Intervention planning for Antibiotic Review Kit (ARK): a digital and behavioural intervention to safely review and reduce antibiotic prescriptions in acute and general medicine

Background

Hospital antimicrobial stewardship strategies, such as “Start Smart, then Focus” in the UK, balance the need for prompt, effective antibiotic treatment with the need to limit antibiotic overuse using “review and revise”. However only a minority of review decisions are to stop antibiotics. Research suggests that this is due to both behavioural and organisational factors.

Objectives

To develop and optimise the ARK (Antibiotic Review Kit) intervention. ARK is a complex digital, organisational and behavioural intervention that supports implementation of “review and revise” to help healthcare professionals safely stop unnecessary antibiotics.
Methods
A theory-, evidence- and person-based approach was used to develop and optimise ARK and its implementation. This was done through iterative stakeholder consultation and in-depth qualitative research with doctors, nurses, and pharmacists in UK hospitals. Barriers and facilitators to the intervention and its implementation, and ways to address them, were identified and then used to inform the intervention’s development.

Results

A key barrier to stopping antibiotics was reportedly a lack of information about the original prescriber’s rationale for and their degree of certainty about the need for antibiotics. An integral component of ARK was the development and optimisation of a Decision Aid and its implementation to increase transparency around initial prescribing decisions.

Conclusions

The key output of this research is a digital and behavioural intervention targeting important barriers to stopping antibiotics at review. ARK will be evaluated in a feasibility study and, if successful, a stepped-wedge cluster-randomised controlled trial at acute hospitals across the NHS.