Mapping and characterisation of antimicrobial stewardship tools for nursing homes in France: the ORANEAT inventory method

Antimicrobial stewardship (AMS) tools have been widely developed to support safe and effective antimicrobial prescribing in nursing homes (NHs). However, access to AMS tools developed and provided by AMS organisations might be hindered by the wide range of stakeholders involved in their development in France. This study aimed to develop an inventory method to systematically review AMS tools that we applied to the NH settings. Organisations involved in AMS at national, regional and local levels in France were mapped using an inductive approach. Their websites were searched until February 2025 to include AMS tools defined as materials used by healthcare professionals (HCPs) and other stakeholders to initiate or expand AMS activities in NHs. We used a tailored TIDieR checklist to characterise the selected tools. For each item of the checklist, characteristics were generated using the constant comparative method, and the CDC core elements of antibiotic stewardship for NHs were integrated as part of the checklist. A network analysis was performed to assess the collaborations between organisations that developed the selected tools. Of 541 AMS tools identified across 238 organisation websites, 96 were AMS tools for NHs and were included in the inventory. Most tools addressed the CDC core elements “Education” ( n = 58, 60.4%) and “Actions to improve antibiotic use” ( n = 39, 40.6%). Limited tools supported “Tracking” ( n = 5, 5.2%), “Drug expertise” ( n = 2, 2.1%), and “Leadership commitment” ( n = 1, 1%), and none addressed “Reporting”, nor “Accountability”. Tools predominantly targeted nurses ( n = 62, 64.6%), GPs/prescribers ( n = 49, 51%), and assistant nurses ( n = 39, 40.6%), with limited resources for residents or families ( n = 9, 9.4%). Urinary tract infections (UTIs) were the primary focus of the tools ( n = 41, 42.7%). Collaborations between organisations were limited, with 26 (27.1%) tools developed through cross-organisation efforts. This inventory method provides an innovative approach to systematically review AMS tools applied to NH settings at the national scale, ensuring a wider access to existing tools and an assessment of critical gaps. Tools addressing leadership commitment, accountability, tracking, and reporting are lacking and should be developed along with other tools through enhanced collaboration to streamline efforts and better support AMS initiatives in NHs. not applicable