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

M Santillo, K Sivyer, A Krusche, F Mowbray, N Jones, T E A Peto, A S Walker, M J Llewelyn, L Yardley, Amy Lee, Catherine Sargent, Chris Butler, Chris Roseveare, Daniel Agranoff, Debbie Lockwood, Donald Lyon, Elizabeth Cross, Elizabeth Darwin, Gavin Barlow, Ian SetchfieldJasmin Islam, Juliet Wright, Kieran Hand, Louella Vaughan, Mark Wilcox, Martin Wiselka, Mike Sharland, Nicola Jones, Nicola Fawcett, Paul Wade, R Martin Dachsel, Rachaeol Sierra, Richard Bellamy, Sacha Pires, Sally Curtis, Samantha Lippett, Sue Crossland, Susan Hopkins, Veronica Garcia-arias, Vikesh Gudka, Will Hamilton, Clifford Gorton

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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 and ARK will be evaluated in a feasibility study and, if successful, a stepped-wedge cluster-randomized controlled trial at acute hospitals across the NHS.
Original languageEnglish
Pages (from-to)3362-3370
JournalJournal of Antimicrobial Chemotherapy
Issue number11
Early online date20 Aug 2019
Publication statusPublished - 1 Nov 2019


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