Reported barriers to implementation included unmotivated staff (28,31,43), staff turnover (23 - 24,27,35), staff and physician resistance (19,26 - 27), inconsistent documentation (27 - 28,47), difficulties in exporting data (35), and miscommunication between electronic systems (47). Staff disruption of implementation initiatives was the most commonly reported barrier. One study described staff as relatively uninvolved in planning (43), whereas another study described staff members focusing more on the role of wound care products and specialty beds than on nursing care when patients developed in-facility pressure ulcers (31). The launching of monthly to quarterly campaigns (28); perseverance by leadership (43); and use of additional education, mentoring, and support at the unit level (31) were solutions given for motivating staff. Staff reverting to previously unsuccessful practices (27), staff turnover (24,27,35), and variations in new staff orientation also slowed program momentum. The development of a strong multidisciplinary team (35), assignment of responsibility for processes to multiple nurses (23), and monthly visits by a state quality improvement organization (27) helped address these issues.