OR nurses are skilled in positioning and padding patients to reduce pressure and shearing of the skin and to ensure that a patient's body is in the best possible alignment while giving the surgeon maximum access to the surgical site. In addition, gel pads and state-of-the-art surgical tables with pressure-reducing padding are the norm in most operating rooms today. So why are we still wrestling with the problem of pressure injuries among surgical patients? When we set out to tackle this issue at our hospital, we discovered that one major hurdle to skin safety was the lack of a standard perioperative assessment tool for identifying each patient's risk for skin breakdown. So we decided to create our own.