Table 4 The final approved LISA assessment tool (LISA-AT) with response anchors one, three, and five after Delphi round 3.

Monitoring

Ensure appropriate monitoring of vital signs before and during the LISA procedure.

Fails to ensure monitoring.

Competent but not consistent monitoring of vital signs.

Excellent monitoring of vital signs before and during the procedure.

Equipment preparation

Ensure all equipment used in the LISA procedure is functioning.

Fails to check equipment/checks equipment incorrectly.

Competent but not consistent check of the equipment.

Excellent check of all the equipment.

Positioning

Position the patient optimally and maintain position during the LISA procedure.

Fails to position the patient.

Competent but not consistent position of the patient throughout the procedure.

Excellent position of the patient during the procedure.

Team-briefing/Team resource management

Perform a team briefing before the LISA procedure including task assignment, outlining potential problems, etc.

Fails to perform team briefing.

Performs team briefing with some experience.

Excellent team briefing.

Pharmacological interventions

Check drugs and doses that may be used as part of the LISA procedure (including antidote if opioid is being used).

Fails to check drugs.

Competent but not consistent check of drugs.

Excellent check of all drugs and doses.

Non-pharmacological interventions

Apply non-pharmacological techniques for pain and stress management.

Poor application of non-pharmacological techniques.

Some application of non-pharmacological techniques

Full application of non-pharmacological techniques.

Laryngoscopy

Competent and non-injurious handling of the laryngoscope and good visualization of the vocal cords including sufficient overview of the airway.

Fails to handle the laryngoscope/injurious handling of the laryngoscope/fails to visualize the vocal cords.

Competent but not consistent handling of the laryngoscope.

Excellent handling of the laryngoscope.

Catheterization

Insert the catheter into the trachea at the desired depth and maintain the position during instillation while retracting the laryngoscope.

Fails to insert the catheter.

Competent but not consistent handling of the catheter.

Excellent handling of the catheter.

Surfactant administration

Slow infusion to allow surfactant to be inhaled by the infant.

Fails to administer surfactant correctly.

Competent but not consistent surfactant administration.

Excellent surfactant administration.

Complications

Manage possible complications during administration.

Fails to manage complications.

Manages complications with some experience.

Excellent management of complications.

Respiratory support

Maintain CPAP/NIV during the LISA procedure.

Fails to maintain CPAP/NIV during the procedure.

Competent but not consistent use of CPAP/NIV during the procedure.

Excellent use of CPAP/NIV during the procedure.

Non-technical skills

Situational awareness, communication, teamwork, team leadership skills.

Fails to use non-technical skills.

Use non-technical skills with some experience.

Excellent use of non-technical skills.

Number of attempts

Number of attempts until the LISA procedure is successfully performed.

Procedure successfully performed only after more than 3 attempts, or procedure is abandoned.

Procedure successfully performed with 2 or 3 attempts.

Procedure successfully performed at the first attempt.

Adherence to algorithm / Time factor

Able to follow this algorithm and minimize time delay in treatment.

Fails to follow the algorithm.

Able to follow the algorithm but with significant time delay.

Able to follow the algorithm with minimal time delay.

Handling of the infant

Gentle handling of the patient during the LISA procedure.

Fails to handle the patient in a gentle way.

Handles the patient with some experience.

Excellent handling of the patient.