Table 2

Implementation plan for pressure injury prevention care bundle

What	Why	Who	How/frequency	Where
Training and education: - On risk factors, pressure injury prevention, equipment, outcomes, protocols.	Access to training was identified as a barrier to pressure injury prevention in nursing homes. To improve pressure injury prevention knowledge and skills in nursing home care staff (registered and unregistered). We identified the following two BCTs as important components of the intervention: information about social and environmental consequences’ and ‘information on health consequences’.	Provided by a tissue viability nurse to nursing home care staff (registered and unregistered).	Training will be provided 1 week prior to the implementation of the care bundle and will be a one-off face-to-face, 3-hour interactive group session. Presentation using PowerPoint and printed materials will be provided to the staff who attend and also to the nursing home for staff who are unable to attend. Additional training sessions will be offered to the nursing home care staff to maximise attendance.	Due to practical reasons, training will be held off-site. Written training materials will be available in the nursing home.
- On the care bundle and each individual element (support surfaces, skin inspection, repositioning) and how to use the care bundle in practice.	To increase the uptake of the care bundle and to familiarise staff with the processes involved.	Provided to nursing home care staff (registered and unregistered) by a researcher with expertise in behaviour change.	Face-to-face 1 hour interactive group session. PowerPoint and printed materials will be provided to staff who attend and also to the nursing home for staff who are unable to attend.
Modelling and demonstration of behaviour: - Skin champions	The skin champions will deliver the care bundle as intended and will be available during a shift. Staff can speak with the skin champions if they have any concerns or queries. Skin champions are also able to demonstrate pressure injury prevention techniques and provide examples of good record keeping (ie, documentation).	Nursing home care staff (likely to be a registered nurse).	This is available face-to-face and is likely to be delivered on an individual basis and will be available as required. The researcher will meet with the skin champions at least bi-weekly to discuss any issues or concerns.	Nursing home.
Implementation of the care bundle:
- Risk assessment	To identify any risk factors for the development of a pressure injury and indicate the frequency with which the care bundle needs to be delivered.	Registered nurse and/or nursing home manager.	Using a validated risk assessment tool, the risk assessment will be completed at least monthly. If there is a change to a resident’s clinical status, the risk assessment should be conducted again.	Nursing home.
Implementation of the care bundle:
- Complete care bundle for each eligible resident (support surfaces, skin inspection, repositioning).	To improve the reliability of care and to prevent pressure injuries using elements identified locally as being important within a nursing home context. To improve the documentation of pressure injury prevention practices.	Nursing home care staff (registered and unregistered).	Nursing home care staff will complete each element of care included within the care bundle. If it is not possible to conduct all of the elements (support surfaces, skin inspection, repositioning) within the care bundle, this must be documented on the overleaf section of the care bundle documentation sheet. The frequency with which this needs to be conducted will depend on each individual resident. The frequency should be amended in line with a resident’s needs and risk. For example, for those at risk of developing a pressure injury, it should be at least every 6 hours, at least every 4 hours for those at a high risk and at least every 2 hours for those at a very high risk. Staff are required to ensure the appropriate pressure relieving equipment is being used and is functioning.	Nursing home.
Prompts and cues	An aide memoire was reported as a facilitator of pressure injury prevention in nursing homes. Thus, posters will be placed in staff communal areas (eg, nursing office) to remind staff of the steps involved within the care bundle. The care bundle itself also acts as a checklist as staff are required to document the provision of care on the care bundle sheets.	The research team will provide posters and care bundle documentation.	The unit manager will decide the positioning of the posters on the unit (see online supplementary appendix 2). The nursing home staff are responsible for the completion of the care bundle and associated documents. These will be available daily throughout the study period.	Nursing home (including nursing office, residents’ bedrooms, residents’ files).
Feedback:	To maintain motivation and engagement with the care bundle.
- On behaviours and outcomes.	To highlight areas of pressure injury prevention where staff are maintaining high levels of care and the areas that could be improved.	Researcher	The research team will provide verbal feedback to the unit manager on a monthly basis during the study period. This will include the number of pressure injuries acquired and adherence to the care bundle. Feedback will be provided in the form of percentages on the following: All-or-none compliance (when all aspects of the care bundle were delivered, including times when it was not possible to complete the care bundle but reasons were documented); Overall adherence with each individual element: support surfaces, skin inspection, repositioning. Following the completion of the study, the above information will be collated and the findings from the whole study period will be presented verbally to the unit manager and nursing home care staff.	Nursing home.