Ventilator Bundle Audit Form
Date Patient HOB up 30 Stress Ulcer DVT Prophylaxis Daily sedation Daily Assessment of Daily Spontaneous
SS # degrees or Prophylaxis w/in w/in 24 hrs vacation readiness to wean Breathing Trial
higher 24 hrs
Yes/Unable Yes/Unable Yes/Unable Yes/Unable/NA Yes/Unable/NA Yes/Unable/NA
No No No No No No
Yes/Unable Yes/Unable Yes/Unable Yes/Unable/NA Yes/Unable/NA Yes/Unable/NA
No No No No No No
Yes/Unable Yes/Unable Yes/Unable Yes/Unable/NA Yes/Unable/NA Yes/Unable/NA
No No No No No No
Yes/Unable Yes/Unable Yes/Unable Yes/Unable/NA Yes/Unable/NA Yes/Unable/NA
No No No No No No
Yes/Unable Yes/Unable Yes/Unable Yes/Unable/NA Yes/Unable/NA Yes/Unable/NA
No No No No No No
Yes/Unable Yes/Unable Yes/Unable Yes/Unable/NA Yes/Unable/NA Yes/Unable/NA
No No No No No No
Yes/Unable Yes/Unable Yes/Unable Yes/Unable/NA Yes/Unable/NA Yes/Unable/NA
No No No No No No
Yes/Unable Yes/Unable Yes/Unable Yes/Unable/NA Yes/Unable/NA Yes/Unable/NA
No No No No No No
Yes/Unable Yes/Unable Yes/Unable Yes/Unable/NA Yes/Unable/NA Yes/Unable/NA
No No No No No No
Yes/Unable Yes/Unable Yes/Unable Yes/Unable/NA Yes/Unable/NA Yes/Unable/NA
No No No No No No
Yes/Unable Yes/Unable Yes/Unable Yes/Unable/NA Yes/Unable/NA Yes/Unable/NA
No No No No No No
Yes/Unable Yes/Unable Yes/Unable Yes/Unable/NA Yes/Unable/NA Yes/Unable/NA
No No No No No No
Yes/Unable Yes/Unable Yes/Unable Yes/Unable/NA Yes/Unable/NA Yes/Unable/NA
No No No No No No
Yes/Unable Yes/Unable Yes/Unable Yes/Unable/NA Yes/Unable/NA Yes/Unable/NA
No No No No No No