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Adaptation and implementation of the ARK (Antibiotic Review Kit) Intervention to safely and substantially reduce antibiotic use in hospitals: A feasibility study

Adaptation and implementation of the ARK (Antibiotic Review Kit) Intervention to safely and substantially reduce antibiotic use in hospitals: A feasibility study
Adaptation and implementation of the ARK (Antibiotic Review Kit) Intervention to safely and substantially reduce antibiotic use in hospitals: A feasibility study
Background: Antimicrobial stewardship initiatives in secondary care depend on clinicians undertaking antibiotic prescription reviews but decisions to limit antibiotic treatment at review are complex. 
Aim: To assess the feasibility and acceptability of implementing ARK (Antibiotic Review Kit), a behaviour change intervention made up of four components (brief online tool, prescribing decision aid, regular data collection and feedback process, and patient leaflet) to support stopping antibiotic treatment when it is safe to do so among hospitalised patients; before definitive evaluation through a stepped-wedge cluster randomised controlled trial. 
Methods: Acceptability of the different intervention elements was assessed over 12-weeks by uptake of the online tool, adoption of the decision aid into prescribing practice, and rates of decisions to stop antibiotics at review (assessed through repeated point-prevalence surveys). Patient perceptions of the information leaflet were assessed through a brief questionnaire. 
Findings: All elements of the intervention were successfully introduced into practice. A total of 132 staff encompassing a broad range of prescribers and non-prescribers completed the online tool (19.4 per 100 acute beds), including 97% (32/33) of the pre-specified essential clinical staff. Among 588 prescription charts evaluated in seven point prevalence surveys over the 12-week implementation period, 82% overall (76-90% at each survey) used the decision aid. The median antibiotic stop rate post implementation was 36% (range 29-40% at each survey) compared with 9% pre implementation (p<0.001). 
Conclusion: ARK provides a feasible and acceptable mechanism to support stopping antibiotics safely at post-prescription reviews in an acute hospital setting.
Antimicrobial stewardship, prescribing practice, antibiotic usage
0195-6701
268-275
Cross, Elizabeth
575782f7-a032-4794-89bf-0a27c7217b95
Sivyer, Katy
c9831d57-7d6b-4bb6-bb3c-770ea7f9b116
Islam, Jasmin
06d0a615-a58b-4272-9a5e-f5474118458c
Santillo, Marta
ea247305-2516-4c12-9c07-bf33cf659038
Mowbray, Fiona
0a9e37a7-06c7-4926-95cb-af2d1eb22157
Peto, Tim
dd1c6791-fff1-4c4f-af11-bfe35e01b959
Walker, Sarah
b586dd08-93f5-4f5a-b79c-7c01e9b03d91
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Llewelyn, Martin
63b583ab-69de-4bd0-b0a7-051f16e69542
Cross, Elizabeth
575782f7-a032-4794-89bf-0a27c7217b95
Sivyer, Katy
c9831d57-7d6b-4bb6-bb3c-770ea7f9b116
Islam, Jasmin
06d0a615-a58b-4272-9a5e-f5474118458c
Santillo, Marta
ea247305-2516-4c12-9c07-bf33cf659038
Mowbray, Fiona
0a9e37a7-06c7-4926-95cb-af2d1eb22157
Peto, Tim
dd1c6791-fff1-4c4f-af11-bfe35e01b959
Walker, Sarah
b586dd08-93f5-4f5a-b79c-7c01e9b03d91
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Llewelyn, Martin
63b583ab-69de-4bd0-b0a7-051f16e69542

Cross, Elizabeth, Sivyer, Katy, Islam, Jasmin, Santillo, Marta, Mowbray, Fiona, Peto, Tim, Walker, Sarah, Yardley, Lucy and Llewelyn, Martin (2019) Adaptation and implementation of the ARK (Antibiotic Review Kit) Intervention to safely and substantially reduce antibiotic use in hospitals: A feasibility study. Journal of Hospital Infection, 103 (3), 268-275. (doi:10.1016/j.jhin.2019.07.017).

Record type: Article

Abstract

Background: Antimicrobial stewardship initiatives in secondary care depend on clinicians undertaking antibiotic prescription reviews but decisions to limit antibiotic treatment at review are complex. 
Aim: To assess the feasibility and acceptability of implementing ARK (Antibiotic Review Kit), a behaviour change intervention made up of four components (brief online tool, prescribing decision aid, regular data collection and feedback process, and patient leaflet) to support stopping antibiotic treatment when it is safe to do so among hospitalised patients; before definitive evaluation through a stepped-wedge cluster randomised controlled trial. 
Methods: Acceptability of the different intervention elements was assessed over 12-weeks by uptake of the online tool, adoption of the decision aid into prescribing practice, and rates of decisions to stop antibiotics at review (assessed through repeated point-prevalence surveys). Patient perceptions of the information leaflet were assessed through a brief questionnaire. 
Findings: All elements of the intervention were successfully introduced into practice. A total of 132 staff encompassing a broad range of prescribers and non-prescribers completed the online tool (19.4 per 100 acute beds), including 97% (32/33) of the pre-specified essential clinical staff. Among 588 prescription charts evaluated in seven point prevalence surveys over the 12-week implementation period, 82% overall (76-90% at each survey) used the decision aid. The median antibiotic stop rate post implementation was 36% (range 29-40% at each survey) compared with 9% pre implementation (p<0.001). 
Conclusion: ARK provides a feasible and acceptable mechanism to support stopping antibiotics safely at post-prescription reviews in an acute hospital setting.

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JHI-D-19-00456 R1 CLEAN - Accepted Manuscript
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Accepted/In Press date: 30 July 2019
e-pub ahead of print date: 5 August 2019
Published date: November 2019
Keywords: Antimicrobial stewardship, prescribing practice, antibiotic usage

Identifiers

Local EPrints ID: 433643
URI: http://eprints.soton.ac.uk/id/eprint/433643
ISSN: 0195-6701
PURE UUID: b8b88414-643f-4f1b-bee7-7dce72b535b6
ORCID for Katy Sivyer: ORCID iD orcid.org/0000-0003-4349-0102
ORCID for Fiona Mowbray: ORCID iD orcid.org/0000-0002-3297-4163
ORCID for Lucy Yardley: ORCID iD orcid.org/0000-0002-3853-883X

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Date deposited: 28 Aug 2019 16:30
Last modified: 07 Oct 2020 05:44

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Contributors

Author: Elizabeth Cross
Author: Katy Sivyer ORCID iD
Author: Jasmin Islam
Author: Marta Santillo
Author: Fiona Mowbray ORCID iD
Author: Tim Peto
Author: Sarah Walker
Author: Lucy Yardley ORCID iD
Author: Martin Llewelyn

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