Audit

Ward number:

Date of Audit:

Antimicrobial 1:

Bed number:

Antimicrobial name

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: _____________________________________________________________________________
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.