Discussion
This protocol outlines the design of this pragmatic RCT to examine the effect of prophylactic sacral dressings on the cumulative incidence of PI in hospitalised adults. Our trial has several strengths. We are using an appropriately powered, robust multicentre pragmatic RCT design that is the largest trial of its kinds in this area. We are conducting an economic evaluation alongside the trial, and a process evaluation to ensure any difference in outcomes between the groups can be attributable to the intervention or contextual issues. With so few economic studies in this area, this parallel cost-effectiveness analysis will provide valuable health economic information to guide decision-making of health service managers to better balance quality patient care with economic efficiencies [