Public Health Apps

Ventilator Observation

Use this mobile form to document the evaluation of a mechanical ventilator and the patient’s response to the ventilatory support. To ensure the ventilator is properly functioning and connected to the patient, complete the observation record for each category - the total number of “Yes” and the total number of observations (“Yes” + “No”). Then sum all categories for overall performance. This ventilator observation form can be used as-is or modified easily using Fulcrum’s drag-and-drop app designer tool.

Ventilator Observation iPhone, iPad Ventilator Observation Android Ventilator Observation Web, Desktop
Ventilator Observation

Date

Observer Role

Initials

Location/Unit

Notes and comments

Summary of Observations

"Yes" Observed

Total Observed

Ventilator: Observation Categories

Patient

"Yes" Observed

Total Observed

Is the head of the bed elevated >30 degrees?

Is the ventilator tubing free of excessive condensation?

Are supplies needed for oral care readily available?