 Good afternoon, everyone. My name is Edwin Loft and I am the Senior Vice President of Integrated and Acute Care and Chief Nursing Officer at Parrish Medical Center in Titusville, Florida on the Space Coast. I have the honor and the privilege of being affiliated with Patient Safety Movement Foundation for several years now. Today we're talking about apps number eight, airway safety application of the app. Situation focusing on airway safety is how do we prevent the unexpected or the unplanned extubation? That is one of the scariest moments for health care providers and patients themselves when an event of this nature happens. And it's also to prevent the complications of errors related to airway management because they are completely preventable. Background, Parrish Healthcare, Parrish Medical Center is part of that, began our journey of high reliability many years ago. We were early adapters of bundle management of evidence-based practices. We read the checklist manifesto, we read the early data and outcomes that proved that errors were preventable, that airway management was safe, could be safe as long as we pay attention. We established a formal process for airway management in 2007. Our board of directors, our leadership, our senior leadership have been committed to a culture of healing since 1999. In fact, our facility is a replacement facility was built in 2002, and it was one of the first entire facilities to be built on the principles of healing. Every site sound, texture, color you see is based on the science of healing. And we use that as our springboard to create the culture of healing and the culture of safety. Airway management, we started there because of the ABCs. It is a driven focused interdisciplinary team. It is led by our interdisciplinary practice council. From the interdisciplinary practice council, we had multiple recommendations. The action plan, which included the team, included the intensivist pulmonologist, respiratory nursing, pharmacy, dietician, everybody that had influence on the person who was receiving the care related to airway management. Our expected outcomes, our goal was easy to state, zero. Zero ventilator acquired events and zero unplanned excavations. As we adopted the one days vent bundle, we did continuous evaluations. We've been doing this again for 13 years now. And we have focused on the very, very intentional look at caring for those patients. We check ourselves every day. We check each other every day. We know if the process is people dependent, we will make errors. Therefore, we focus on reminding ourselves that it is process driven and that we may adjust things over time, but we only adjust when the evidence is strong and supportive of those outcomes. So what did we do? We looked at the assessment of this current state in 2017. We actually had zero unexpected excavations in 2018. Our rate was 0.0026. And again, our goal was zero and to sustain zero. So after re-implementation in 2017-18, where do we stand today? Well, going back to 2007, we have had zero ventilator associated events, pneumonias since 2007. We were very proud of that. In unplanned excavations, we've had a total of five since January of 2007, which represents a rate of 1.0611 per 1000 bed days. And there have been no complications related from those unplanned excavations. The results are based on a focus and performance improvement. A focus on giving the care partner at the bedside the authority and the autonomy to make the right decisions for the person that we have the honor to provide to partner and care with. The nurse can make the call, make the recommendation to the physician, the physician respects the nurse and the respiratory therapist and what they're doing, even to the point of the nutritional supplements that are provided in support of a healthy airway management program. Thank you. Have a good day.