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
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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.
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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
