Resources and FAQs

No. ARK has been designed so that prescribers can both ensure patients get started on antibiotics promptly when there is a risk of severe infection and protect patients from antibiotic overuse through effective antibiotic review and revise.

Most patients started on antibiotics acutely in hospitals either don’t have significant bacterial infection or are adequately treated by short duration treatment. Patients who really do need antibiotic treatment courses of longer than 3 days will be identified by investigations over the first 2-3 days of treatment and then a course can be prescribed. Antibiotic resistance is not really driven by stopping antibiotics early. It is driven by continuing antibiotics when they are no longer needed.

If ARK is properly implemented this should happen very rarely and if it does, there is actually no risk of patients coming to harm.

When a patient is on antibiotics pending diagnostic review, its important they are reviewed each day as, by definition, the diagnosis and treatment are not established for this patient. A “reviewed” prescription can be written at any time up to 72 hours and so before weekends or bank holidays teams should be aware who is still on a “pending review” prescription and either ensure review is scheduled over the weekend or ensure review is completed before the weekend.

If a prescription is “hard-stopped” over a weekend and then with hindsight the team realise they should have carried on antibiotics, this doesn’t really pose any significant risk to the patient as they will already have had 3 days treatment – enough for many common infections anyway – and antibiotics can just be restarted.

Detailed information is in the implementation guidance but sustaining use of ARK in the long term relies on embedding the different elements of ARK at your trust because they work together to support sustainability.

For the online learning, this means ensuring that prescribers are required to do the module at induction either as part of ePMA training or antibiotic stewardship training and as part of regular updates for mandatory training or CPD.

For the decision aid this means establishing the categories in ePMA (or paper charts if you trust still uses them). Information elsewhere on the ARKimplementation.org website can help with this.

Regular reports on use of decision aid category use and stop rates from your ePMA system should be used for feedback to teams to reinforce learning.

The whole clinical team should have access to resources for the patient information to ensure this is supplied to patients.

ARK is an evidence-based toolkit to support hospital prescribers follow government guidance “Start Smart then Focus” for antibiotic use in hospitals. So its not about using antibiotics in a different way but about following existing good practice better. This means that you should still get antibiotics whenever you need them but reduce the chances you might get antibiotics when you don’t need them. This will protect you from side-effects of antibiotic treatment including risk of antibiotic resistance.

Every acute NHS trust should introduce ARK as it has been developed by frontline NHS staff to support them implement NHS guidance for antibiotic use in hospitals “Start Smart then Focus”. Although the guidance has existed for many years, antibiotic overuse in hospitals has continued to rise because prescribers have lacked the tools to support them implement it. ARK provides those tools and is now recommended by “Start Smart then Focus”. Ark will:

• Protect patients from harms from antibiotic overuse, including antimicrobial resistance.
• Support clinical staff use antibiotics more safely and effectively.
• Embed cost-effective, evidence-based antibiotic prescribing, in line with “Start Smart then Focus”.
• Ensure hospitals to achieve safe reductions in antibiotic overuse.

Successfully introducing ARK requires leadership and support from Trust managers to facilitate embedding key elements in practice. In particular

The online learning. Although the Code of Practice on Prevention and Control of Infection requires NHS trusts to ensure all staff receive proper training in responsible antimicrobial use In some trusts induction and mandatory training for prescribers does not include specific training. ARK provides a short, highly rated training module ready to use.

The decision aid. ARK requires embedding the decision aid in ePMA (or paper charts). While different ePMA suppliers are increasingly offering solutions for this they may need to be switched on or configured within your ePMA system. Your antimicrobial stewardship pharmacists and ePMA teams will can access resources and peer support to implement the decision aid but trust-wide senior leadership is needed to ensure the necessary adaptations are agreed.

Experience of antibiotic use in NHS hospitals prior to the introduction of ARK is that antibiotic use has risen inexorably, driving up antibiotic resistance, other harms and costs. Without introducing ARK it is unlikely your Trust will develop other clinically effective, safe and cost-effective solutions to reducing antibiotic overuse.