Table 1 Characteristics of included studies

De Visschere et al. (2012) [31], Belgium.

Cluster-randomised controlled trial.

Nurses, nurse aids. Level of training not stated.

12 nursing homes (N = 297).

Nursing home residents, mean age 84 years, high degree of physical disability and cognitive impairment.

Patient outcome: oral hygiene level of the participating residents: dental plaque, denture plaque, tongue plaque (primary outcomes).

Dental plaque: Silnes and Löe plaque index. Denture plaque: Augsburger and Elahi Methylene-blue test. Tongue plaque: Winkel tongue coating index. Tests carried out by trained external examiners.

Measured once after the 6 months intervention period.

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Köpke et al. (2012) [32], Germany.

Cluster-randomised controlled trial.

Nurses with three years of vocational training, certified nurse assistants with 1 year vocational training, untrained nurse assistants.

36 nursing homes (N = 3670).

Nursing home residents, mean age 85.5 years, high degree of physical disability and cognitive impairment.

Professional practice: the number of residents with physical restraints after 6 months (primary outcome). Restraint use at 3 months (secondary outcome).

Unannounced observation by blinded investigators on three different occasions during one day.

Measured after 3 and 6 months during the 6 months intervention period.

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Tjia et al. (2015) [36], USA.

Cluster-randomised controlled trial.

Nurses, certified nurse assistants, physicians, nursing home leaders. Level of training not stated.

42 nursing homes (N = unknown).

Professional practice:

Facility-level change in atypical antipsychotic prescribing rates (primary outcome).

Screening of pharmacy dispensing data. Not stated who assessed the data.

Measured monthly during the 12 months intervention period.

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Van Gaal (2011a/b) [33, 34], Netherlands.

Cluster-randomised controlled trial.

Nurses. Level of training not stated.

10 wards from 6 nursing homes (N = 392).

Nursing home residents, mean age 78 years, half of them physically impaired. No cognitive impairment.

Patient outcome (Part I): Incidence of adverse events: pressure ulcer, urinary tract infections and falls (primary outcome).

Professional practice (Part II): adequate care given to nursing home residents at risk of adverse events (secondary outcome).

Primary outcome: chart review and inspection of patient’s skin by independent research assistants.

Secondary outcome: chart review and patient observation by independent research assistants.

Primary outcomes: measured weekly during post-intervention follow up.

Secondary outcomes: measured weekly during post-intervention follow-up. Three additional observational visits on every ward. No measurement during the 14 months intervention period.

9 months.

Ward et al. (2010) [35], Australia.

Cluster-randomised controlled trial.

Nursing home staff including physicians. Level of training not stated.

88 nursing homes (N = 5391).

Nursing home residents, mean age 85.5 years, about 70 % able to stand or walk with or without assistance, 21 % received dementia-specific care.

Professional practice: use of vitamin D supplements, use of hip protectors (primary outcomes).

Patient outcome: change in fall rates, residents with a fractured neck of femur (primary outcomes).

Chart review by nursing home staff.

Monthly during the 17 months intervention period.

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