Skin care, renal failure and hospital protocol: recognizing unique needs of the chronic patient CA, 69-year-old male weighing 147 pounds was hospitalized on various patient care units over a 2 year period of time. The threat to skin care, renal failure with subsequent dialysis, and long-term hospitalization were the chief issues challenging the WOC nurse. Immobility was a factor as the patient sustained bilateral above the knee amputation. Further, dialysis three times weekly was required. For a twelve month period of time the patient was on a pressure prevention support surface (air-fluidized therapy). Skin breakdown had occurred and was worsening despite use of this product which was designated as the product of choice per hospital protocol. The WOC nurse investigated the situation to discover that no pressure ulcer prevention/treatment surface was used during the time the patient was off the unit for dialysis. Low air loss with pulsation on a standard hospital frame could be used to transport the patient off the unit, and therefore prevented a lapse in therapy, this was ordered. The pressure ulcer resolved. This study suggests that protocols, although essential tools for standardized patient care, should be evaluated with the understanding of the patients' unique and individualized needs.