Compliance with the Ventilator Bundle is defined as the percentage of intensive care patients on mechanical ventilation for whom all four of the elements of the Ventilator Bundle are documented on daily goals sheets and/or elsewhere in the medical record.

NOTE: This is an "all or nothing" indicator.  If any of the four elements are not documented, do not count the patient in the numerator.  If a bundle element is contraindicated for a particular patient and this is documented appropriately in the medical record, then the patient is considered compliant with regard to that measure.

Our experience has been that teams begin to demonstrate improvement in outcomes when they get the process right more frequently.  Therefore, we choose to measure the compliance with the entire Ventilator Bundle, not just parts of the bundle.

95 percent of all patients on mechanical ventilation in the ICU receive all four elements of the Ventilator Bundle.

On a given day, select all the ventilated patients and assess them for compliance with the Ventilator Bundle.  If even one element is missing, the case is not in compliance with the bundle.  For example, if there are 7 ventilated patients, and 6 have all four bundle elements completed then there is 86 percent (6 divided by 7) compliance with the Ventilator Bundle.  If all 7 patients had all four elements completed, compliance would be 100 percent.  If all 7 patients were missing even a single bundle item, compliance would be 0 percent.

Conduct the sample one day per week.  The sample should include all patients on mechanical ventilation in the ICU.  Only patients with all four aspects of the Ventilator Bundle in place are recorded as being in compliance with the Ventilator Bundle.  This is a weekly prevalence measure.  Rotate the days of the week and the shifts.  On the day of the sample, all patients on mechanical ventilation and their respective medical records are exampled for evidence of bundle compliance.

Calculate this weekly measure as follows:

(Number of ICU patients on mechanical ventilation who received all four elements of the Ventilator Bundle) / (Total number of ICU patients on mechanical ventilation on day of week of sample). Multiply by 100 to obtain percentage.

NOTE: Use daily goals sheets and/or medical records as a data source.  Incorporating the four elements of the bundle into your daily goals sheets and reviewing them for implementation of the Ventilator Bundle during multidisciplinary rounds allows for easy review of the bundle compliance.  This also serves as a reminder during rounds to increase compliance with the bundle elements.