DENTAL ITEM CODE 927 - ANTIMICROBIAL PRESCRIPTION AUDIT

Prescription 1

Date of prescription

Dental Record Number

Clinician Name or Code

Reason for prescribing

If acute odontogenic infection, was definitive treatment provided first (e.g. open & drain, extraction etc.)

Primary antibiotic prescribed
Secondary antibiotic prescribed
Follow the "antimicrobial creed"?

Appropriately prescribed in line with the Therapeutic Guidelines Oral & Dental (2012)

Prescription 2

Date of prescription

Dental Record Number

Clinician Name or Code

Reason for prescribing

If acute odontogenic infection, was definitive treatment provided first (e.g. open & drain, extraction etc.)

Primary antibiotic prescribed
Secondary antibiotic prescribed
Follow the "antimicrobial creed"?

Appropriately prescribed in line with the Therapeutic Guidelines Oral & Dental (2012)

Prescription 3

Date of prescription

Dental Record Number

Clinician Name or Code

Reason for prescribing

If acute odontogenic infection, was definitive treatment provided first (e.g. open & drain, extraction etc.)

Primary antibiotic prescribed
Secondary antibiotic prescribed
Follow the "antimicrobial creed"?

Appropriately prescribed in line with the Therapeutic Guidelines Oral & Dental (2012)

Prescription 4

Date of prescription

Dental Record Number

Clinician Name or Code

Reason for prescribing

If acute odontogenic infection, was definitive treatment provided first (e.g. open & drain, extraction etc.)

Primary antibiotic prescribed
Secondary antibiotic prescribed
Follow the "antimicrobial creed"?

Appropriately prescribed in line with the Therapeutic Guidelines Oral & Dental (2012)

Prescription 5

Date of prescription

Dental Record Number

Clinician Name or Code

Reason for prescribing

If acute odontogenic infection, was definitive treatment provided first (e.g. open & drain, extraction etc.)

Primary antibiotic prescribed
Secondary antibiotic prescribed
Follow the "antimicrobial creed"?

Appropriately prescribed in line with the Therapeutic Guidelines Oral & Dental (2012)

Prescription 6

Date of prescription

Dental Record Number

Clinician Name or Code

Reason for prescribing

If acute odontogenic infection, was definitive treatment provided first (e.g. open & drain, extraction etc.)

Primary antibiotic prescribed
Secondary antibiotic prescribed
Follow the "antimicrobial creed"?

Appropriately prescribed in line with the Therapeutic Guidelines Oral & Dental (2012)

Prescription 7

Date of prescription

Dental Record Number

Clinician Name or Code

Reason for prescribing

If acute odontogenic infection, was definitive treatment provided first (e.g. open & drain, extraction etc.)

Primary antibiotic prescribed
Secondary antibiotic prescribed
Follow the "antimicrobial creed"?

Appropriately prescribed in line with the Therapeutic Guidelines Oral & Dental (2012)

Prescription 8

Date of prescription

Dental Record Number

Clinician Name or Code

Reason for prescribing

If acute odontogenic infection, was definitive treatment provided first (e.g. open & drain, extraction etc.)

Primary antibiotic prescribed
Secondary antibiotic prescribed
Follow the "antimicrobial creed"?

Appropriately prescribed in line with the Therapeutic Guidelines Oral & Dental (2012)

Prescription 9

Date of prescription

Dental Record Number

Clinician Name or Code

Reason for prescribing

If acute odontogenic infection, was definitive treatment provided first (e.g. open & drain, extraction etc.)

Primary antibiotic prescribed
Secondary antibiotic prescribed
Follow the "antimicrobial creed"?

Appropriately prescribed in line with the Therapeutic Guidelines Oral & Dental (2012)

Prescription 10

Date of prescription

Dental Record Number

Clinician Name or Code

Reason for prescribing

If acute odontogenic infection, was definitive treatment provided first (e.g. open & drain, extraction etc.)

Primary antibiotic prescribed
Secondary antibiotic prescribed
Follow the "antimicrobial creed"?

Appropriately prescribed in line with the Therapeutic Guidelines Oral & Dental (2012)

Prescription 11

Date of prescription

Dental Record Number

Clinician Name or Code

Reason for prescribing

If acute odontogenic infection, was definitive treatment provided first (e.g. open & drain, extraction etc.)

Primary antibiotic prescribed
Secondary antibiotic prescribed
Follow the "antimicrobial creed"?

Appropriately prescribed in line with the Therapeutic Guidelines Oral & Dental (2012)

Prescription 12

Date of prescription

Dental Record Number

Clinician Name or Code

Reason for prescribing

If acute odontogenic infection, was definitive treatment provided first (e.g. open & drain, extraction etc.)

Primary antibiotic prescribed
Secondary antibiotic prescribed
Follow the "antimicrobial creed"?

Appropriately prescribed in line with the Therapeutic Guidelines Oral & Dental (2012)

Prescription 13

Date of prescription

Dental Record Number

Clinician Name or Code

Reason for prescribing

If acute odontogenic infection, was definitive treatment provided first (e.g. open & drain, extraction etc.)

Primary antibiotic prescribed
Secondary antibiotic prescribed
Follow the "antimicrobial creed"?

Appropriately prescribed in line with the Therapeutic Guidelines Oral & Dental (2012)

Prescription 14

Date of prescription

Dental Record Number

Clinician Name or Code

Reason for prescribing

If acute odontogenic infection, was definitive treatment provided first (e.g. open & drain, extraction etc.)

Primary antibiotic prescribed
Secondary antibiotic prescribed
Follow the "antimicrobial creed"?

Appropriately prescribed in line with the Therapeutic Guidelines Oral & Dental (2012)

Prescription 15

Date of prescription

Dental Record Number

Clinician Name or Code

Reason for prescribing

If acute odontogenic infection, was definitive treatment provided first (e.g. open & drain, extraction etc.)

Primary antibiotic prescribed
Secondary antibiotic prescribed
Follow the "antimicrobial creed"?

Appropriately prescribed in line with the Therapeutic Guidelines Oral & Dental (2012)

Prescription 16

Date of prescription

Dental Record Number

Clinician Name or Code

Reason for prescribing

If acute odontogenic infection, was definitive treatment provided first (e.g. open & drain, extraction etc.)

Primary antibiotic prescribed
Secondary antibiotic prescribed
Follow the "antimicrobial creed"?

Appropriately prescribed in line with the Therapeutic Guidelines Oral & Dental (2012)

Prescription 17

Date of prescription

Dental Record Number

Clinician Name or Code

Reason for prescribing

If acute odontogenic infection, was definitive treatment provided first (e.g. open & drain, extraction etc.)

Primary antibiotic prescribed
Secondary antibiotic prescribed
Follow the "antimicrobial creed"?

Appropriately prescribed in line with the Therapeutic Guidelines Oral & Dental (2012)

Prescription 18

Date of prescription

Dental Record Number

Clinician Name or Code

Reason for prescribing

If acute odontogenic infection, was definitive treatment provided first (e.g. open & drain, extraction etc.)

Primary antibiotic prescribed
Secondary antibiotic prescribed
Follow the "antimicrobial creed"?

Appropriately prescribed in line with the Therapeutic Guidelines Oral & Dental (2012)

Prescription 19

Date of prescription

Dental Record Number

Clinician Name or Code

Reason for prescribing

If acute odontogenic infection, was definitive treatment provided first (e.g. open & drain, extraction etc.)

Primary antibiotic prescribed
Secondary antibiotic prescribed
Follow the "antimicrobial creed"?

Appropriately prescribed in line with the Therapeutic Guidelines Oral & Dental (2012)

Prescription 20

Date of prescription

Dental Record Number

Clinician Name or Code

Reason for prescribing

If acute odontogenic infection, was definitive treatment provided first (e.g. open & drain, extraction etc.)

Primary antibiotic prescribed
Secondary antibiotic prescribed
Follow the "antimicrobial creed"?

Appropriately prescribed in line with the Therapeutic Guidelines Oral & Dental (2012)

Prescription 21

Date of prescription

Dental Record Number

Clinician Name or Code

Reason for prescribing

If acute odontogenic infection, was definitive treatment provided first (e.g. open & drain, extraction etc.)

Primary antibiotic prescribed
Secondary antibiotic prescribed
Follow the "antimicrobial creed"?

Appropriately prescribed in line with the Therapeutic Guidelines Oral & Dental (2012)

Prescription 22

Date of prescription

Dental Record Number

Clinician Name or Code

Reason for prescribing

If acute odontogenic infection, was definitive treatment provided first (e.g. open & drain, extraction etc.)

Primary antibiotic prescribed
Secondary antibiotic prescribed
Follow the "antimicrobial creed"?

Appropriately prescribed in line with the Therapeutic Guidelines Oral & Dental (2012)

Prescription 23

Date of prescription

Dental Record Number

Clinician Name or Code

Reason for prescribing

If acute odontogenic infection, was definitive treatment provided first (e.g. open & drain, extraction etc.)

Primary antibiotic prescribed
Secondary antibiotic prescribed
Follow the "antimicrobial creed"?

Appropriately prescribed in line with the Therapeutic Guidelines Oral & Dental (2012)

Prescription 24

Date of prescription

Dental Record Number

Clinician Name or Code

Reason for prescribing

If acute odontogenic infection, was definitive treatment provided first (e.g. open & drain, extraction etc.)

Primary antibiotic prescribed
Secondary antibiotic prescribed
Follow the "antimicrobial creed"?

Appropriately prescribed in line with the Therapeutic Guidelines Oral & Dental (2012)

Prescription 25

Date of prescription

Dental Record Number

Clinician Name or Code

Reason for prescribing

If acute odontogenic infection, was definitive treatment provided first (e.g. open & drain, extraction etc.)

Primary antibiotic prescribed
Secondary antibiotic prescribed
Follow the "antimicrobial creed"?

Appropriately prescribed in line with the Therapeutic Guidelines Oral & Dental (2012)

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.