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Implementation Science
Published in: Implementation Science 1/2009

Open Access 01-12-2009 | Research article

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

Authors: Shannon D Scott, Martin H Osmond, Kathy A O'Leary, Ian D Graham, Jeremy Grimshaw, Terry Klassen, the Pediatric Emergency Research Canada (PERC) MDI/spacer Study Group

Published in: Implementation Science | Issue 1/2009

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Abstract

Background

Despite recent research supporting the use of metered dose inhalers with spacer devices (MDI/spacers) in pediatric emergency departments (PEDs) for acute exacerbations of asthma, uptake of this practice has been slow. The objectives of this study were to determine the barriers and supports to implementing MDI/spacer research and to identify factors associated with early and late adoption of MDI/spacers in Canadian PEDs.

Methods

Using a comparative case study design, we classified nine tertiary care pediatric hospital PEDs based on their stage of implementation. Data were collected using focus group interviews with physicians, registered nurses (RNs), and respiratory therapists (RTs), and individual interviews with both patient care and medical directors at each site. Initial coding was based on the Ottawa Model of Research Use (OMRU) categories of elements known to influence the uptake of innovations.

Results

One hundred and fifty healthcare professionals from nine different healthcare institutions participated in this study. Lack of leadership in the form of a research champion, a lack of consensus about the benefits of MDI/spacers among staff, perceived resistance from patients/parents, and perceived increased cost and workload associated with MDI/spacer use were the most prevalent barriers to the adoption of the MDI/spacer. Common strategies used by early-adopting sites included the active participation of all professional groups in the adoption process in addition to a well-planned and executed educational component for staff, patients, and families. Early adopter sites were also more likely to have the MDI/spacer included in a clinical protocol/pathway.

Conclusion

Potential barriers and supports to implementation have been identified that will help EDs adopt MDI/spacer use. Future interventions intended to increase MDI/spacer use in PEDs will need to be sensitive to the barriers identified in this study.
Appendix
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Metadata
Title
Barriers and supports to implementation of MDI/spacer use in nine Canadian pediatric emergency departments: a qualitative study
Authors
Shannon D Scott
Martin H Osmond
Kathy A O'Leary
Ian D Graham
Jeremy Grimshaw
Terry Klassen
the Pediatric Emergency Research Canada (PERC) MDI/spacer Study Group
Publication date
01-12-2009
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2009
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/1748-5908-4-65

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