In DOI parlance, confirmation occurs when a deci-sion is made to adopt or reject the innovation. If the innovation has not been effectively taken through the clinical practice improvement process, then sustainabil-ity of the innovation is threatened, even if direct-care staff and leadership support the idea. The process is iterative and ongoing. In the oral care program, the process allowed for new information to be gathered and incorporated into care systems to meet individualized resident issues and adapt new care innovations as they become known.