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

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

  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
  1. *barriers and supports discussed by two or more sites