Background: The effects of radiation on the skin are particularly troublesome for patients and can result in impaired quality of life and an inability to perform activities of daily living. Skin care during radiation therapy is needed to prevent and treat radiation dermatitis. Patient adherence to prescribed skin care protocols is paramount to an optimal outcome but not always monitored closely. Objectives: The focus of this study was to optimize patient adherence to the Oncology Nursing Society's Putting Evidence Into Practice recommendations for skin care during radiation therapy. Methods: A multidimensional approach was used to enhance adherence to the skin care protocol. Outcomes measured included adherence, patient satisfaction, and skin condition. Findings: Five interacting dimensions affect adherence: health-system, socioeconomic, therapy-related, patient-related, and condition-related factors. Self-reported adherence to the washing and moisturizing protocol from treatment week 4 through treatment week 7 was high. Implementation of the skin care protocol introduced in this study has led to a statistically significant decrease in the level of skin toxicity.