Think Ethics: Insights from the Health Research Authority Approval Process for Antimicrobial Stewardship During COVID-19 Research at an English NHS Foundation Trust

This communication article explores the Health Research Authority's (HRA) approval process for a research project on antimicrobial stewardship (AMS) conducted at an English NHS Foundation Trust during the COVID-19 pandemic. The project, involving a retrospective review of patient records and a survey of healthcare professionals, faced the intimidating task of navigating the Integrated Research Application System (IRAS). The streamlined HRA process, incorporating a thorough review by the NHS Research Ethics Committee (REC) and regulatory checks, efficiently replaced the need for multiple reviews across NHS organisations. Obtaining HRA approval required strict adherence to confidentiality requirements and thorough documentation submission, including research protocols and participant information sheets. The REC's evaluation process covered both full committee reviews and proportionate reviews, each with specific timeframes. This methodical approach ensured the protection of participant rights and dignity. Post-approval, the project could not commence until all regulatory approvals were in place, necessitating effective project management skills and strategic communication. The study yielded valuable insights into AMS practices prior to and during the pandemic, highlighting shifts in antibiotic prescribing patterns and the impact of COVID-19 on these practices. Notably, the study revealed the importance of robust AMS to ensure appropriate use and combat antimicrobial resistance. Reflecting on this journey, key lessons include the importance of public and patient involvement, the e​f​f​e​c​t​i​