Strengths and limitations of this study
Strengths of this study include obtaining data from multiple sources and stakeholders from five different acute hospital wards across seven implementation cycles.Another strength was the independence of the core process evaluation team from the feasibility trial team.Due to the nature of the intervention, documentary evidence from patients’ notes was used by improvement leads to complete intervention checklists and this information could not be verified by researchers.The research team could not confirm whether implementation was due to changes in clinical care, documenting practices or due to improvement leads’ own actions.