Implementation of an Audit and Feedback Intervention for Antimicrobial Stewardship in Long-Term Care Facilities

Antimicrobial resistance is increasingly recognized as a major public health challenge, and inappropriate antibiotic use in long term care facilities (LTCF) plays an important role in this problem. In these settings, clinicians care for frail and multimorbid patients, face atypical clinical presentations, and often work with limited diagnostic resources. As a result, antibiotic prescribing is frequently empirical and highly variable between institutions. While antimicrobial stewardship ( programs are well established in hospitals, practical and context adapted feedback interventions remain scarce in LTCFs.
 

The aim o f this project is to develop, implement, and evaluate a feedback based intervention to support antimicrobial stewardship in LTCFs. The project builds on existing quality improvement structures and routinely collected prescribing data to provide structured feedback to healthcare teams. Rather than focusing on controlling or auditing individual
prescriptions, the intervention is designed to support reflection, discussion, and locally driven improvement in everyday practice.

The core of the intervention is the delivery of structured feedback on antibiotic use. Prescribing data of a specific LTCF will be summarized in a dashboard, benchmarked against similar LTCFs The dashboard will be used as a flexible support tool to explore different types of indicators and visualizations that may be relevant for clinical teams. Feedback
sessions using the dashboard will be integrated into existing pharmacist-led quality circles, which already provide a trusted setting for interprofessional exchange in many LTCFs. Pharmacists will receive specific training to facilitate these sessions, encourage discussion, provide information on existing guidelines, and support teams in interpreting the
data. Participation in the feedback intervention will be voluntary, and the acceptability of the intervention, including reasons for participation or refusal, will be considered an important outcome of the study.
 

From a scientific perspective, the main objective is not only to develop a feedback tool, but to understand how a feedback interven tion can be implemented effectively in routine LTCF practice. The study will be guided by the Consolidated Framework for Implementation Research and will use qualitative and mixed methods to explore three key
implementation outcomes: acceptability, appropriateness, and feasibility. Interviews, focus groups, and observations will allow an in depth analysis of how the intervention is perceived, how it is adapted locally, and how it is integrated into existing workflows.
 

The expected outcome of the project is a well described, context sensitive feedback model for antimicrobial stewardship in LTCFs, together with practical recommendations for future scale up. By relying on existing infrastructures, established quality circles, and close collaboration with field professionals, this project aims to support sustainable improvements
in antibiotic use and to inform the development of pragmatic stewardship strategies in long term care.