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

In addition to complementing Osmond's work, our findings also build upon the work of Hurley and colleagues [7] . They explored Canadian ED healthcare professionals' perceptions associated with the use or non-use of MDI/ spacers for the delivery of beta-agonist respiratory medications in two teaching hospitals. They discovered the main impediments to be increased workload, increased equipment costs, myths about the superiority of nebulisation, and interprofessional conflict. While there are parallels in terms of some of the identified barriers to MDI/spacer adoption, our findings revealed a more dynamic picture with early adopter and yet to adopt sites sharing some of the barriers, yet early adopter sites created/generated support and leadership to overcome the barriers. Through a more robust research design and a larger sample size, we were able to build upon Hurley's findings and learn that clarity about cost implications and the support from leadership and a MDI/spacer champion can be integral components to successful adoption.