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Barriers and facilitators to the administration of prehospital tranexamic acid: A paramedic interview study using the theoretical domains framework

Goodwin, Laura; Nicholson, Helen; Robinson, Maria; Bedson, Adam; Black, Sarah; Kirby, Kim; Taylor, Hazel; Voss, Sarah; Benger, Jonathan

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Authors

Laura Goodwin

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Helen Nicholson Helen5.Nicholson@uwe.ac.uk
Senior Research Fellow in Emergency Care

Maria Robinson

Adam Bedson

Sarah Black

Kim Kirby

Hazel Taylor

Sarah Voss Sarah.Voss@uwe.ac.uk
Professor of Emergency and Critical Care

Jonathan Benger



Abstract

BACKGROUND: Tranexamic 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. METHODS: Interviews 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). RESULTS: Barriers 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). CONCLUSIONS: This 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.

Journal Article Type Article
Acceptance Date Oct 25, 2021
Online Publication Date Nov 11, 2021
Publication Date Jul 1, 2022
Deposit Date Oct 27, 2021
Publicly Available Date Dec 12, 2021
Journal Emergency medicine journal : EMJ
Print ISSN 1472-0205
Electronic ISSN 1472-0213
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 39
Issue 7
Pages 540-546
DOI https://doi.org/10.1136/emermed-2020-210622
Keywords prehospital tranexamic acid; tranexamic acid; theoretical domains framework
Public URL https://uwe-repository.worktribe.com/output/8033060

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Barriers and facilitators to the administration of prehospital tranexamic acid: a paramedic interview study using the theoretical domains framework (382 Kb)
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http://creativecommons.org/licenses/by-nc/4.0/

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Copyright Statement
This article has been accepted for publication in Emergency Medicine Journal (2021) following peer review, and the Version of Record can be accessed online at http://dx.doi.org/10.1136/emermed-2020-210622.

© BMJ Publishing Group Ltd 2021. Reuse of this manuscript version (excluding any databases, tables, diagrams, photographs and other images or illustrative material included where a another copyright owner is identified) is permitted strictly pursuant to the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC-BY-NC 4.0) http://creativecommons.org


Barriers and facilitators to the administration of pre-hospital tranexamic acid: A paramedic interview study using the theoretical domains framework (76 Kb)
Document

Licence
http://creativecommons.org/licenses/by-nc/4.0/

Publisher Licence URL
http://creativecommons.org/licenses/by-nc/4.0/

Copyright Statement
This article has been accepted for publication in Emergency Medicine Journal (2021) following peer review, and the Version of Record can be accessed online at http://dx.doi.org/10.1136/emermed-2020-210622.

© BMJ Publishing Group Ltd 2021. Reuse of this manuscript version (excluding any databases, tables, diagrams, photographs and other images or illustrative material included where a another copyright owner is identified) is permitted strictly pursuant to the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC-BY-NC 4.0) http://creativecommons.org






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