Table 1 Summary of reported barriers
Author (year) and country | Study design and population | TDF Domain | Description of reported barrier |
|---|---|---|---|
Al-Azzam et al. (2012) [35] Jordan | Quantitative, descriptive (cross-sectional survey) | Knowledge | Personal barrier (intrapersonal): - Lack of guideline knowledge |
Physicians | Environmental context and resources | Organisational barriers: - Work flow - Lack of organisational communication - Drug unavailability - Drug cost - Presence of institutional policy (preventing the use of international guidelines – note that authors were determining compliance to international guidelines in this paper) | |
Bonfait et al. (2010) [36] France | Quantitative, descriptive | Social/Professional role and identity | Personal barriers (interpersonal): - Lack of role delegation for prescribing and administering antibiotics |
Orthopaedic surgeons | Knowledge | Personal barriers (intrapersonal): - Lack of awareness of guideline content - Antibiotics not administered due to “negligence or oversight” | |
Memory, attention and decision processes | |||
Environmental context and resources | Organisational barriers: - Lack of communication between specialties (anaesthetists and surgeons) at induction - Insufficient staff training - Excessive workload and inappropriate work allocation - Lack of written guidelines - Guidelines present in the wrong place – inaccessible in theatre or on the wards | ||
Broom et al. (2018) [37] Australia | Qualitative | Memory attention and decision processes | Personal barriers (intrapersonal): -Forgetfulness - Lack of confidence in ability to protect against adverse consequences/ fear of repercussions (infections) hence extended duration of prophylaxis (“peace of mind”) - Level of experience (junior vs senior) |
Surgeons Anaesthetists | Beliefs about consequences | ||
Beliefs about capabilities | |||
Emotion | |||
Skills | |||
Knowledge | |||
Social influences | Organisational barriers: - Culture of improvisation as the norm rather than guideline adherence - Antibiotic prophylaxis is seen as low priority by staff in theatre especially if competing demands are present | ||
Environmental context and resources | |||
Chen et al. (2018) [38] USA | Quantitative descriptive | Knowledge | Personal barriers (intrapersonal): - Lack of awareness - Reliance on personal experience to determine practice |
Beliefs about capabilities | |||
Paediatric electrophysiologists | Environmental context and resources | Organisational barriers: - Presence of institutional guidelines (preventing national guidelines from being used – note that authors were reviewing compliance to national guidelines in this study) - Lack of data present for paediatric population (hence national guidelines not being adhered to) | |
Madubueze et al. (2015) [39] Nigeria | Quantitative descriptive | Skills | Personal barriers (intrapersonal): - Habits that have been picked up during training or practice - Belief that proper aseptic techniques are not being followed on site |
Orthopaedic surgeons | Beliefs about consequences | ||
Environmental context and resources | Organisational barriers: - Work environment sterility (not considered clean enough hence the extension of antibiotic use) | ||
Tan et al. (2006) [40] Canada | Qualitative | Social/professional role and identity | Personal barriers (interpersonal): Role perception: - Shared responsibility: belief that there is a shared responsibility in administering antibiotics (should be administered by whoever it is most convenient for at the time) - Individual responsibility: belief that antibiotic should be administered by nurse or anaesthesiologist - Resignation: anaesthesiologists expressed resentment at having to administer antibiotics – was considered external to scope of practice; violation of medical hierarchy |
Anaesthesiologists Surgeons Peri-operative administrators (nurse/anaesthesia administrators) Nurses Pharmacist | Social influences | ||
Emotion | |||
Environmental context and resources | Organisational barriers: - Inherent unpredictability of workflow systems as well as unanticipated changes to workflow - Antibiotic prophylaxis considered as low priority given other competing concerns in theatre - Administration is seen as inconvenient as it disrupts preoperative routine - Lack of verbal communication regarding antibiotics information |