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Evaluating and prioritizing antimicrobial stewardship programs for nursing homes: A modified Delphi panel
Shaul Z Kruger1, Susan E Bronskill2,3,4, Lianne Jeffs5,6,7
1Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Background:
Antibiotic use in nursing homes is often inappropriate, in terms of overuse and misuse, and it can be linked to adverse events and antimicrobial resistance. Antimicrobial stewardship programs (ASPs) can optimize antibiotic use by minimizing unnecessary prescriptions, treatment cost, and the overall spread of antimicrobial resistance. Nursing home providers and residents are candidates for ASP implementation, yet guidelines for implementation are limited.
Objective:
To support nursing home providers with the selection and adoption of ASP interventions.
Design And Setting:
A multiphase modified Delphi method to assess 15 ASP interventions across criteria addressing scientific merit, feasibility, impact, accountability, and importance. This study included surveys supplemented with a 1-day consensus meeting.
Participants:
A 16-member multidisciplinary panel of experts and resident representatives.
Results:
From highest to lowest, 6 interventions were prioritized by the panel: (1) guidelines for empiric prescribing, (2) audit and feedback, (3) communication tools, (4) short-course antibiotic therapy, (5) scheduled antibiotic reassessment, and (6) clinical decision support systems. Several interventions were not endorsed: antibiograms, educational interventions, formulary review, and automatic substitution. A lack of nursing home resources was noted, which could impede multifaceted interventions.
Conclusions:
Nursing home providers should consider 6 key interventions for ASPs. Such interventions may be feasible for nursing home settings and impactful for improving antibiotic use; however, scientific merit supporting each is variable. A multifaceted approach may be necessary for long-term improvement but difficult to implement.
Insights
Antimicrobial stewardship programs (ASPs) in nursing homes can improve antibiotic use. Six key interventions, including prescribing guidelines and audit feedback, were prioritized by experts for feasibility and impact.
Area of Science:
- Geriatric Medicine
- Infectious Diseases
- Healthcare Management
Background:
- Inappropriate antibiotic use in nursing homes contributes to adverse events and antimicrobial resistance.
- Antimicrobial stewardship programs (ASPs) are crucial for optimizing antibiotic prescribing and reducing resistance.
- Limited guidelines exist for implementing ASPs in nursing home settings.
Purpose of the Study:
- To support nursing home providers in selecting and adopting effective ASP interventions.
- To identify and prioritize key ASP interventions for nursing home settings.
Main Methods:
- A modified Delphi method involving a multidisciplinary panel of 16 experts and resident representatives.
- Assessment of 15 ASP interventions based on scientific merit, feasibility, impact, accountability, and importance.
- Surveys and a consensus meeting were utilized to gather expert opinions.
Main Results:
- Six ASP interventions were prioritized: prescribing guidelines, audit and feedback, communication tools, short-course therapy, reassessment, and decision support systems.
- Several interventions, including antibiograms and educational programs, were not endorsed.
- Limited nursing home resources may hinder the implementation of multifaceted interventions.
Conclusions:
- Nursing homes should consider implementing six prioritized ASP interventions to improve antibiotic use.
- While interventions show potential feasibility and impact, their scientific support varies.
- A multifaceted approach is likely needed for sustained improvement but presents implementation challenges.
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