Antimicrobials are medicines that kill or slow the growth of microbes, including antibiotics, antivirals, antifungals and antiparasitics. Antimicrobial stewardship in aged care is the ongoing effort by a provider and its clinicians to use them appropriately, so treatment keeps working and resistance is slowed.
Under the Strengthened Quality Standards this is a provider responsibility. Action 5.2.1 asks you to implement a stewardship system that suits your service. Here is what that looks like day to day.
Key Takeaways
- Antimicrobial stewardship is a provider-led program that promotes appropriate antimicrobial use. Prescribers still make the prescribing decisions, but the provider builds the system around them.
- Outcome 5.2 requires a stewardship system that follows contemporary, evidence-based practice and is relevant to the service context.
- A workable program has named accountability, a policy, a prescribing review pathway with GPs and pharmacists, monitoring, staff education and clear communication with residents and families.
- Care workers observe and report changes to a nurse. They do not ask for antibiotics and never change a dose.
What do antimicrobials and resistance mean?
The Commission describes antimicrobials as medicines used to prevent and treat infections. Antibiotics work on bacteria only, so they do nothing for colds and flu caused by viruses.
Antimicrobial resistance happens when microorganisms change in response to medicines that once would have killed them. Common infections then become harder to treat, and the risk of spread, severe illness and death rises. Stewardship is the response, and our antimicrobial stewardship glossary entry gives staff a short definition.
Why does stewardship matter in aged care?
The national AMR website says infection rates are often high in aged care homes because residents are often frail, have several medical conditions, have weaker immune systems, are incontinent, or need help with daily activities. Residents of services with high antimicrobial use face a higher risk of resistant infection, including residents who are not taking antimicrobials, because organisms pass between people.
The same page reports that prescribing in aged care homes rose by over 11% from 2022 to 2023 and calls it an area of concern. The Commission says its aims are safer, more appropriate use, less resident harm, and preventing and containing resistance.
Where does stewardship sit in the Strengthened Quality Standards?
It sits in Standard 5 (Clinical Care), Outcome 5.2, preventing and controlling infections in delivering clinical care services. Action 5.2.1 is the stewardship action. Action 5.2.2 covers managing infection, including clean and aseptic technique and reviewing invasive devices such as urinary catheters. The Commission's guidance on preventing and controlling infections adds that Outcome 5.2 is closely related to Outcome 4.2, which requires general infection prevention and control in all service environments.
So stewardship is a clinical governance matter and an infection control matter at once. Your clinical governance framework policy should say who is accountable for antimicrobial use, and your infection prevention and control policy should link to it. Our guide to infection prevention and control in aged care covers the IPC lead role. Fewer infections means fewer prescriptions.
This article is general information, not legal advice. Check the Aged Care Act 2024 and Aged Care Rules 2025 for your obligations.
What should a provider have in place?
The Commission's self-assessment tool covers governance, policies, education, monitoring and feedback. These elements follow that shape, scaled to your service.
- Governance: one person on the executive accountable, a clinical lead running it, and stewardship as a standing item at the clinical governance committee.
- Policy: purpose, roles, how prescribing is reviewed, how use is monitored and how people are educated. Align it with your medication management policy, because antimicrobials follow the same storage, administration and recording rules as any medicine.
- Prescribing review pathway: agree with GPs, nurse practitioners and pharmacists how antimicrobial prescriptions are reviewed. The AMR website tells health professionals to consider safe alternatives, prescribe according to the therapeutic guidelines, use diagnostics where possible and advise on managing symptoms without antimicrobials. Make those steps easy by giving prescribers clear, consistent observations.
- Monitoring and data: pick a few measures and review them regularly. The Commission publishes an audit tool and clinical pathway forms for suspected urinary tract infections, with and without a catheter. Reviewing catheters also supports action 5.2.2.
- Staff education: hand hygiene, vaccination, what antimicrobials are, and the reporting role. Keep attendance records.
- Resident and family communication: a consistent message, covered below.
Who does what: prescribers, pharmacists, nurses and workers?
- Prescribers (GPs, nurse practitioners) decide whether an antimicrobial is needed and which one. That is a clinical decision.
- Pharmacists support quality use of medicines. The Commission notes an aged care on-site pharmacist can review medications and support staff, including during transitions of care.
- Registered nurses assess the person, escalate concerns to the prescriber and follow up on the response.
- Care workers notice and report changes such as new confusion, a fever, a change in eating or drinking, or a worsening wound. They tell the nurse and record what they saw.
Put it in your policy and induction: workers do not ask a GP for antibiotics, suggest a medicine, or change, skip or stop a dose. Hospital returns are a common point for new courses, so see our guide to medication safety at transitions of care.
How should you talk with residents and families?
Some families expect an antibiotic whenever a person seems unwell. The AMR website suggests residents and families understand that antibiotics only work against bacteria, ask about other ways to relieve symptoms, and take only what is prescribed for them, never leftovers. It also asks them not to pressure health professionals who say a medicine is not needed.
The Commission offers a consumer resource, "Do you need antibiotics?", in 25 languages. Share it at admission, and record conversations in the care file, including questions that went back to the GP.
What changes in home care?
The Commission's self-assessment tool is written for residential services. Action 5.2.1 asks for a system relevant to the service context, so a home care program should not be a residential one copied word for word.
In a person's own home there is often no on-site nurse, the prescriber may be a GP you have never spoken with, and workers are often alone for short visits. Focus on what you control: train workers to report changes promptly through your escalation pathway, record what the person says about their medicines, make sure care partners know how to raise a question with the treating GP, and confirm who manages medicines in each service agreement.
What evidence should you be able to show?
Action 5.2.1 asks you to implement a system, so keep records that show it running:
- the stewardship policy, with an owner and review date
- governance minutes where antimicrobial use was discussed
- a completed self-assessment with an action plan
- audit results and what changed because of them
- training records for nurses and care workers
- records of conversations with prescribers, pharmacists, residents and families
The Commission calls the self-assessment tool optional but highly recommended. It also notes that the tool predates the new Aged Care Act and that its pages are being updated, so cross-check references against the current Standards.
Related Resources
- Policy mapping to the Quality Standards
- Infection prevention and control in aged care
- Infection prevention and control policy template
- Medication management policy template
- Antimicrobial stewardship glossary entry
- Commission antimicrobial stewardship page
- AMR guidance for aged care
Common Questions About Antimicrobial Stewardship in Aged Care
1. Is antimicrobial stewardship mandatory for aged care providers?
Action 5.2.1 asks the provider to implement a stewardship system relevant to the service context. The Commission's self-assessment tool is optional.
2. What is the difference between an antibiotic and an antimicrobial?
An antibiotic is one type of antimicrobial and works against bacteria. Antimicrobial is the wider term and also covers antivirals, antifungals and antiparasitics.
3. Can a care worker ask a GP for antibiotics for a resident?
No. Workers report changes to a nurse, who escalates to the prescriber. Whether an antimicrobial is needed is the prescriber's clinical decision.
4. Who should lead stewardship in a small service?
Name one accountable person and one clinical lead, often a registered nurse or the IPC lead, and agree a GP and pharmacist contact. A simple program works if it is documented and reviewed.
5. What should we do first?
Complete the Commission's self-assessment tool with your clinical lead and a pharmacist or GP. It shows your gaps and gives you an action plan for your clinical governance committee.
Stewardship works when every role is clear
Antimicrobial stewardship is a provider system, not a single policy or a prescriber's private decision. It works when governance, prescribers, pharmacists, nurses and care workers each know their part, and when you can show the records. Workers observe and report, and clinicians decide. Start by completing the self-assessment tool, then take the gaps to your next clinical governance meeting.
