Table 1.

Barriers to AMS

Barriers	Response
Management backing/commitment	T3: “ AMS is difficult because we are going to experience friction e.g. autonomy in auditing prescriptions, without management backing it won’t work” T2: “there is no commitment from the leadership of the hospital. In Nigeria, we have this general attitude of not implementing policies”
Interprofessional rivalry	S2: “likely barrier is our professional rivalry, it’s for everybody to realize that we are in this workplace for the benefit of patients” T3: “one of the things with bringing guideline for hospital use is if the hospital has an antibiogram. To do this effectively, we need very good working relationship with pharmacist, doctors, clinical microbiologists etc. in most institutions in Nigeria, there is this rivalry that may make it difficult to work together seamlessly”
Shortage of healthcare professionals	S3: “In the state, generally, there’s a dearth in manpower. Imagine no qualified staff to run those specialized laboratories” T3: “AMS is an intensive program, we are few with other professional duties, so there will be need for dedicated staff”
Poor laboratory services	S3: “in the institution, reporting is a problem, poor laboratory services like we talked about. Antibiotic resistance involves testing”
Lack of training for healthcare professionals	S1: “In my institution, adequate education of health professionals and update on current use of antimicrobial guidelines is a big challenge”