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

Background: Little is known about implementation of antimicrobial stewardship (AMS) programs in retirement homes, a setting with an older adult population which is at increased risk of antibiotic-related harm. This study evaluated a pharmacist-led prospective audit and feedback (PAF) pilot program in retirement homes. Methods: This quasi-experimental study evaluated antibiotic use in 9 intervention homes and 396 control homes from June 2022 to May 2023 (baseline period), compared to June 2023 to December 2024 (intervention period). PAF was conducted remotely by long-term care pharmacists; recommendations were provided to the prescriber via fax. The primary outcome was antibiotic days of therapy (DOT) per 1000 resident-days. Determinants to implementation were gathered from participating pharmacists and mapped to the Theoretical Domains Framework. Results: During the intervention, of 794 antibiotic assessments, 89 recommendations were made and 27 (30%) were accepted. Total antibiotic use measured in DOT per 1,000 resident days in intervention homes was similar before and after PAF (54.0 before vs. 57.9 after). Similarly, usage in the control group was relatively stable (49.0 before vs. 51.6 after) (DiD Analysis: +2.4 DOT/1,000 resident days, 95% CI -7.8, 12.3). Barriers to PAF implementation included communication challenges (communication via fax) and limited clinical information (lack of indication on prescription). Facilitators included organizational support and pharmacist motivation. Conclusions: While this pilot had limited uptake and was not associated with a change in antibiotic use, it highlighted important barriers and facilitators for AMS in retirement homes. This initiative strengthened local capabilities for antibiotic use surveillance to support future AMS interventions.