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From 2014 to 2016, device related pressure injuries accounted for 62–81% of all hospital acquired pressure injuries. From January to June 2014, there were 5 BiPAP/CPAP pressure injuries noted, accounting for 3.579 injuries per 1000 ventilator days. In 2015, hospital data revealed that 26.5% of all hospital acquired pressure injuries occurred to prone surgical spine patients.Collaborative teams including respiratory therapists and operating room staff were convened and crafted new strategies.Adhesive foam dressings on patient faces with BiPAP/CPAP masks and prior to orthopedic spinal surgery were used to prevent device and operating room positioning pressure injuries.From July to December 2014 there were 0 BiPAP/CPAP pressure injuries. After interventions in March of 2016 through the remainder of 2016, zero pressure injuries occurred when the adhesive foam dressings were applied to the potential pressure injury areas pre-operatively.We used real time patient data to drive efforts and create a new culture in the pediatric setting that honors critical airway maintenance, operative room positioning, and preventative skin protection.Pressure injuries can be device and positioning related.Real time data drives targeted interventions.Collaboration with key stakeholders are critical to achieve desired outcomes.