ARK-Hospital is an NIHR-funded applied research programme which aims to substantially reduce antibiotic overuse through better “review & revise” decisions. It is led by a network of NHS clinicians and investigators from the Universities of Oxford, Southampton and Sussex.
Department of Health guidance in place since 2011 promotes an initiative called ‘Start Smart then Focus’ to encourage prudent use of antibiotics in hospitals. This recommends early effective antibiotics followed by active ‘review and revise’ 24-72 hours later, with a decision to either stop antibiotics, switch from intravenous to oral administration, continue and review again, change (if possible to antibiotics with narrower spectrum of activity), or move to outpatient intravenous antibiotic therapy.
For many reasons, ‘review and revise’ is not very effective at controlling unnecessary antibiotic use. When doctors review prescriptions antibiotics are mostly continued even though detailed studies suggest they could be stopped in many cases. It is estimated that 30% of antibiotic courses could be stopped at review and revise. The UK Government has committed to a 50% reduction in inappropriate use of antibiotics in hospitals by 2020. A CQUIN for reducing antibiotic use was introduced in 2016 and this will remain a CQUIN until 2019 at least. The CQUIN data indicate that currently >90% of courses are continued at review and revise.
The main question addressed by ARK-Hospital is whether a package of interventions, designed carefully following theories of health psychology and behaviour change, can increase healthcare worker uptake of the ‘review and revise’ strategy, and whether a similarly designed leaflet for patients can increase patient acceptability of shorter antibiotic therapy durations driven by ‘review and revise’.
ARK started in March 2016. The intervention – which includes educational material, a decision tool, a patient leaflet and tools to support audit and feedback – has been developed in iterative and close engagement with patients and healthcare workers.
to access the ARK online training tool.