Table 2 Summary of concepts and instruments / measurements used to collect data

Cumulative incidence of (new) PrUs for pre-intervention (baseline) period

Cumulative Incidence rate = [(# of residents with 1 or more new PrUs during a 1-month period) ÷ (# of NH residents with 3 or more day stay)] ×  100; calculated monthly to establish baseline over the 12-month period before each NH intervention begins.

• MDS 3.0

• NH self-report

• EMR data extract

Cumulative incidence of (new) PrUs for intervention period

Cumulative Incidence rate = [(# of residents with 1 or more new PrUs during intervention period) ÷ (# of residents participating in intervention for 3 or more days)] ×  100; calculated for the full 4-week intervention period.

• MDS 3.0

• NH self-report

• EMR data extract

Braden Scale©

The Braden scale is being used per protocol by participating NHs to assess resident risk for PrUs at intervention start and weekly thereafter.

• EMR data extract

Repositioning frequency

The scheduled duration of time for a resident’s pressure exposure as reflected by the 2-, 3-, or 4-h time interval at which the resident is repositioned; each NH will be randomly assigned to one of the study’s 3 arms and will use a single NH-wide repositioning frequency.

• PMS Central Server containing Monitoring Management Software

Recorded repositioning frequency

The actual time interval at which repositioning occurs, as documented by the Leaf sensor; recorded in clock time hours and minutes, 24 h per day, from start to end of resident’s participation in the 4-week intervention.

Repositioning activities of residents will be captured using the Patient Monitoring System; Admission, Discharge, Transfer (ADT) feed from NHS to Monitoring System enables a match for Study ID# to resident movement, which is required for resident tracking in the event of room change, discharge/readmission, or other events.

• PMS Central Server containing Monitoring Management Software

Repositioning protocol adherence: % agreement

Percentage of agreement between scheduled repositioning frequency and repositioning frequency recorded by wireless sensor:

[(scheduled clock time - recorded clock time = # minutes difference) ÷ 60] ×  100]; calculated for each resident’s repositioning episode.

• PMS Central Server containing Monitoring Management Software

Medical Severity —Comprehensive Severity Index (CSI)

Calculated score on severity resulting from distillation of physiologic parameters, signs, symptoms, laboratory results, physical findings, and diagnoses, using the modified Comprehensive Severity Index (CSI), a risk adjustment system. The more abnormal the signs and symptoms, the higher the severity score: Level 1 is normal to mild, and Level 4 is catastrophic, life-threatening, or likely to result in organ failure.

Individual components thought to influence a resident’s skin tolerance to pressure exposure will be monitored from assessment to assessment for Leaf, resident care parameters, CSI, and Braden score, with data extracted from EMR and the most recent MDS 3.0 assessment (initial, annual, quarterly, or change in status).

• MDS 3.0

• EMR data extract

Clinically assessed risk level (Braden Scale)

Total summed score (range 6 to 23) on the Braden Scale for Predicting Pressure Sore Risk©, comprised of 6 subscales (sensory perception, mobility, activity, moisture, nutrition, and friction & shear). Braden Score will be categorized as low (15–23), moderate (13–14), or high (10–12) risk. Collected weekly during intervention. Routinely collected by NH on admission, weekly ×  4, quarterly, and upon suspected change in health condition. Change in category will be extracted.

• EMR data extract

Culture Assessment

Demographic & NCAT data will be used to assess the basic characteristics of participants and healthcare setting and clinical area worked. Data to be collected from each participant include, Length of time employed, job category, age, and gender.

• Qualtrics survey on iPads

Staff mix

The number of RNs, LPNs, and CNAs who work at each NH per day each day during the 4-week intervention at that NH, and for 12 months prior to intervention start.

• NH self-report

Staff turnover rate

[(Number of nursing staff (CNA, LPN, & RN) who leave during the time period) ÷ (Number of nursing staff at beginning + Number of nursing staff at the end ÷ 2)] × 100.

• NH self-report

Labor cost:

 1) Training

 2) Conducting repositions

1) Time needed for training nursing staff multiplied by respective wage & fringe rates of training participants, 2) number of repositioning’s for each NH and study arm and time to conduct repositioning collected by wireless sensor system; multiplied by nurse wage & fringe rate.

• NH self-report

Non-labor cost inputs

Market prices paid fully depreciated over their respective useful life will be used to calculate daily equipment cost rates. Includes VE surfaces, Leaf services, and sensor use.

• NH self-report