Understanding the implementation of the Antibiotic Review Kit (ARK) intervention in hospitals: healthcare professionals' perspectives

Background/purpose: Antibiotic Review Kit (ARK) is a behavioural intervention that aims to safely reduce antibiotic use in hospitals by supporting healthcare professionals (HCPs) to stop antibiotics early if they are no longer needed. Results from a feasibility study in one hospital are promising, with rates of stopping increasing from 9% (6/69) at baseline to 35% (156/450) post-implementation (p<0.0001). However, little is known about the feasibility and acceptability of ARK in different hospital contexts. The purpose of the current study was to understand HCPs’ experiences of implementing ARK in an initial sample of 15 hospitals taking part in a cluster-randomised stepped-wedge trial. Methods: ARK champions (N=15) leading the implementation of ARK at their hospital were invited to take part in a 30-50 minute telephone interview three to nine months after the end of the initial 12-week implementation period. Semi-structured interviews explored their experiences of planning, implementing and sustaining ARK. Interviews were recorded and transcribed verbatim, before undergoing inductive thematic analysis. Results: Five key themes emerged. Champions had ‘positive perceptions of ARK overall’, even when challenges were encountered. They felt that good ‘staff relationships and engagement’ facilitated implementation. Key issues included ‘staffing and time pressures’, ‘managing drug chart changes’, and the limited impact of ‘using ARK only in acute medical units’, rather than implementing it more widely. Conclusions and implications: Although there are some challenges to implementing ARK, the intervention appeared to be acceptable and feasible. Better implementation may be supported through wider engagement with clinical teams across different hospital wards.