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Am J Perinatol 2024; 41(S 01): e1163-e1171
DOI: 10.1055/s-0042-1760449
Original Article

Assessing Barriers to Utilization of Premedication for Neonatal Intubation Based on the Theoretical Domains Framework

Dianne T. Lee
1   Department of Pediatrics, Children's Mercy Kansas City Hospital, Kansas City, Missouri
,
Christie J. Bruno
2   Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
,
Mona Sharifi
3   Department of Pediatrics, Center for Implementation Science, Yale University School of Medicine, New Haven, Connecticut
,
Veronika Shabanova
2   Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
,
Lindsay C. Johnston
2   Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
› Author Affiliations
Funding M.S. was supported by grant number K08HS024332 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.
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Abstract

Objective This study aimed to identify barriers and facilitators of premedication utilization for nonemergent neonatal intubations (NIs) in a level IV neonatal intensive care unit (NICU).

Study Design Between November 2018 and January 2019, multidisciplinary providers at a level IV NICU were invited to participate in an anonymous, electronic survey based on Theoretical Domains Framework to identify influences on utilization of evidence-based recommendations for NI premedication.

Results Of 186 surveys distributed, 84 (45%) providers responded. Most agreed with premedication use in the following domains: professional role/identity (86%), emotions (79%), skills (72%), optimism (71%), and memory, attention, and decision process (71%). Domains with less agreement include social influences (42%), knowledge (57%), intention (60%), belief about capabilities (63%), and behavior regulation (64%). Additional barriers include environmental context and resources, and beliefs about consequences.

Conclusion Several factors influence premedication use for nonemergent NI and may serve as facilitators and/or barriers. Efforts to address barriers should incorporate a multidisciplinary approach to improve patient outcomes and decrease procedure-related pain.

Key Points

  • Premedication for NIs can optimize conditions and decrease rates of tracheal intubation adverse events but there is significant international and institutional variation for premedication use for NI.

  • Guided by implementation science methods, the Theoretical Domains Framework was utilized to construct a novel assessment tool to determine potential barriers to and facilitators of the use of premedication for NI.

  • Several factors influence premedication for nonemergent NI.

Keywords

neonatal intubation - premedication - Theoretical Domains Framework - implementation science

Authors' Contributions

D.T.L., M.S., C.J.B. and L.C.J. conceptualized and designed the study, analyzed the data, drafted the initial manuscript, and reviewed and revised the manuscript. D.T.L. coordinated and supervised data collection. V.S. performed statistical analyses. All authors interpreted the data, and critically reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.


Ethical Approval and Patient Consent

Institutional Review Board Human Subjects Committee deemed the study to be exempt from review (Yale HSC no.: 2000023147). The study was performed in accordance with the Declaration of Helsinki.




Publication History

Received: 17 June 2022

Accepted: 08 December 2022

Article published online:
16 January 2023

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