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CMH Antimicrobial Audit
CMH Antimicrobial Audit
Rosie Soffair

CMH Antimicrobial Audit

Weekly Antibiotic Audit

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Free CMH Antimicrobial Audit Checklist

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Information

  • Document No.

  • Audit Title

  • Conducted on

  • Auditor

  • Location

  • Medical Team Name

  • Ward number:

  • Date of Audit:

  • Antimicrobial 1:

  • Bed number:

  • Antimicrobial name

    • Amoxicillin
    • Ampicillin
    • Azithromycin
    • Ceftazidime
    • Ceftriaxone
    • Ciprofloxacin
    • Clindamycin
    • Co-amoxiclav
    • Co-trimoxazole
    • Ertapenem
    • Erythromycin
    • Gentamicin
    • Flucloxacillin
    • Metronidazole
    • Piperacillin-Tazobactam
    • Vancomycin
    • other

  • 1.1. Indication Documented on drug chart:

  • 1.2. Therapy duration/stop date/review date documented?:

  • 1.3 If duration was recorded, was it appropriate?

  • 1.4 Was the choice of antibiotic appropriate?

  • 1.5 Any inappropriate IV lines?

  • 1.6 Inappropriate catheter?

  • 1.7 Is the patient infectious?

  • If yes, are they appropriately isolated?

  • 1.8 Appropriate cultures sent?

  • 1.9 Appropriate Route?

  • 1.10 Appropriate dose?

  • Antimicrobial 2

  • Bed number:

  • Name antibiotic:

  • 2.1. Indication Documented?

  • 2.2. Therapy duration/stop date/review date documented?:

  • 2.3. If duration was recorded, was it appropriate?

  • 2.4. Was the choice of antibiotic appropriate?

  • 2.5 Any inappropriate IV lines?

  • 2.6 Inappropriate catheter?

  • 2.7 Is the patient infectious?

  • If yes, are they appropriately isolated?

  • 2.8 Appropriate cultures sent?

  • 2.9 Appropriate Route?

  • 2.10 Appropriate dose?

  • Antimicrobial 3

  • Bed number:

  • Name antibiotic:

  • 3.1. Indication Documented?

  • 3.2. Therapy duration/stop date/review date documented?

  • 3.3. If duration was recorded, was it appropriate?

  • 3.4. Was the choice of antibiotic appropriate?

  • 3.5 Any inappropriate IV lines?

  • 3.6 Inappropriate catheter?

  • 3.7 Is the patient infectious?

  • If yes, are they appropriately isolated?

  • 3.8 Appropriate cultures sent?

  • 3.9 Appropriate Route?

  • 3.10 Appropriate dose?

  • Antimicrobial 4

  • Bed number:

  • Name antibiotic:

  • 4.1. Indication Documented?:

  • 4.2. Therapy duration/stop date/review date documented?

  • 4.3. If duration was recorded, was it appropriate:

  • 4.4. Was the choice of antibiotic appropriate?

  • 4.5 Any inappropriate IV lines?

  • 4.6 Inappropriate catheter?

  • 4.7 Is the patient infectious?

  • If yes, are they appropriately isolated?

  • 4.8 Appropriate cultures sent?

  • 4.9 Appropriate Route?

  • 4.10 Appropriate dose?

  • Antimicrobial 5

  • Bed number:

  • Name antibiotic:

  • 5.1. Indication Documented?

  • 5.2. Therapy duration/stop date/review date documented?

  • 5.3. If duration was recorded, was it appropriate?

  • 5.4. Was the choice of antibiotic appropriate?

  • 5.5 Any inappropriate IV lines?

  • 5.6 Inappropriate catheter?

  • 5.7 Is the patient infectious?

  • If yes, are they appropriately isolated?

  • 6.2. Therapy duration/stop date/review date documented?

  • 5.8 Appropriate cultures sent?

  • 5.9 Appropriate Route?

  • 5.10 Appropriate dose?

  • Antimicrobial 6

  • Bed number:

  • Name antibiotic:

  • 6.1. Indication Documented?

  • 6.3. If duration was documented, was it appropriate?

  • 6.4. Was the choice of antibiotic appropriate?

  • 6.5 Any inappropriate IV lines?

  • 6.6 Inappropriate catheter?

  • 6.7 Is the patient infectious?

  • If yes, are they appropriately isolated?

  • 6.8 Appropriate cultures sent?

  • 6.9 Appropriate Route?

  • 6.10 Appropriate dose?

  • Antimicrobial 7

  • Bed number:

  • Name antibiotic:

  • 7.1. Indication Documented?

  • 7.2. Therapy duration/stop date/review date documented?:

  • 7.3. If duration was recorded, was it appropriate?

  • 7.4. Was the choice of antibiotic appropriate?

  • 7.5 Any inappropriate IV lines?

  • 7.6 Inappropriate catheter?

  • 7.7 Is the patient infectious?

  • If yes, are they appropriately isolated?

  • 7.8 Appropriate cultures sent?

  • 7.9 Appropriate Route?

  • 7.10 Appropriate dose?

  • Antimicrobial 8

  • Bed number:

  • Name antibiotic:

  • 8.1. Indication Documented?

  • 8.2. Therapy duration/stop date/review date documented?

  • 8.3. If duration was recorded, was it appropriate?

  • 8.4. Was the choice of antibiotic appropriate?

  • 8.5 Any inappropriate IV lines?

  • 8.6 Inappropriate catheter?

  • 8.7 Is the patient infectious?

  • If yes, are they appropriately isolated?

  • 8.8 Appropriate cultures sent?

  • 8.9 Appropriate Route?

  • 8.10 Appropriate dose?

  • Antimicrobial 9

  • Bed number:

  • Name antibiotic:

  • 9.1. Indication Documented?

  • 9.2. Therapy duration/stop date/review date documented?

  • 9.3. If duration was recorded, was it appropriate?

  • 9.4. Was the choice of antibiotic appropriate?

  • 9.5 Any inappropriate IV lines?

  • 9.6 Inappropriate catheter?

  • 9.7 Is the patient infectious?

  • If yes, are they appropriately isolated?

  • 9.8 Appropriate cultures sent?

  • 9.9 Appropriate Route?

  • 9.10 Appropriate dose?

  • Antimicrobial 10

  • Bed number:

  • Name antibiotic:

  • 10.1. Indication Documented?

  • 10.2. Therapy duration/stop date/review date recorded?

  • 10.3. If duration was recorded, was it appropriate?

  • 10.4. Was the choice of antibiotic appropriate?

  • 10.5 Any inappropriate IV lines?

  • 10.6 Inappropriate catheter?

  • 10.7 Is the patient infectious?

  • If yes, are they appropriately isolated?

  • 10.8 Appropriate cultures sent?

  • 10.9 Appropriate Route?

  • 10.10 Appropriate dose?

  • Antimicrobial 11

  • Bed number:

  • Name antibiotic:

  • 11.1. Indication Documented?

  • 11.2. Therapy duration/stop date/review date documented?

  • 11.3. If duration was recorded, was it appropriate?

  • 11.4. Was the choice of antibiotic appropriate?

  • 11.5 Any inappropriate IV lines?

  • 11.6 Inappropriate catheter?

  • 11.7 Is the patient infectious?

  • If yes, are they appropriately isolated?

  • 11.8 Appropriate cultures sent?

  • 11.9 Appropriate Route?

  • 11.10 Appropriate dose?

  • Antimicrobial 12

  • Bed number:

  • Name antibiotic:

  • 12.1. Indication Documented?

  • 12.2. Therapy duration/stop date/review date documented?

  • 12.3. If duration was recorded, was it appropriate?

  • 12.4. Was the choice of antibiotic appropriate?:

  • 12.5 Any inappropriate IV lines?

  • 12.6 Inappropriate catheter?

  • 12.7 Is the patient infectious?

  • If yes, are they appropriately isolated?

  • 12.8 Appropriate cultures sent?

  • 12.9 Appropriate Route?

  • 12.10 Appropriate dose?

  • Antimicrobial 13

  • Bed number:

  • Name antibiotic:

  • 13.1. Indication Documented?

  • 13.2. Therapy duration/stop date/review date documented?

  • 13.3. If duration was recorded, was it appropriate?

  • 13.4. Was the choice of antibiotic appropriate?

  • 13.5 Any inappropriate IV lines?

  • 13.6 Inappropriate catheter?

  • 13.7 Is the patient infectious?

  • If yes, are they appropriately isolated?

  • 13.8 Appropriate cultures sent?

  • 13.9 Appropriate Route?

  • 13.10 Appropriate dose?

  • Antimicrobial 14

  • Bed number:

  • Name antibiotic:

  • 14.1. Indication Documented?

  • 14.2. Therapy duration/stop date/review date documented?

  • 14.3. If duration was recorded, was it appropriate?

  • 14.4. Was the choice of antibiotic appropriate?

  • 14.5 Any inappropriate IV lines?

  • 14.6 Inappropriate catheter?

  • 14.7 Is the patient infectious?

  • If yes, are they appropriately isolated?

  • 14.8 Appropriate cultures sent?

  • 14.9 Appropriate Route?

  • 14.10 Appropriate dose?

  • Antimicrobial 15

  • Bed number

  • Name antibiotic:

  • 15.1. Indication Documented?

  • 15.2. Therapy duration/stop date/review date documented?

  • 15.3. If duration was documented, was it appropriate?

  • 15.4. Was the choice of antibiotic appropriate?

  • 15.5 Any inappropriate IV lines?

  • 15.6 Inappropriate catheter?

  • 15.7 Is the patient infectious?

  • If yes, are they appropriately isolated?

  • 15.8 Appropriate cultures sent?

  • 15.9 Appropriate Route?

  • 15.10 Appropriate dose?

  • Name of person completing audit:

  • Signature of person completing audit: _____________________________________________________________________________

CMH Antimicrobial Audit
Rosie Soffair

CMH Antimicrobial Audit

Weekly Antibiotic Audit

Use this Template
The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.

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