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J Antimicrob Chemother. 2019 Aug 20. pii: dkz333. doi: 10.1093/jac/dkz333. [Epub ahead of print]

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

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Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK.
Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Nuffield Department of Medicine, University of Oxford, Oxford, UK.
NIHR Biomedical Centre, Oxford, UK.
Brighton and Sussex Medical School, University of Sussex, Falmer, UK.
School of Psychological Science, University of Bristol, Bristol, UK.



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.


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.


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.


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.


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.


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