Table 2 Summary of recommendations to implement an AMS program

1. Conditions for establishing an antimicrobial stewardship (AMS) program

1.1 Ensure commitment from the Board of Directors.

• Define the vision on necessity of an AMS program.

• Allocate human and financial resources.

1.2 Ensure human and financial resources are sufficient to carry out an AMS program that fits the nursing home.

• Allocate a physician for this task.

• Establish service agreements in which AMS is an integral part of the services for nonemployed professionals.

1.3 Form a project team to set up and implement an AMS program.

• Establish a project team comprised of members with relevant expertise: a physician, a pharmacist, a medical microbiologist, an infection control practitioner, a member of the management team (MT) or an authorized project team member, on behalf of the MT.

2. Embedding an AMS program within a nursing home

2.1 Align antibiotic- and infection control policies and bring both areas of expertise within the responsibility of the same committee.

• Consolidate AMS and infection control policies under one committee.

2.2 Set up an Antibiotic team (A-team).

• Establish an A-team comprised of a physician, pharmacist, clinical microbiologist, and preferably also an infection control practitioner.

2.3 Discuss the AMS program with all physicians and make the AMS program a regular topic during meetings (e.g., pharmacotherapy audit meetings (PTAMs)).

• Involve all physicians from the start and keeping them informed about the process.

• Make the AMS program a regular topic in during meetings (e.g., PTAMs).

2.4 Offer education on antibiotic use and resistance to nurses and carers.

• Determine the mode(s) of education, as well as whether it should be followed during work or personal time, and the possibility to gain accreditation points.

2.5 Discuss how volunteers should be informed.

• Use reliable, publicly accessible sources of information to disseminate.

2.6 Discuss how to inform residents/their representatives.

• Inform residents through various media.

• Use reliable, publicly accessible sources of information to disseminate.

3. A-team activities

3.1 Define the responsibilities and authority of the A-team.

• Keep treatment protocols up-to-date.

• Monitor compliance.

• Emphasize that the opinion of A-team considered as highly valued, although the ultimate responsibility for prescribing antibiotics remains of the individual physician.

3.2 Define the working process of the A-team, including selection criteria.

• Conduct a periodic retrospective review of the antibiotic prescriptions prior to scheduled plenary meetings (e.g., PTAMs) based on predetermined selection criteria.

• Evaluate the activities of the A-team among colleague physicians.

3.3 Define the tasks of all A-team members.

• Define the tasks of each A-team member.