title: Antimicrobial stewardship in residential aged care facilities: need and readiness assessment.
abstract: BACKGROUND
  Information about the feasibility, barriers and facilitators of antimicrobial stewardship (AMS) in residential aged care facilities (RACFs) has been scant. Exploring the prevailing perceptions and attitudes of key healthcare providers towards antibiotic prescribing behaviour, antibiotic resistance and AMS in the RACF setting is imperative to guide AMS interventions.
  
  
  METHODS
  Semi-structured interviews and focus groups were conducted with key RACF healthcare providers until saturation of themes occurred. Participants were recruited using purposive and snowball sampling. The framework approach was applied for data analysis.
  
  
  RESULTS
  A total of 40 nurses, 15 general practitioners (GPs) and 6 pharmacists from 12 RACFs were recruited. Five major themes emerged; perceptions of current antibiotic prescribing behaviour, perceptions of antibiotic resistance, attitude towards and understanding of AMS, perceived barriers to and facilitators of AMS implementation, and feasible AMS interventions. A higher proportion of GPs and pharmacists compared with nurses felt there was over-prescribing of antibiotics in the RACF setting. Antibiotic resistance was generally perceived as an issue for infection control rather than impacting clinical decisions. All key stakeholders were supportive of AMS implementation in RACFs; however, they recognized barriers related to workload and logistical issues. A range of practical AMS interventions were identified, with nursing-based education, aged-care specific antibiotic guidelines and regular antibiotic surveillance deemed most useful and feasible.
  
  
  CONCLUSIONS
  Areas of antibiotic over-prescribing have been identified from different healthcare providers' perspectives. However, concern about the clinical impact of antibiotic resistance was generally lacking. Importantly, information gathered about feasibility, barriers and facilitators of various AMS interventions will provide important insights to guide development of AMS programs in the RACF setting.
authors: Ching Jou
authors: CJ
authors: Lim
authors: Megan
authors: M
authors: Kwong
authors: Rhonda L
authors: RL
authors: Stuart
authors: Kirsty L
authors: KL
authors: Buising
authors: N Deborah
authors: ND
authors: Friedman
authors: Noleen
authors: N
authors: Bennett
authors: Allen C
authors: AC
authors: Cheng
authors: Anton Y
authors: AY
authors: Peleg
authors: Department of Medicine, University of Melbourne, Royal Melbourne Hospital, 4th Floor, Clinical Sciences Building, Royal Parade, Parkville, VIC 3050, Australia. Caroline.Marshall@mh.org.au.
authors: Caroline
authors: C
authors: Marshall
authors: David C M
authors: DC
authors: Kong
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001291:Attitude of Health Personnel; D001424:Bacterial Infections / Q000188:drug therapy* / Q000517:prevention & control; D004352:Drug Resistance, Microbial; D004358:Drug Therapy / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D058005:General Practitioners / Q000523:psychology; D006707:Homes for the Aged / Q000592:standards*; D006801:Humans; D057970:Inappropriate Prescribing / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000523:psychology; D010465:Perception
chemical_list: D000900:Anti-Bacterial Agents