Small cycles, big impact: Applying PDSA to antimicrobial stewardship in aged residential care
| Thursday, August 27, 2026 |
| 11:00 AM - 11:30 AM |
| Tāwhirimātea 1 |
Overview
Mikaela Shannon
Speaker
Mrs Mikaela Shannon
Clinical Director
PSC
Small Cycles, Big Impact: Applying PDSA to Antimicrobial Stewardship in Aged Residential Care
Abstract
Rationale:
Antimicrobial resistance (AMR) is a growing patient safety risk in aged residential care, where high antibiotic utilisation and clinical complexity increase the likelihood of inappropriate prescribing. Variation in practice across multiple sites can limit the consistent application of antimicrobial stewardship (AMS). This project aimed to implement a standardised AMS programme across 14 aged care sites, supporting over 900 residents, to strengthen Infection Prevention and Control (IPC) practice and reduce unwarranted variation through an interprofessional approach.
Methodology:
A structured quality improvement approach using the Plan–Do–Study–Act (PDSA) cycle was applied over 18 months. An interprofessional team—including IPC Leads, nurses, general practitioners, pharmacists, and care staff—supported implementation. IPC Leads acted as local change agents, facilitating rollout of a standardised AMS policy, conducting antibiotic prescribing audits, and delivering targeted education. Regular audit cycles and feedback loops enabled real-time data sharing, increasing visibility of prescribing practices and supporting continuous improvement. Iterative PDSA cycles allowed adaptation to local contexts while maintaining programme consistency.
Significant Results:
The programme resulted in a reduction in overall antibiotic use and improved consistency in prescribing practices across all 14 sites. There was increased compliance with AMS policy, enhanced documentation, and clearer visibility of antibiotic use at both site and organisational levels. Staff demonstrated improved understanding and application of best practice standards. The interprofessional model strengthened collaboration and accountability, embedding AMS into routine IPC governance.
Conclusions:
An interprofessional, PDSA-driven approach enabled effective translation of policy into practice, resulting in measurable improvements in antimicrobial use across a large, multi-site aged care population.
Recommendations:
Sustained interprofessional collaboration, ongoing audit and feedback, and continued investment in IPC leadership are essential to maintain gains and support scalability across the sector.
Antimicrobial resistance (AMR) is a growing patient safety risk in aged residential care, where high antibiotic utilisation and clinical complexity increase the likelihood of inappropriate prescribing. Variation in practice across multiple sites can limit the consistent application of antimicrobial stewardship (AMS). This project aimed to implement a standardised AMS programme across 14 aged care sites, supporting over 900 residents, to strengthen Infection Prevention and Control (IPC) practice and reduce unwarranted variation through an interprofessional approach.
Methodology:
A structured quality improvement approach using the Plan–Do–Study–Act (PDSA) cycle was applied over 18 months. An interprofessional team—including IPC Leads, nurses, general practitioners, pharmacists, and care staff—supported implementation. IPC Leads acted as local change agents, facilitating rollout of a standardised AMS policy, conducting antibiotic prescribing audits, and delivering targeted education. Regular audit cycles and feedback loops enabled real-time data sharing, increasing visibility of prescribing practices and supporting continuous improvement. Iterative PDSA cycles allowed adaptation to local contexts while maintaining programme consistency.
Significant Results:
The programme resulted in a reduction in overall antibiotic use and improved consistency in prescribing practices across all 14 sites. There was increased compliance with AMS policy, enhanced documentation, and clearer visibility of antibiotic use at both site and organisational levels. Staff demonstrated improved understanding and application of best practice standards. The interprofessional model strengthened collaboration and accountability, embedding AMS into routine IPC governance.
Conclusions:
An interprofessional, PDSA-driven approach enabled effective translation of policy into practice, resulting in measurable improvements in antimicrobial use across a large, multi-site aged care population.
Recommendations:
Sustained interprofessional collaboration, ongoing audit and feedback, and continued investment in IPC leadership are essential to maintain gains and support scalability across the sector.
Biography
Mikaela Shannon is a New Zealand‑based nursing and aged‑care leader currently serving as Clinical Director at Presbyterian Support Central’s Enliven aged care services, a major provider of residential and community elder care across the lower North Island of Aotearoa NZ. She joined the organisation in 2023, bringing over a decade of experience in patient safety, quality improvement, nursing leadership and clinical governance.
Mikaela’s professional journey started early — she began working in healthcare at age 16 and spent many years progressing through roles from healthcare assistant into clinical practice and leadership, including over 15 years working in hospital settings before moving into aged care.
In her role as Clinical Director, Mikaela focuses on ensuring high‑quality, resident‑centred care, safety indicators, quality systems, and holistic clinical practice across multiple care homes and services. She emphasises wellbeing, dignity and respect for elders and values ongoing professional learning – she is also actively completing a PhD related to health and aged care quality.
