Table 3.

Summary of findings

Framework		Summary of findings pre-implementation	Summary of findings post-implementation
		Design of inpatient chart, insufficient space on IDL and delays with discharge communication process HEPMA anticipated to improve safety	Improved clarity on inpatient chart and improved quality of IDLs
TDF Domain	TDF Construct	Summary of findings pre-implementation	Summary of findings post- implementation
Knowledge	Procedural knowledge, knowledge of task environment	Staff knew what to do and familiarity described as important, limitations of documentation and processes described	Staff provided detailed descriptions of HEPMA processes and tasks
Skills	Competence, practice	Staff mainly felt competent and ease of access cited as a positive factor, although illegibility described as problematic	ANPs, junior doctors and pharmacists rated themselves as skilful HEPMA users; consultant doctors had varying skill levels
Social/professional role and identity	Professional role, professional confidence	Non-medical prescribers described professional aspect of prescribing	Positive impact on professional role, an increase in confidence described by ANPs and pharmacists
Beliefs about capabilities	Perceived competence, self confidence	Anxiety described due to existing documentation and processes	ANPs, junior doctors and pharmacists all perceived competent; variability with consultant doctors
Beliefs about consequences	Outcome expectancies, consequences	Patient safety a major concern with prescribing errors reported by numerous interviewees, queries from GPs regarding missing or incomplete information frequently related to medicines were reported	Improvement in patient safety, quality of IDL and number of first and final discharge letters, lack of engagement by some consultant doctors and introduction of new error types
Environmental context and resource	Resources, critical incidents	Constraints due to documentation design and time pressures were described, incident reports only completed by pharmacist professional group	Improved design for inpatient and discharge sections, no documentation of a formal incident about HEPMA
Social influences	Social pressure, group conformity	Not applicable	Variability evident amongst practitioners
Behavioural regulation	Self-monitoring, action planning	Not applicable	Process for self-checking developed by some staff