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The monitoring of specialty bed use by the certified ET nurse and the NQAC has been in full implementation since June 1989 with significant yearly cost reductions in the use of specialty care beds. The $238,000 costs from fiscal year 1987 (July 1986 to June 30, 1987) were reduced to $60,000 in fiscal year 1989 with an approximate cost savings of 75%. Additional cost savings have been achieved through the implementation of the other recommendations in this study. Although cost savings would have resulted from a stricter policy in specialty bed approval and utilization alone, such savings probably would have affected the quality of patient care. This project allowed nursing and medical staff members to work with the departments of Administration and Finance to ensure that patient care would not be significantly affected. Significant cost savings were obtained through use of the five interventions that are indicated in the introduction. Nursing was permitted to examine its own practice and implement changes in documentation, nursing standards, skin-care products, policies and procedures, and in other areas to strive for clinical excellence as monitored through its quality assurance plan. The addition of a certified ET nurse to coordinate a hospital-wide multidisciplinary approach that is consistent with and clinically relevant to current practice standards is essential to a successful program for pressure-sore prevention and management within the current reimbursement systems.