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Barriers and facilitators to the administration of prehospital tranexamic acid: A paramedic interview study using the theoretical domains framework
- Publication Year :
- 2022
- Publisher :
- BMJ Publishing Group, 2022.
-
Abstract
- BackgroundTranexamic acid (TXA) is an antifibrinolytic drug used to prevent bleeding. It was introduced as an intervention for post-traumatic haemorrhage across emergency medical services (EMS) in the UK during 2012. However, despite strong evidence of effectiveness, prehospital TXA administration rates are low. This study used the theoretical domains framework (TDF) to identify barriers and facilitators to the administration of TXA to trauma patients by EMS providers (paramedics) in the UK.MethodsInterviews were completed with 18 UK paramedics from a single EMS provider organisation. A convenience sampling approach was used, and interviews continued until thematic saturation was reached. Semistructured telephone interviews explored paramedics’ experiences of administering TXA to trauma patients, including identifying whether or not patients were at risk of bleeding. Data were analysed inductively using thematic analysis (stage 1). Themes were mapped to the theoretical domains of the TDF to identify behavioural theory-derived barriers and facilitators to the administration of TXA to trauma patients (stage 2). Belief statements were identified and assessed for importance according to prevalence, discordance and evidence base (stage 3).ResultsBarriers and facilitators to paramedics’ administration of TXA to trauma patients were represented by 11 of the 14 domains of the TDF. Important barriers included a lack of knowledge and experience with TXA (Domain: Knowledge and Skills), confusion and restrictions relating to the guidelines for TXA administration (Domain: Social/professional role and identity), a lack of resources (Domain: Environmental context and resources) and difficulty in identifying patients at risk of bleeding (Domain: Memory, attention and decision processes).ConclusionsThis study presents a behavioural theory-based approach to identifying barriers and facilitators to the prehospital administration of TXA to trauma patients in the UK. It identifies multiple influencing factors that may serve as a basis for developing an intervention to increase prehospital administration of TXA.
- Subjects :
- medicine.medical_specialty
Emergency Medical Services
Allied Health Personnel
Context (language use)
Hemorrhage
Critical Care and Intensive Care Medicine
tranexamic acid
theoretical domains framework
Intervention (counseling)
medicine
Emergency medical services
Humans
Centre for Health and Clinical Research
Qualitative Research
business.industry
General Medicine
Antifibrinolytic Agents
prehospital tranexamic acid
Family medicine
Emergency Medicine
Interview study
Decision process
Thematic analysis
business
Administration (government)
Tranexamic acid
medicine.drug
Subjects
Details
- Language :
- English
- ISSN :
- 14720205 and 14720213
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....c584a9b872633aa449d26a0494251418