Santillo, M;
Sivyer, K;
Krusche, A;
Mowbray, F;
Jones, N;
Peto, TEA;
Walker, A;
... Yardley, L; + view all
(2019)
Intervention planning for ARK (Antibiotic Review Kit): a digital and behavioural intervention to safely review and reduce antibiotic prescriptions in acute and general medicine.
Journal of Antimicrobial Chemotherapy
, 74
(11)
pp. 3362-3370.
10.1093/jac/dkz333.
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Abstract
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 organizational factors. Objectives: To develop and optimize the Antibiotic Review Kit (ARK) intervention. ARK is a complex digital, organizational 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 optimize 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 to and facilitators of 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 optimization 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 (see http://bsac-vle.com/ark-the-antibiotic-review-kit/ and http://antibioticreviewkit.org.uk/). ARK will be evaluated in a feasibility study and, if successful, a stepped-wedge cluster-randomized controlled trial at acute hospitals across the NHS.
| Type: | Article |
|---|---|
| Title: | Intervention planning for ARK (Antibiotic Review Kit): a digital and behavioural intervention to safely review and reduce antibiotic prescriptions in acute and general medicine |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1093/jac/dkz333 |
| Publisher version: | https://doi.org/10.1093/jac/dkz333 |
| Language: | English |
| Additional information: | © The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
| Keywords: | antibiotics, consultation, decision support techniques, feedback, nurses, pharmacists, prescribing behavior, antimicrobial stewardship, transparency, behavioral health interventions |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10078420 |
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