|Actors||Capability||Context||Coherence||Cognitive participation||Collective action||Reflexive monitoring|
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.|
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.|