Multidisciplinary Implementation Dynamics and Systemic Barriers
The successful implementation of antimicrobial stewardship in residential aged care facilities depends on reconciling structural governance mechanisms with the complex psychosocial dynamics that shape clinical decision-making. Qualitative investigations across Australian care settings demonstrate that prescribing patterns cannot be understood solely through quantitative surveillance metrics; instead, they reflect nuanced sociocultural, technical, and environmental factors that govern long-term care environments (NCAS, 2021). Although multidisciplinary stakeholders, including general practitioners, nurses, and pharmacists, broadly support stewardship objectives, practical implementation encounters persistent logistical challenges and substantial workload constraints in routine clinical practice (Lim et al., 2014). Disparate perceptions of antimicrobial resistance further complicate these clinical initiatives, as resistance is frequently conceptualised as an isolated infection control problem rather than an immediate determinant influencing bedside decisions (Lim et al., 2014). Furthermore, systematic evidence indicates that existing evaluative frameworks fail to adequately capture affective dimensions, such as clinical staff risk perceptions, professional role ambiguities, and emotional pressures arising from resident family expectations (Cross et al., 2022). Addressing these multifaceted barriers requires a coordinated approach that combines targeted nursing education, aged-care specific prescribing guidelines, and routine surveillance mechanisms with interdisciplinary communication models (Cross et al., 2022; Lim et al., 2014). Consequently, sustainable antimicrobial stewardship programs in residential aged care must move beyond rigid procedural compliance by actively supporting healthcare workers in navigating risk perceptions, diagnostic uncertainty, and family expectations to optimize prescribing practices and curb resistance.