Barriers and supports to implementation of MDI/spacer use in nine Canadian pediatric emergency departments: a qualitative study

Table 2 Barriers and supports to MDI/spacer use by site*

	Early Adopters			Adopting		Yet to adopt
	A	B	C	D	E	F	G	H	J
BARRIERS to MDI Use
Evidence-based Innovation
Increased cost to the ED	x					x	x	x	x
Parental resistance	x	x	x	x	x	x	x	x	x
Extra time/extra work for nurses	x			x	x	x	x	x	x
Sterilization issues for the spacer devices				x			x	x
Cost of the spacer to the patient		x				x			x
(Potential) Adopters
Entrenched ideas/scepticism	x		x					x
Not convinced by the research/no clear advantage						x	x	x	x
Practice Environment
Language barrier (parents)						x	x	x
Concerns about overtreatment at home by parents						x	x
Institutional bureaucracy						x	x
Lack of supplies or resources		x			x	x	x	x	x
Inconsistency of use in facility/region	x		x		x		x	x
SUPPORTS/FACILITATORS to MDI Use
Evidence-based Innovation
Clear advantage acknowledged/'buy in'	x		x	x		x	x
Perceived reduction in transmission of infection	x	x			x
(Potential) Adopters
Being involved in research			x		x		x
Practice Environment
Clear written protocol including MDI use				x			x	x	x
Encouraging staff participation in the change process	x			x					x
Having resources for patient education			x	x		x	x		x
Consistent treatment across department/facility/region	x				x	x	x		x
RT support		x	x		x		x
Presence of a research champion	x			x	x	x
Staff presented with rationale/evidence		x	x	x	x		x		x
Adequate resources/supplies	x			x		x	x	x
Education for staff	x			x	x	x	x	x	x

ISSN: 1748-5908