ABSTRACT: The perioperative environment presents complex challenges for protecting patient’s skin during surgery. At a large academic medical center, an assessment of resources, current knowledge, and data of reported skin events provided baseline information and the necessity of a skin integrity protocol. With an increased number of skin events in multiple surgical specialties and various approaches being taken to protect skin, an intraoperative skin integrity protocol based on evidence-based research and professional association recommendations was developed. Development of the protocol included variables specific to the surgical patient and special considerations for various patients. An educational presentation was given to staff to improve knowledge of skin integrity and how to implement the protocol. Following implementation, data indicated that skin events decreased with the use of an intraoperative skin integrity protocol. Using this framework, other nursing specialties can use an evidence-based research approach to develop protocols that will improve patient care.