antibiotic consumption, confirming the sample size required for a full-scale trial evaluating the ePAMS+ intervention	Quantitative	Yes	Antibiotic consumption data modelled and residual variance used to inform sample size calculations for future ePAMS+ evaluation studies