Endotracheal intubations are performed for a multitude of reasons and occasionally extend for long periods of time. Multiple advances on commercially produced products that secure the endotracheal tube while protecting the delicate tissues of the face had emerged with the use of new technology. Despite these developments in technology, respiratory device-related facial pressure injuries continue to occur. The Medical Intensive Care Unit (MICU) of the South Texas Veterans Healthcare System at San Antonio, Texas witnessed the rise of respiratory device-related facial pressure injuries triggering a collaborative effort between nursing and respiratory staff. Through this collaboration, a Plan Do Study Act (PDSA) was initiated and made use as the framework of the project. The collaboration developed and implemented a safety checklist to help nursing and respiratory staff determine the safest device for endotracheal tube securement. The emphasis of the project was on the care and maintenance best practice standards to cater to individual patient facial contours, shape, and sizes. The Agency for Healthcare Research and Quality - PDSA cycle was utilized in the execution of the safety checklist in daily rounds among intubated patients, with minor adjustments in each cycle to better the standards. The MICU nurses and respiratory therapists were educated on the safety checklist and intent of the project prior to laminating and posting the checklist for daily staff rounding. Once education needs of the staff were met, The MICU nurse manager and respiratory therapy manager met at bedside for each intubated patient to establish an initial culture of rounding on patients while applying the checklist with bedside staff. Multiple concerns were noted during the initial phases requiring a return to the planning phase before roll-out to bedside staff. With the re-implementation of the safety checklist and daily rounds, the Medical Intensive Care Unit has reduced their respiratory device-related facial pressure injuries and increased checklist compliance amongst nursing and respiratory staff. Reports of improper device selection have significantly decreased for mechanically intubated patients within the MICU.