Actors | Capability | Context | Coherence | Cognitive participation | Collective action | Reflexive monitoring |
---|---|---|---|---|---|---|
AMT | Â | Limitations on organisational support to resource / prioritise AMT work. Limited availability of technical solutions to support prescribing review. | Â | Constraints on AMT leadership engaging with all stakeholder groups. | Â | 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. | Â | Â | Lack of confidence to challenge consultant decisions. | No feedback on prescribing indicator audits, therefore no reflection on personal practice. |
Consultants or locum medical staff | Â | Â | 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 | Â | Resource constraints and role priorities which limit opportunities for AMS related activities. | Â | Â | Â | Â |