Data analysis

Both the field notes and the transcribed interviews were included in the materials that formed the units of analyses. Data were analysed by using the content analysis approach, as described by Graneheim and Lundman.^{98 99} A combination of deductive and inductive elements were used in Study 2, whereas a solely inductive approach was undertaken for Study 3. At the outset, the analytic process was driven by a deductive reasoning, and consensus on a coding list was made by the analytic team (HVW, ASH, and SH) prior to commencing the analyses. The coding list included the

“who”, “where” and “when”, in relation to initial and follow-up prescription,

preparation, and administration of SAP. An outline of the steps in the analytic process is illustrated in Figure 7.

36

*The deductive coding process was directed at the Norwegian national regulation framework for medication management.

Figure 7. An overview of the process of the deductive and inductive content analyses for studies 2 and 3.

In the following, each step in the analytic process is described in detail.

Step 1: Familiarising with data

Prior to coding, I, as the principal researcher, transcribed all 22 interviews and read through all transcriptions once. A selection of transcriptions was also read by supervisors SH and ASH in order to obtain a sense of and validate the whole coding procedure. Three interviews were excluded for further analyses (Figure 6) due to lack of relevance to context (exclusion of 1 interview, study site 2) and lack of

participation in SAP work processes (exclusion of 2 interviews, study site 3).

Step 2: Deductive coding process

19 interviews were included for the deductive coding and were transferred into NVivo Pro V.11.4 computer software for analysis. All text parts, which were considered appropriate to fit into the predetermined coding list, were extracted and mapped into a tentative outline of the clinical pathway of SAP. This part of the analysis was performed at a concrete analytic level, where abstractions and degrees of interpretations were low.

1. Familiarising with data

2. Deductive coding process*

3. Inductive coding

process 4. Forming categories

5. Interpretation 6. Findings of analyses:

Study 2

7. Inductive coding process

8. Interpretation

9. Findings of analysis:

Study 3

Step 3: Inductive coding process

The leftover data that did not fit in to the previously selected codes constituted the data used for the inductive analysis. During this part of the analysis, we looked for similarities and differences in the data, searching for patterns that could further elaborate on the work processes surrounding the provision of SAP. During this step, the analytic process moved between a close approach, at a concrete analytic level, and a distant approach, at a more abstract level.

Step 4: Forming categories

Codes that were derived from condensed meaning units were grouped into categories, which shared common characteristics. The categories were labelled to describe the content of the category, also referenced as the manifest content or the “what”.⁹⁸ An example of category development is illustrated in Table 5 (page 39). The presented category is part of study results reported in Study 2.

Step 5: Interpretation

In the final step of the analyses, we moved to a high degree of interpretation, at a more abstract level of analysing the latent content. This search, for a unifying “red thread” running through the already labelled categories, resulted in subthemes and a main theme.

Table 5. Example of category development in the qualitative analysis Category Diverse prescription order systems

Description of category

Different units have different SAP prescription practises, and prescriptions may be performed electronically or in paper forms.

Codes  Electronic, surgical planning system

 Electronic medication chart

 Paper-forms

 Wall poster in operating theatre

 Oral prescription

 Pre-authorised prescription protocols Examples

from the data

Field

notes Observations of how SAP is prescribed and documented;

1) standardised, as a default prescription in the surgical planning system,

2) electronic medication chart,

3) signed preoperative paper surgery-schedule forms, 4) wall-poster of a standardised, authorised procedure, describing which types of surgery require which types of antibiotics, in the OT with the anaesthesia team.

Informant

quotes Nurse anaesthetist: “…we have a laminated wall poster document of the standardised types of surgeries; this surgery requires this.. [antibiotic] and this type of surgery requires that [antibiotic]”. “The surgical antibiotic prophylaxis is to be prescribed in the patient’s medication chart by the surgeon, if there is an indication. Sometimes, the antibiotic prophylaxis is prescribed in the electronic surgical planning system as well”.

Anaesthetist: “The antibiotic is administered accordingly to a standardised template. This template was reviewed and updated one year ago by infection disease specialists, and management of antibiotic prophylaxis vary accordingly to the different types of surgery, either with or without implants. We just totally comply with this template”.

Surgeon: “As long as the patient belongs to this department, the antibiotic prophylaxis is to be prescribed in the medication chart. In case it is not written in the medication chart, then, it [the antibiotic] is not prescribed properly”.

Step 6: Findings of analysis for Study 2

A total of 9 categories, divided into 3 subthemes with one overarching theme, comprised the findings of the analytic process, reported in Study 2.

For the analysis of the data used in Study 3, we included 8 interviews from study site 2, and all 9 interviews performed at study site 3.

Step 7: Inductive coding process

A total of 17 interviews and all observations were included in the inductive coding process in exploring how members of the perioperative multidisciplinary teams integrate the SSC within their risk management. The inductive coding process, at this stage, involved an already established familiarity with the data, as 15 of the

interviews had been thoroughly read. Despite this, we looked for new similarities and differences in the data regarding how the team members viewed utilisation of the SSC in relation to perioperative teamwork. The analytic process moved between a concrete approach of identifying specific parts of importance, either in support of or against the SSC, and a distant approach at a more abstract level, thus indicating the former.

Step 8: Interpretation

In the final step of analyses, the themes derived from the categories were kept at a low abstraction level. Yet the interpretation in relation to the research question was of a higher degree.

Step 9: Findings of analysis for Study 3

A total of 8 categories, divided into 3 themes comprised the findings of the analytic process, were reported in Study 3.

40