Antibiotic Review Kit for Hospitals (ARK-Hospital)

Conditions

Antibiotic resistance Infections and Infestations

Llewelyn MJ, Budgell EP, Laskawiec-Szkonter M, Cross ELA, Alexander R, Bond S, Coles P, Conlon-Bingham G, Dymond S, Evans M, Fok R, Frost KJ, Garcia-Arias V, Glass S, Gormley C, Gray K, Hamson C, Harvey D, Hills T, Iyer S, Johnson A, Jones N, Kang P, Kiapi G, Mack D, Makanga C, Mawer D, McCullagh B, Mirfenderesky M, McEwen R, Nag S, Nagar A, Northfield J, O'Driscoll J, Pegden A, Porter R, Powell N, Price D, Sheridan E, Slatter M, Stewart B, Watson C, Weichert I, Sivyer K, Wordsworth S, Quaddy J, Santillo M, Krusche A, Roope LSJ, Mowbray F, Hand KS, Dobson M, Crook DW, Vaughan L, Hopkins S, Yardley L, Peto TEA, Walker AS.

2022-10-0422 citations

10.1016/s1473-3099(22)00508-4

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

Mowbray F, Sivyer K, Santillo M, Jones N, Peto TEA, Walker AS, Llewelyn MJ, Yardley L.

2020-04-045 citations

10.1186/s40814-020-00590-5

Antibiotic Review Kit for Hospitals (ARK-Hospital): study protocol for a stepped-wedge cluster-randomised controlled trial.

Walker AS, Budgell E, Laskawiec-Szkonter M, Sivyer K, Wordsworth S, Quaddy J, Santillo M, Krusche A, Roope LSJ, Bright N, Mowbray F, Jones N, Hand K, Rahman N, Dobson M, Hedley E, Crook D, Sharland M, Roseveare C, Hobbs FDR, Butler C, Vaughan L, Hopkins S, Yardley L, Peto TEA, Llewelyn MJ, ARK trial team.

2019-07-116 citations

10.1186/s13063-019-3497-y

Interventions

This study consists of a behavioural intervention delivered to healthcare professionals involved in antibiotic prescribing or administration in adult inpatients admitted to acute/general medicine at d

Eligibility

Sex/Gender

All

Inclusion criteria

Inclusion criteria: NHS Trusts: 1. Acute or district general NHS Trust admitting patients to acute/general medicine 2. Willing to implement the intervention in healthcare professionals involved in antibiotic prescribing or administration in adult acute/general medicine, and able to identify a local ‘champion’ to lead this 3. Able to provide the required routine electronic data on adult patients admitted to acute/general medicine over the required time periods Participant level for patient/carer interviews that form part of the process evaluation: 1. Participant is willing and able to give informed consent for participation in the interview study 2. Male or female, aged 18 years or above 3. Admitted to acute/general medicine 4. Has received a course of antibiotic treatment started in hospital in the last 7-14 days 5. Either the patient themselves, or a close friend or family member who supported the patient during their inpatient stay and antibiotic treatment

Exclusion criteria

Exclusion criteria: Not meeting inclusion criteria.

Design outcomes

Primary

Measure	Time frame
Feasibility phase: 1. Acceptability of the intervention for healthcare professionals and patients are assessed through qualitative process evaluation at the end of the three month feasibility trial 2. Barriers to implementation are assessed through qualitative process evaluation at the end of the three month feasibility trial Pilot phase: Uptake of the online training component of the intervention is measured by the proportion of locally identified and prespecified essential individuals who complete the online training (recorded electronically) at three months of being invited to complete the training Main trial: 1. Effect of introducing the intervention on the 30-day mortality post-admission is measured using death rates from hospital records at 30 days after admission to the acute/general medicine unit 2. Effect of introducing the intervention on the antibiotic exposure per acute/general medical admission is measured using the defined-daily-doses (DDD) of antibiotics per acute/general medical admission in the electronic hospital prescribing records at each admission and discharge	—

Measure

Time frame

Feasibility phase: 1. Acceptability of the intervention for healthcare professionals and patients are assessed through qualitative process evaluation at the end of the three month feasibility trial 2. Barriers to implementation are assessed through qualitative process evaluation at the end of the three month feasibility trial Pilot phase: Uptake of the online training component of the intervention is measured by the proportion of locally identified and prespecified essential individuals who complete the online training (recorded electronically) at three months of being invited to complete the training Main trial: 1. Effect of introducing the intervention on the 30-day mortality post-admission is measured using death rates from hospital records at 30 days after admission to the acute/general medicine unit 2. Effect of introducing the intervention on the antibiotic exposure per acute/general medical admission is measured using the defined-daily-doses (DDD) of antibiotics per acute/general medical admission in the electronic hospital prescribing records at each admission and discharge

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Secondary

Measure	Time frame
Pilot phase: 1. Uptake of the ARK 'review and revise' procedure within the intervention is measured using the proportion of regularly audited antibiotics prescriptions which document the ARK classification criteria at three months of being invited to complete the training. 2. Antibiotic exposure per acute/general medical admission before and after introducing the intervention is measured using the DDD of antibiotics per acute/general medical admission in the electronic hospital prescribing records at hospital admission and discharge Main trial: 1. Effect of introducing the intervention on antibiotic exposure using different metrics i measured using the DDD per occupied bed-day, days on antibiotics per admission and bed day (length-of-therapy (LOT)), antibiotic days per admission and bed-day (days-of-therapy, DOT), carbapenem DDD, DOT and LOT per admission and per bed-day) at each admission and discharge. 2. Effect of introducing the intervention on adverse outcomes is measured using the ICU admission during current admission, total length-of-stay (hours), antibiotic restart after discontinuation, re-admission in the 30 days after discharge, C. difficile diarrhoea, mortality over the longer-term using repeated cross-sectional surveys at current admission, re-admissions, up to 30 days post-discharge and for 90 days post admission (for mortality) 3. Impact of the intervention on the fecal flora is measured using the proportion of discarded fecal samples from medical inpatients from which extended spectrum beta-lactamase (ESBL)-carrying Enterobacteriaceae can be isolated during hospital stay 4. Cost-effectiveness is measured using resource-utilisation and costs during hospital admission and 30 days post discharge 5. Uptake and acceptability of the online training component of intervention is measured using the proportion of locally identified and prespecified essential individuals who drive prescribing decisions for acute/general medical inpatients at the Trust who co	—

Measure

Time frame

Pilot phase: 1. Uptake of the ARK 'review and revise' procedure within the intervention is measured using the proportion of regularly audited antibiotics prescriptions which document the ARK classification criteria at three months of being invited to complete the training. 2. Antibiotic exposure per acute/general medical admission before and after introducing the intervention is measured using the DDD of antibiotics per acute/general medical admission in the electronic hospital prescribing records at hospital admission and discharge Main trial: 1. Effect of introducing the intervention on antibiotic exposure using different metrics i measured using the DDD per occupied bed-day, days on antibiotics per admission and bed day (length-of-therapy (LOT)), antibiotic days per admission and bed-day (days-of-therapy, DOT), carbapenem DDD, DOT and LOT per admission and per bed-day) at each admission and discharge. 2. Effect of introducing the intervention on adverse outcomes is measured using the ICU admission during current admission, total length-of-stay (hours), antibiotic restart after discontinuation, re-admission in the 30 days after discharge, C. difficile diarrhoea, mortality over the longer-term using repeated cross-sectional surveys at current admission, re-admissions, up to 30 days post-discharge and for 90 days post admission (for mortality) 3. Impact of the intervention on the fecal flora is measured using the proportion of discarded fecal samples from medical inpatients from which extended spectrum beta-lactamase (ESBL)-carrying Enterobacteriaceae can be isolated during hospital stay 4. Cost-effectiveness is measured using resource-utilisation and costs during hospital admission and 30 days post discharge 5. Uptake and acceptability of the online training component of intervention is measured using the proportion of locally identified and prespecified essential individuals who drive prescribing decisions for acute/general medical inpatients at the Trust who co

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Countries

England, United Kingdom

Contacts

Public ContactSarah Walker

sarah.walker@ndm.ox.ac.uk+44 1865 225205

Outcome results

None listed