Designing behavioral interventions using the capability-opportunity-motivation-behavior model and the theoretical domains framework to optimize oxygen saturation maintenance by NICU providers

OBJECTIVE: Despite evidence-based guidelines, SpO(2) maintenance-related practices of care providers remain inconsistent. Our aim was to evaluate the impact of interprofessional learning workshops, bedside coaching, and neonatal intensive care unit (NICU) level enablers on targeted behavioral change of NICU staff, focusing on SpO(2) maintenance. METHODS: NICU is a specialized area of the hospital with sophisticated monitors where multidisciplinary staff provide round-the-clock care for sick and preterm infants. As a subset of a quality improvement project to improve SpO(2) maintenance and reduce desaturation events, three targeted evidence-based staff behaviors were deemed as important based on established capability-opportunity-motivation-behavior and theoretical domains framework models: setting SpO(2) alarm limits, using SpO(2) alarm management algorithms, and reporting daily summaries of SpO(2) during rounds. We conducted interprofessional workshops, provided bedside coaching, and altered unit NICU processes (guidelines, automated SpO(2) histogram printouts, defined staff standard work) and measured demonstrable changes in staff reaction, learning, and behaviors by direct observation of behaviors and survey questionnaires. RESULTS: Two hundred and seventy-five (87%) and 210 (80%) of NICU staff attended workshops and received bedside coaching, respectively. The proportion of staff expressing satisfaction with workshop and bedside coaching was 85% and 82%, respectively. The proportion of staff reporting improvement in their knowledge and confidence related to SpO(2) maintenance increased significantly following the workshop. Targeted behaviors related to SpO(2) maintenance like setting appropriate alarm limits, adhering to SpO(2) management algorithm, and reporting daily SpO(2) summaries during rounds increased from 80% to 96%, 0% to 64%, and 20% to 70%, respectively. CONCLUSION: Focused behavioral change interventions aimed at improving staff capability, opportunity, and motivation resulted in a demonstrable change in targeted staff behaviors related to SpO(2) maintenance. Further research is needed to establish ways of optimizing intended staff behaviors while implementing care bundles in a given setting.