Titration Audit

Medication #1

Patient Identifier

Prescriber

Date/Time of order

Name of Medication

Was there an order for the incremental units the rate can be increased or decreased (e.g. 5mcg)?

What was the incremental units the rate can be increased or decreased?

Was there an order for the frequency of incremental dose titration (e.g. every 5 minutes)?

What is the frequency of incremental dose titration change?

Was there a clinical goal specified (e.g. RASS Score, SBP, HR, MAP)?

What was the clinical goal ordered (e.g. RASS Score of -2, SBP > 90)?

Was there a maximum rate/dose ordered or when to call the ordering LIP (e.g. do not exceed 20mcg/kg/min or call for HR greater than 120)?

What was the maximum rate/dose ordered or call parameter?

What was the ordered starting rate/dose of the infusion?

Start date/time of infusion
Time of first adjustment

Was the first adjustment compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#2)

Was adjustment #2 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#3)

Was adjustment #3 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#4)

Was adjustment #4 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#5)

Was adjustment #5 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#6)

Was adjustment #6 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#7)

Was adjustment #7 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#8)

Was adjustment #8 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Comments

Medication #2

Patient Identifier

Prescriber

Date/Time of order

Name of Medication

Was there an order for the incremental units the rate can be increased or decreased (e.g. 5mcg)?

What was the incremental units the rate can be increased or decreased?

Was there an order for the frequency of incremental dose titration (e.g. every 5 minutes)?

What is the frequency of incremental dose titration change?

Was there a clinical goal specified (e.g. RASS Score, SBP, HR, MAP)?

What was the clinical goal ordered (e.g. RASS Score of -2, SBP > 90)?

Was there a maximum rate/dose ordered or when to call the ordering LIP (e.g. do not exceed 20mcg/kg/min or call for HR greater than 120)?

What was the maximum rate/dose ordered or call parameter?

What was the ordered starting rate/dose of the infusion?

Start date/time of infusion
Time of first adjustment

Was the first adjustment compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#2)

Was adjustment #2 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#3)

Was adjustment #3 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#4)

Was adjustment #4 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#5)

Was adjustment #5 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#6)

Was adjustment #6 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#7)

Was adjustment #7 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#8)

Was adjustment #8 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Comments

Medication #3

Patient Identifier

Prescriber

Date/Time of order

Name of Medication

Was there an order for the incremental units the rate can be increased or decreased (e.g. 5mcg)?

What was the incremental units the rate can be increased or decreased?

Was there an order for the frequency of incremental dose titration (e.g. every 5 minutes)?

What is the frequency of incremental dose titration change?

Was there a clinical goal specified (e.g. RASS Score, SBP, HR, MAP)?

What was the clinical goal ordered (e.g. RASS Score of -2, SBP > 90)?

Was there a maximum rate/dose ordered or when to call the ordering LIP (e.g. do not exceed 20mcg/kg/min or call for HR greater than 120)?

What was the maximum rate/dose ordered or call parameter?

What was the ordered starting rate/dose of the infusion?

Start date/time of infusion
Time of first adjustment

Was the first adjustment compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#2)

Was adjustment #2 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#3)

Was adjustment #3 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#4)

Was adjustment #4 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#5)

Was adjustment #5 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#6)

Was adjustment #6 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#7)

Was adjustment #7 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#8)

Was adjustment #8 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Comments

Medication #4

Patient Identifier

Prescriber

Date/Time of order

Name of Medication

Was there an order for the incremental units the rate can be increased or decreased (e.g. 5mcg)?

What was the incremental units the rate can be increased or decreased?

Was there an order for the frequency of incremental dose titration (e.g. every 5 minutes)?

What is the frequency of incremental dose titration change?

Was there a clinical goal specified (e.g. RASS Score, SBP, HR, MAP)?

What was the clinical goal ordered (e.g. RASS Score of -2, SBP > 90)?

Was there a maximum rate/dose ordered or when to call the ordering LIP (e.g. do not exceed 20mcg/kg/min or call for HR greater than 120)?

What was the maximum rate/dose ordered or call parameter?

What was the ordered starting rate/dose of the infusion?

Start date/time of infusion
Time of first adjustment

Was the first adjustment compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#2)

Was adjustment #2 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#3)

Was adjustment #3 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#4)

Was adjustment #4 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#5)

Was adjustment #5 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#6)

Was adjustment #6 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#7)

Was adjustment #7 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#8)

Was adjustment #8 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Comments

Medication #5

Patient Identifier

Prescriber

Date/Time of order

Name of Medication

Was there an order for the incremental units the rate can be increased or decreased (e.g. 5mcg)?

What was the incremental units the rate can be increased or decreased?

Was there an order for the frequency of incremental dose titration (e.g. every 5 minutes)?

What is the frequency of incremental dose titration change?

Was there a clinical goal specified (e.g. RASS Score, SBP, HR, MAP)?

What was the clinical goal ordered (e.g. RASS Score of -2, SBP > 90)?

Was there a maximum rate/dose ordered or when to call the ordering LIP (e.g. do not exceed 20mcg/kg/min or call for HR greater than 120)?

What was the maximum rate/dose ordered or call parameter?

What was the ordered starting rate/dose of the infusion?

Start date/time of infusion
Time of first adjustment

Was the first adjustment compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#2)

Was adjustment #2 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#3)

Was adjustment #3 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#4)

Was adjustment #4 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#5)

Was adjustment #5 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#6)

Was adjustment #6 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#7)

Was adjustment #7 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Time of next adjustment (#8)

Was adjustment #8 compliant with the ordered frequency/incremental dose?

Why?

Was the reason documented?

Comments

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.