A Delphi Process for Reaching Nationwide Consensus on Antimicrobial Intravenous-to-oral Switch Criteria and Development of an Antimicrobial Intravenous-to-oral Switch Decision Aid

Introduction Antimicrobial stewardship (AMS) strategies, such as intravenous-to-oral switch (IVOS), promote optimal antimicrobial use, contributing to safer and more effective patient care and tackling antimicrobial resistance (AMR). Aim This study aimed to achieve nationwide multidisciplinary expert consensus on antimicrobial IVOS criteria for timely switch in hospitalised adult patients and to design an IVOS decision aid to operationalise agreed IVOS criteria in the hospital setting. Method A 4-step Delphi process was chosen to achieve expert consensus on IVOS criteria and decision aid; it included Step One) Pilot/1 st round questionnaire, Step Two) Virtual meeting, Step Three) 2 nd round questionnaire and Step 4) Workshop. This study follows the Appraisal of Guidelines for Research and Evaluation II instrument checklist. Results Step One questionnaire of 42 IVOS criteria had 24 respondents, 15 of whom participated in Step Two, where 37 criteria were accepted for the next step. Step Three had 242 respondents (England n=195, Northern Ireland n=18, Scotland n=18, Wales n=11); 27 criteria were accepted. Step Four had 48 survey respondents and 33 workshop participants; where consensus was achieved for 24 criteria and comments received on a proposed IVOS decision aid. Research recommendations include the use of evidence-based standardised IVOS criteria. Discussion and Conclusion This study achieved nationwide expert consensus on antimicrobial IVOS criteria for timely switch in the hospitalised adult population. For criteria operationalisation, an IVOS decision aid was developed. Further research is required to provide clinical validation of the consensus IVOS criteria and to expand this work into the paediatric and international settings.