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Table 3 Summary of analysis

From: Mechanisms affecting the implementation of a national antimicrobial stewardship programme; multi-professional perspectives explained using normalisation process theory

Actors Capability Context Coherence Cognitive participation Collective action Reflexive monitoring
AMT   Limitations on organisational support to resource / prioritise AMT work.
Limited availability of technical solutions to support prescribing review.
  Constraints on AMT leadership engaging with all stakeholder groups.   Lack of provision of direct feedback of indicator audits to clinicians.
Prescribing doctors Lack of continuity in medical cover makes ongoing review of prescribing decisions challenging. Medical hierarchies create limited ability to influence team norms or practices.    Lack of confidence to challenge consultant decisions. No feedback on prescribing indicator audits, therefore no reflection on personal practice.
Consultants or locum medical staff    Lack of provision of or engagement with AMS updates. Competing issues impede prioritisation of AMS. Lack of continuity of medical staff impedes ongoing AMS activity. Limited feedback on prescribing indicator audits, therefore no reflection on personal practice.
Nurses   AMS often not viewed as a nursing role or responsibility.
Limited opportunities for engagement.
Lack of time and access to AMS training. Lack of awareness of potential nurse’s role in AMS. Lack of engagement in AMS activities.
Lack of confidence to question doctors’ decisions.
 
Clinical Pharmacists   Resource constraints and role priorities which limit opportunities for AMS related activities.