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

Antimicrobial stewardship: a COVID casualty?

“…It has been proposed that this diagnostic uncertainty can be managed by utilising decision support tools to support prescribers undertaking antimicrobial prescribing [ 13 ]. One such tool was incorporated into the Antibiotic Review Kit (ARK) intervention which, having been successful in increasing rates of stopping unnecessary antibiotics in a feasibility study at a single centre, was expanded to hospitals across the UK in 2018 [ 14 ]. One of the aims of this is to prevent decision inertia, whereby an antibiotic, appropriately started in the context of an unwell patient and incomplete information, is continued despite further evidence becoming available of alternate, often non-infectious, diagnoses.…”

Impact of antibiotic use on patient-level risk of death in 36 million hospital admissions in England

“…This is challenging in clinical practice. We have reported previously that hospitals which do this well have lower rates of C. difficile infection [34], and interventions to increase stop rates at review are feasible in hospital settings [25]. It is to be expected that at hospitals where antibiotic prescription reviews are done well, fewer antibiotics would be used without compromising patient outcomes.…”

“…Although 20-30% of prescriptions may be safely stopped at review [23], stop and review dates are poorly documented [24] and opportunities to stop early or "de-escalate"i.e. switch from parenteral to oral antibiotics, or to agents with a narrower spectrum of activityare often missed [25][26][27][28]. In NHS hospitals antibiotic consumption has continued to increase year-on-year [18] despite the introduction of financial incentives to reduce overuse [29].…”

Patient engagement with antibiotic messaging in secondary care: a qualitative feasibility study of the ‘review and revise’ experience

“…For the feasibility trial, all intervention elements were implemented in one medium-sized acute hospital in the UK. Full details of how ARK was used by healthcare professionals during the study are available in a separate publication [12]. The qualitative study described here was an investigation of the feasibility and acceptability of the patient leaflet element of the intervention among patients at the feasibility study site.…”