Table 3.

Open coded responses and excerpts for two axial coding themes: contributions to inadequate and adequate prescribing, organized in line with the SIEPS model²²

Systems component	Category	Coded items (n)	Excerpt
People	Confidence/guessing/memory	30	“The seniors are confident in what they are doing. Or at least they think they are and they think they’re right.”
	Peer pressure	19	“I’ve had it where I was told to prescribe this and they’ll tell me the dose and times but I still go and … because someone else told me what to do, and they might be more senior than me but it’s my signature on it so … He gave me a funny look, like a dirty look as if I’m not trusting them!”
	Challenging colleagues	3	“I think they can be quite understanding, because my consultant told me to prescribe amiodarone once for a patient, and I said ‘OK’ and then I thought about it and I thought ‘no, I’m not happy.’ And I rang him back and I said ‘I’m not prescribing it,’ and he said ‘OK, give him a beta-blocker!’”
	Incorrect advice	13	“Recently, I was asked to prescribe zopiclone 7.5 mg by a nurse. I never prescribed this drug before, so I checked and I prescribed 3.75 (as advised by the BNF).”
	Choosing positive role models	43	“In particular I have found it useful talking to more experienced nurses who have worked in my specialty for a long time and are familiar with the common drugs used on the ward.”
Tasks	Independent checks	21	“Having other people look at your prescription chart … I regularly ask my ward pharmacist for advice.”
	Double checking	30	“I worry if I have not checked my prescriptions and it’s easier for me and safer for patients if I just double check.”
Technology and tools	Seeking sources of prescribing information	244	“I have become more aware that I should use reliable, identifiable sources when dealing with unfamiliar medications such as the BNF or BNF online. This means that a verified dosing regimen can be used.”
	Systems and technology	10	“They have different colored drug charts, which I quite like. Like that because you can see instantly if someone’s got an allergy or not based on the color of the drug chart in front of you. It does make you think when you’re about to prescribe something ‘hang on it’s yellow.”
Environment	Interruptions	20	“There’s an ECG in your face and somebody behind you waiting to ask you something and you just lose track of what you’re doing …”
	Workspace	11	“Having two drug cards and quite often one disappears and you might not know that there’s another one and that means you’re not aware that they are receiving different drug.”
	New and challenging situations	8	“It’s usually in an emergency setting that you have to give them, and you’re not happy, because you’ve not used it that many times before.”
Organization	Training	10	“Our university didn’t place much emphasis on prescribing, until the very last few weeks of our course, so it’s very much something that I’ve had to teach myself.”
	Cultivation of safety culture	7	“I’ve seen quite a lot of drug errors and people have said ‘Oh you know there was an F 1 who did this’ but no one’s ever said they were stupid, they’ve just said this is an error, I’ve never seen anyone being blamed.”

Abbreviations: f1, foundation doctor year 1; BNF, British National Formulary; ECG, electrocardiograph.