Table 3 Barriers to barcode medication administration (BCMA) use mapped to the COM-B (Capability, Opportunity, Motivation - Behaviour) Framework and the Theoretical Domain Framework (TDF)
COM-B | THEORETICAL DOMAINS FRAMEWORK | THEMES (SUB-THEMES) |
|---|---|---|
CAPABILITY: PSYCHOLOGICAL | KNOWLEDGE | Training on BCMA Unaware of troubleshooting guides Infection Control Uncertainty regarding using BCMA |
MEMORY, ATTENTION AND DECISION PROCESSES | Training on BCMA Delays between training and implementation Time-efficiency Lack of cognitive capacity to use system with available staffing and workload | |
CAPABILITY: PHYSICAL | SKILLS | Training on BCMA Lack of follow up / refresher sessions Inadequate training Temporary staff not trained |
OPPORTUNITY: SOCIAL | SOCIAL INFLUENCES | Culture and Accountability No ward culture of using system Effect on patient interaction Patients not receptive to wristband being scanned. |
OPPORTUNITY: PHYSICAL | ENVIRONMENTAL CONTEXT AND RESOURCES | Staffing and Workload Short-staffing reduces perceived feasibility High workload limits use of BCMA Ergonomics of BCMA Trolley Physical challenges when using BCMA trolley Ergonomics of ward Physical Obstacles Wireless signal not consistent Drug-Related Unable to scan some medications Number of Medications Equipment Hardware malfunction Software issues |
MOTIVATION: AUTOMATIC | REINFORCEMENT | Culture and Accountability Use not enforced out of hours Lack of perceived repercussions Not enforced by management Effect on patient interaction Diminished patient interaction |
MOTIVATION: REFLECTIVE | PROFESSIONAL ROLE AND IDENTITY | Workload / Staffing Other competing responsibilities as nurse in charge |
BELIEFS ABOUT CAPABILITIES | Time-efficiency Perception that don’t have enough time to use BCMA | |
GOALS | Workload / Staffing Requirement to complete other tasks | |
INTENTIONS | Time-efficiency Perception that BCMA takes longer | |
BELIEFS ABOUT CONSEQUENCES | Culture and Accountability Lack of perceived repercussions |