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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