Implementation of the Antimicrobial Review Kit (ARK) to optimise antimicrobial prescribing at the Royal Cornwall Hospital: a behavioural change odyssey

Antibiotic use drives antimicrobial resistance (AMR). The Antimicrobial Review Kit (ARK) study is a complex intervention based on national antibiotic stewardship guidance. We describe the implementation of ARK at a 760-bed teaching hospital that uses electronic prescribing. An online education module was disseminated to healthcare workers, and the ARK decision tool was incorporated into the medical clerking pro forma. From July 2018, junior doctors audited the frequency, the outcomes of pre-72-hour antibiotic reviews and the use of the ARK tool. The data were used to formulate specialty-level feedback and bench marking. First-phase data were plotted on statistical process control (SPC) charts to distinguish between common and special cause variation. There was significant improvement in antibiotic review rates (81% to 93%) and stop rates (10% to 15%). The stop rate reached 25% in the most recent data. Given the promising trends, it may be possible to achieve the target stop rate of 30%.