Advancing antimicrobial stewardship programs in retirement homes: a quality improvement pilot using prospective audit...

Area of Science:

• Geriatric Pharmacy
• Infectious Disease Management
• Healthcare Quality Improvement

Background:

• Retirement homes house older adults at high risk for antibiotic-related harm.
• Antimicrobial stewardship (AMS) program implementation in these settings is poorly understood.
• A pharmacist-led prospective audit and feedback (PAF) pilot program was evaluated in retirement homes.

Purpose of the Study:

• To evaluate the implementation and impact of a pharmacist-led PAF pilot program in retirement homes.
• To identify barriers and facilitators to implementing AMS interventions in this population.
• To assess changes in antibiotic use following the PAF intervention.

Main Methods:

• A quasi-experimental study compared antibiotic use in 9 intervention homes and 396 control homes.
• The intervention involved remote PAF by long-term care pharmacists, with recommendations faxed to prescribers.
• Antibiotic use was measured as days of therapy (DOT) per 1000 resident-days; implementation determinants were mapped to the Theoretical Domains Framework.

Main Results:

• Of 794 antibiotic assessments, only 27% of 89 recommendations were accepted.
• Antibiotic use (DOT/1000 resident-days) remained similar before and after PAF in intervention homes (54.0 vs. 57.9).
• Barriers included communication via fax and limited clinical information; facilitators were organizational support and pharmacist motivation.

Conclusions:

• The pilot program had limited uptake and did not change overall antibiotic use in retirement homes.
• Important barriers and facilitators for AMS implementation in retirement homes were identified.
• The initiative enhanced local capacity for antibiotic use surveillance to support future AMS interventions.