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

Scott, Shannon D; Osmond, Martin H; O'Leary, Kathy A; Graham, Ian D; Grimshaw, Jeremy; Klassen, Terry

The clinicians from the sites participating in this study exhibited a range of knowledge, attitudes, and skills regarding the MDI/spacer. The majority of participants were aware of the results of research concerning the effectiveness of MDI/spacers, with physicians and respiratory therapists in general being more knowledgeable than nurses about specific studies. Even in adopting sites, there were individuals who had believed that nebulisation was more effective, especially for those patients who were in the moderate to severe range. The perception is that the majority of individuals, specifically physicians, needed to have 'bought-in' to the idea of using MDI/spacers for the adoption to take place. In order for this to occur, individuals needed to believe that the relative advantage gained by changing practice was 'worth' the energy and resources needed to make the change. Interestingly, buy-in on an individual level was often present at non-adopting sites, but because of other barriers and/or a lack of consensus, adoption had not occurred. Our findings on the characteristics of the adopters reflect the complexity of the MDI/ spacer adoption process. While individual clinicians may be aware of the advantages of MDI/spacer use, the actually 'adoption' of MDI/spacers is actually an institutional or department decision because it requires support from different disciplines, as well as the allocation of different resources and products.