Table 4 Feasible antimicrobial stewardship interventions deemed useful by three key stakeholders

Education

Q1. “They (GPs) are very much used to their general practice, but the treatment of geriatric case load is different…well obviously educating the GPs is really important.” (GP 14, 27 yr)

Q2. “We all talk about the 5 rights of medication, and I’m sure there are 5 rights about antibiotic use. So you know just reminding people, are we creating a superbug, are we giving antibiotics when they're not required.” (NUM 8, 12 yr)

Q3. “But if we could educate the nurses who are there every day, you know at the coalface, when they could see the doctor’s keeping prescribing [antibiotics], they could just bring it up with the GP…” (Consultant pharmacist 2, 12 yr)

Policy and guidelines

Q4. “… the [antibiotic] therapeutic guidelines might say okay for a pharyngitis you might use this [antibiotic], in a penicillin allergic patient you’ll use this or for a community acquired pneumonia you’ll use this, and for a hospital acquired pneumonia this is what we recommend…I think it’d be useful if they [guidelines] were there, to sort of say well you know based on trials we’ve found that nursing home patients need two courses or they don’t need any more than the regular.” (GP 3, 12 yr)

Q5. “Some sorts of protocol like when, say for UTI, when to start antibiotics, what stage of infection, signs and symptoms you have to really go on antibiotics. For respiratory infections when the person has to go on antibiotics, and when we see what kind of signs and symptoms definitely should be on antibiotics or something like that, would be helpful I think.” (RN 14, 9 months)

Q6. “So if you have got universal policies on infection control and antibiotic uses, you have got a bit of a chance [to facilitate consistent antibiotic prescribing practices].” (Consultant pharmacist 5, 12 yr)

Surveillance/auditing of antibiotic use

Q7. “Because well I always prescribe Abbocillin® for tonsillitis but it’s amazing how many people prescribe Amoxil® or Ceclor® or Keflex® or something like that, you know. And yeah so obviously that kind of auditing is a good idea.” (GP 8, 20 yr)

Q8. “I think it's helpful to do [antibiotic surveillance], because we do know that sometimes people are left on medications for too long, and unless someone’s got that awareness of it to say ‘I don’t think this might be working’.” (Executive nurse 3, 10 yr)

Q9. “Just getting a general idea and another set of eyes on the actual outcome of the patient would definitely help with the prescribing habits as well… I believe that obviously RMMR [consultant] pharmacists they can come in because they get access more to clinical notes than what a community pharmacist would do.” (Community pharmacist 4, 4 yr)