We would like to thank Bambi and colleagues for their interest in our work. They asked many important questions, which we will address.

Regarding the first comment on lack of statistical tests performed on agreement, no analysis was conducted as there was no disagreement among the assessments during the validation period. All of the nurses on the team were either certified wound nurses or nurses with multiple years of experience on our pressure ulcer team conducting weekly or monthly skin audits. Therefore, we had a high level of expertise on skin assessment and pressure ulcer staging before project initiation. The 2 respiratory therapists involved in data collection were educated throughout the research development phase that occurred over 6 months as we were exploring the problem and planning interventions.

We agree that pressure ulcer development is multifactorial and that pressure ulcers can occur...

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