Table 1

Outer context domains to support scale in antibiotic stewardship in long-term care homes (LTCHs)

Incentives and policy

  • LTCH antibiotic stewardship honour roll with tiered system of status.12

  • Regulatory requirement that LTCHs document antibiotic stewardship activities.

Performance metrics and data feedback

  • National quality measure discouraging the treatment of asymptomatic bacteriuria.19

  • Quarterly reports to LTCH on rates of urine culturing and antibiotic use.

  • Regional dashboards with performance measures to promote peer pressure.

Interorganisational networks

  • Leveraging antibiotic stewardship expertise in acute care hospitals that LTCHs already have a relationship with to address stewardship across the care continuum.20

  • Collaboration with LTCH and their contracted laboratory to develop facility-specific antibiograms.12