Table 1 Protocol for implementation of intervention approach

(1) PrU Prevention and Study Protocol Education

 Content: Introduces all NH nursing staff to PrU etiology, evidence-based PrU prevention practices, benefits of repositioning, & EMR documentation. Outlines roles & responsibilities, staff work flow, & performance & documentation of movement of residents. Content includes NH-wide repositioning strategy & suggestions for best practice implementation with cueing every 2, 3, or 4 h (24 h/day, 7 days/wk) depending on NH’s hourly protocol.

 Delivery Strategies:

  • Researcher leads initial session containing videos embedded in PowerPoint overview with simulation of repositioning & documentation process, followed by questions & answers.

  • Reference cards provided to all staff summarizing PrU etiology & staff responsibilities in relation to study protocol, day-to-day procedures, & directions for carrying out the protocol & completing study measures & documentation.

Establish knowledge of PrU etiology prevention practices, & study protocol.

Facilitate consistency in response to intervention protocols, safety, & group effectiveness.

Encourage problem-centered thinking & learning by demonstration and return demonstration.

RNs, LPNs, NAs, NPs

Initial session week prior to repositioning protocol start; for new staff orientation: one 60-min session followed by one-on-one training as needed when working.

(2) Champion Training

 Champion Training Class:

  Champions will learn to facilitate the educational component & practice mentoring on study strategy, problem-solving about protocol implementation, EMR documentation, & observation checklist completion; Leaf sensor placement with system activation check & skin monitoring.

 Support by Research Facilitators:

  A researcher will contact each champion every week via phone or videoconferencing during the intervention for support, advising, or refreshers as needed; champions will also have a phone number to call to seek help from research staff as needed.

Prepare champions to mentor staff, build trust, maintain consistency, and facilitate sustained implementation.

Volunteer nursing staff

Week prior to repositioning protocol start: one 60-min session.

(3) Patient Monitoring System Training

 Focus is on patient monitoring, responding to the 2-, 3-, or 4-h visual cues on the screen displays located at nursing station and in hallway on clinical unit, and review sample data feedback & practice interpretation.

 Placement of Sensor on Resident:

  Focus is on licensed nurse & process for sensor placement and oversight of CNA routine observation. Staff will learn to place sensor and ensure its activation and to remove and discharge sensor. Leaf placement will be periodically checked by champions to ensure fidelity.

Staff will be prepared to monitor the screen display for repositioning status (cue & next repositioning times) and to complete the appropriate documentation.

RNs, LPNs, NAs, NPs

Week prior to repositioning protocol start:

Part of PrU Prevention Protocol & Education session followed by one-on-one on-the-job training as needed.

(4) VE Support Surface Audit

 This will be completed at each NH site according to NH system’s policy. Each NH will provide audit documentation demonstrating that all mattresses are adequate and have been examined (those that were not adequate were replaced) within the last year according to NH system’s Mattress and Safety Audit Guidelines.

Ensure viable mattresses in use prior to intervention start

Research team and NH staff

Minimum of 1 month prior to repositioning protocol start.