Barriers to the application of theme months included the high turn-over of registered nurses (range 16.9–26.0% per year 2007–2010) and engaging the night shift staff. The registered nurses on the night shift applied the risk assessment tool less frequently when a patient was admitted the first years compared to day shift. Performance improved after personal feedback in late 2009 from the quality improvement coordinator to registered nurses who did not document risk assessment according to routines.