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

Participants in adopter sites perceived that the presence of a professional (or professionals) within the department willing to champion the practice change was one of the most significant factors influencing in the adoption of the MDI/spacer. Most often, these individuals were respected clinicians by virtue of their experience and/or clinical expertise, had an interest in the specific clinical area (asthma), or had used MDI/spacers previously at another site. In two of the three early adopting sites, leadership at the clinical level was instrumental in achieving 'buy-in' by staff, and subsequently, adoption. Buy-in was achieved by providing both credible evidence and persuasive arguments for adoption of the practice. In sites that had not yet adopted MDI/spacer use, clinicians willing to champion the MDI/spacer research were recognized as being important to the change process, but either no one had committed to the role, someone had in the past but had not been successful, or someone was in the process of garnering support for the practice change, but had not yet achieved their goal. The consensus among participants was that a physician should be in the championing role, and it should be a person who has considerable credibility as a clinician.