Table 1.

Intervention Timeline

Date	Intervention(s)
January 2014	• Began participation in Solutions for Patient Safety UE Initiative
May 2014	• Biweekly NICU multidisciplinary team meetings began
August 2014	• Start of NICU data collection
	• Current UE questionnaire form initiated, including binary responses related to best practices for ETT position maintenance (see figure 1, Supplemental Digital Content)
December 2014	• “UE Bundle” developed
	○ Commercial securement device use
	○ Appropriate size and location of the device
	○ Device adhesive intact
	○ Appropriate position of ETT documented
	○ ETT in place within 0.5 cm of documentation
February 2015	• Respiratory therapist made responsible for event capture
	• ETT forms added to intubation boxes
July 2015	• Labeling securement device and replacement every 7 days added to bundle based on manufacturer’s recommendation
October 2015	• Categorization of events as preventable (caregiver engaged with infant or manipulating ETT tube at the time of event) or unpreventable to increase staff empowerment
March 2016	• Project presented to Family Advisory Council for parental feedback
May 2016	• Tape for ETT securement to device discontinued by manufacturer
May 2016 to June 2017	• Multiple tape brands tried
June 2016	• “Airway Cards” initiated at bedsides of ventilated patients (including ETT size and depth, cuffed versus uncuffed): Trouble with adaptation and implementation
January 2017	• UE adopted as NICU service line QI metric for bonus and best practice
May 2017	• Candy-caning started as standard of care
July 2017	• New tape chosen as replacement and candy-caning taping technique stopped
November 2017	• Candy-caning reinitiated due to increased events related to tube sliding through tape
January 2018	• Candy-caning added to audit
	• Encouraged “airway guardian” use—ETT sole responsibility
March 2018	• Airway cards re-emphasized
	• Respiratory care assistants became responsible to place and fill out airway cards
April 2018	• Radiology collaborative—initiated “best position during x-ray” to standardize patient positioning and ETT placement during films
May 2018	• RT presence at x-rays (confirm placement and monitor ETT)
	• RT presence at morning x-ray rounds to discuss ETT placement on film
July 2018	• Airway cards transitioned to RT responsibility and updated to include the following:
	○ ETT size and depth
	○ Due date for ETT securement device change
	○ ETT depth and patient weight at last x-ray
	○ Date, time, and RT initials from last airway card update
August 2018	• Parent education handout for skin-to-skin updated with information about intubated infants