The process of evaluation is linked closely to sustainability since strategies that are ineffective need to be modified or replaced with alternatives that will yield desired clinical outcomes and are acceptable and feasible for staff. Quality monitoring methods were incorporated into weekly nursing rounds that were initiated by the treatment nurse, MDS nurse, and GAPN. The quality monitoring form developed was based on the University of Iowa protocol, Oral Hygiene Care Out-comes21 to track the resident’s assessments, oral health status, care plan, nursing staff implementation, and identification of resident care problems.