Evaluating and Prioritizing Antimicrobial Stewardship Programs for Nursing Homes: A Modified Delphi Panel

Antibiotic use in nursing homes (NHs) is often inappropriate and linked to adverse events and antimicrobial resistance (AMR). Antimicrobial stewardship programs (ASPs) are initiatives that optimize antibiotic use by minimizing inappropriate use, treatment cost, and the overall spread of AMR. NH providers and residents are candidates for ASP implementation; yet, guidelines for implementation are limited. We utilized the Modified Delphi Method to provide NH providers with 2 tools: (1) a prioritized list of necessary ASPs, and (2) resources for implementation. 16 panelists completed two survey rounds, attended an in-person meeting, and evaluated 15 ASP interventions across several criteria. 6 interventions were prioritized for NHs: (1) guidelines for empiric prescribing, (2) audit and feedback, and communication tools (tied), (3) short course antibiotic therapy, (4) scheduled antibiotic reassessment, and (5) clinical decision support systems. Interventions may need to be delivered using a multifaceted approach; however, this is likely infeasible for nursing homes.M.Sc