IntroductionThe high incidence of unsafe anaesthetic care leads to adverse events and increases the burden on patient safety. An important reason for unsafe anaesthesia care is the lack of non-technical skills (NTS), which are defined as personal cognitive, social or interpersonal skills, among anaesthetists. The anaesthetists’ NTS (ANTS) behavioural marker system has been widely used to evaluate and improve anaesthetists’ behavioural performance to ensure patient safety. This protocol describes a planned systematic review aiming to determine the validity and reliability of the ANTS behavioural marker system and its application as a tool for the training and assessment of ANTS and for improving patient safety.Methods and analysisThis systematic review follows the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol. Studies that applied the ANTS behavioural marker system in a meaningful way, including using the ANTS behavioural marker system to guide data collection, analysis, coding, measurement, and/or reporting, which have been published in peer-reviewed journals, will be eligible. A citation search strategy will be employed. We will search Scopus and Web of Science for publications from 2002 to May 2022, which cite the three original ANTS behavioural marker system publications by Fletcheret al. We will also search the references of the relevant reviews for additional eligible studies. For each study, two authors will independently screen papers to determine eligibility and will extract the data. The quality of the included studies will be assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists. A framework analysis approach that consists of five steps—familiarisation, identifying a thematic data extraction framework, indexing, charting, mapping and interpretation—will be used to synthesise and report the data.Ethics and disseminationEthics approval is not required for this study. The findings will be disseminated primarily through peer-reviewed publications and conference presentations.PROSPERO registration numberCRD42022297773.

Background The incidence of procedural pain is high in pediatric patients. Poorly treated pain will contribute to a variety of short-term and long-term adverse effects in children. There are many evidence-based effective pain treatments for reducing procedural pain, such as topical anesthetics, skin-to-skin care, sweet solutions, and breastfeeding; however, in clinical settings, the rate of using these effective procedural pain treatments is still very low. This systematic review aims to synthesize the barriers and facilitators to the implementation of effective procedural pain treatments in pediatric patients. Methods Primary studies will be included if they report any barriers or facilitators to procedural pain treatments in pediatric patients. There are no restrictions on the year and language of publication of studies. Both published studies and grey literature will be identified. We will search published studies through Medline(OVID), EMBASE, CINAHL, PsycINFO, Web of Science, and Scopus. Grey literature will be searched through Google Scholar, OpenGrey, e-theses online service, ProQuest, WorldCat, Networked Digital Library of Theses and Dissertations, Open Access Theses and Dissertations, and public health organization websites. The Mixed Methods Appraisal Tool will be used to assess all studies' quality. The Consolidated Framework for Implementation Research will be used as a theoretical framework to code the barriers and facilitators in each study. A meta-synthesis method will be used to synthesize the findings across studies. Discussion In this review, the CFIR framework will be used to systematically collect and analyze barriers and facilitators to procedural pain management in pediatric patients. The mixed studies review is necessary to include the heterogeneity of different studies to give us a more complete picture of the context in which the intervention was implemented. The next step could be to develop interventions that target these factors to better improve clinical outcomes for patients. Systematic review registration CRD42022322319