Table 2 Relevant quotes on general information and determinants of antimicrobial prescribing

General information about antimicrobial prescribing

P11: “If the infection is more complicated to manage, it will be managed in the emergency room. That’s why I’m telling you that it’s not very complicated to manage an infection in nursing homes”

P10: “Situations in which we need help? It’s a clinical situation that doesn’t get better, a bronchitis for example that doesn’t get better despite the start of ceftriaxone.”

Determinants of antimicrobial prescribing

Resident characteristics

P2: “The question is whether the resident will be able to swallow or not. That’s the big question.”

P3: “What I’ve learned in palliative care is that if it’s [the infection] well tolerated and there’s no fever, there’s no point in giving antibiotics.”

P3: “Residents aren’t able to express an opinion about antimicrobial prescribing because the majority suffer cognitive impairment.”

Environmental context and resources

P3: “There’s one thing we never do that we should do: blood cultures. We tried but it’s too complicated. Often, we don’t have the equipment. One person [nurse] who has to take care of 100 people makes it already difficult to manage emergencies.”

P2: “I feel like I’m in prehistoric times. To get a biological check-up in emergency is complicated. So, there are times when I start a treatment before I’ve had the results”.

P8: “Sometimes it’s 24 h to get a medication. We don’t get the antimicrobial susceptibility testing that quickly. So, sometimes, we’re already at 5 days of treatment, there’s only 2 left, so if the micro-organism is susceptible, I don’t change.”

P5: “I think that the patients in nursing homes are very subject to the current problems of nursing homes and that antibiotic therapy is one of them. The lack of equipment, the fact that we have to do more and more with less and less staff and equipment.”

Professional role and identity

P4: “As a medical coordinator, I believe that my role is to keep an eye on prescriptions. I shouldn’t control or censor, but if I see things that don’t conform to good practice, I should review it with the prescribing physician. I think it’s defined in a very theoretical way but not at all in a practical way. I would say that is only at my initiative.”

Prescribers beliefs /Paradoxical motivations

P4: “I’m not saying that we do things well, but even the fact that we don’t do it very well doesn’t create too many problems for us.”

P11: “Prescribing is easy because it’s simple stuff which is easy to manage.”

P13: “I feel that the younger generation is really trained, now we know that we shouldn’t prescribe too much.”

Perceived consequences

P11: “I can’t imagine leaving someone with an infection even if they are almost at the end of their life, leaving them in uncomfortable conditions when a simple antibiotic could improve the situation.”

P4: “It is always in our interest to avoid a trip to the emergency room. And from time to time, we say to ourselves, ok, we prefer an empiric antibiotic therapy.”