User Experience of a Clinical Decision Support System (CDSS) in the Form of a Mobile App in Supporting Antimicrobial Stewardship

Abstract

Electronic clinical decision support system (CDSS) delivered through smartphone applications have been shown to improve adherence to prescribing guidelines. Their growing use within the NHS highlights the importance of evaluating usability, adoption, and impact on prescribing behaviours. Microguide, a widely used platform in UK was upgraded from version 1(M1) to version 2 (M2) incorporating decision support to strengthen antimicrobial stewardship.
This study explored prescribers’ experiences with the upgraded Microguide M2 at Mid and South Essex NHS Foundation Trust that used Intravenous to oral switch support tool. A mixed method design was conducted, combining online surveys, application analytics and interviews to compare experiences pre and post implementation of M2.
Quantitative analysis showed that perceived usefulness declined slightly with the upgrade, median scores fell from 4.0 (M1) to 3.5 (M2), a statistically significant difference (Mann-Whitney U test p<0.05). The M2 tool itself was rated moderately useful (median score 3.0), with only 37.5% of prescribers reporting consistent use, though those who used it found it clinically supportive. Despite these perceptions, the Trust level outcomes improved.
Compliance with national metrics strengthened during 2023/2024 financial year, with inappropriate continuation of IV antibiotics reduced to 14% by quarter 4, suggesting positive stewardship impact in practice.
The qualitative findings revealed barriers such as technical instability and PIN code access, yet clinicians valued M2 as a trusted, quick reference educational aid. It was particularly useful in reinforcing stewardship principles, supporting Intravenous to oral switch, and empowering junior doctors to challenge inappropriate prescribing.
In conclusion, Microguide M2 with Intravenous to oral switch functionality represents a valuable adjunct to AMS practice, contributing to improved compliance with national standards and enhancing prescriber confidence. To maximise impact, integration into workflows, addressing technical barriers, and embedding behavioural frameworks are recommended.

Date of Award	10 Feb 2026
Original language	English
Awarding Institution	University of Portsmouth
Supervisor	Paul Rutter (Supervisor) & Sarah Hill (Supervisor)