Purpose: Long term care facilities face rigid federal guidelines for prevention and treatment of pressure ulcers, known as the F-tag 314. Failure to comply can result in heavy monetary fines or closure of the facility. The CMS Medical Patient Safety Initiative is developing similar ways to monitor pressure ulcers in the acute care setting. With this in mind, OSF Saint Francis Medical Center a 710-licensed bed acute care facility located in Peoria, Illinois, has made strides in implementing a comprehensive pressure ulcer prevention program to address this fore coming challenge. Objectives: By using the Six Sigma methodologies: define, measure, analyze, improve, and control, SFMC set out to improve prevention methods and reduce pressure ulcer incidence by 50%. Identifying accountability, knowledge deficit, and lack of communication as the root causes, the Six Sigma team focused on ways to improve these areas. To establish accountability, roles and responsibilities were redefined to include ultimate ownership by the staff RN and the unit manager to act as a process owner, ensuring compliance. The knowledge deficit was addressed by revising the current Skin Breakdown Prevention Protocol and biweekly staff education. Updates included posted signs identifying patients at risk, pocket guides with prevention tips, and a lift team to assist with patient mobility. Communication improvements involved selecting a nursing unit skin champion. This staff member serves as a skin care resource attending monthly skin meetings and participating in quarterly prevalence and incidence studies. Outcomes: Implementation of a comprehensive pressure ulcer prevention program has demonstrated sustained improvements. SFMC pressure ulcer incidence has decrease from 9.4% to below 4% in the last 6 quarters. Our program is an ongoing process preparing for the future challenges in healthcare.