Table 3.

Summary of analysis

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.