Audit

Anti-Microbial 1

MRN Number

Consultant

Anti-Microbial:
Type of Infection:

Has the prescription been changed?

If changed:

Duration (administered before change):

How Changed:

If NOT changed:

Duration (administered so far):

Is there documentation in the medical notes

If yes (tick all that apply):

Comments:

Anti-Microbial 2

MRN Number

Consultant

Anti-Microbial:
Type of Infection:

Has the prescription been changed?

If changed:

Duration (administered before change):

How Changed:

If NOT changed:

Duration (administered so far):

Is there documentation in the medical notes

If yes (tick all that apply):

Comments:

Anti-Microbial 3

MRN Number

Consultant

Anti-Microbial:
Type of Infection:

Has the prescription been changed?

If changed:

Duration (administered before change):

How Changed:

If NOT changed:

Duration (administered so far):

Is there documentation in the medical notes

If yes (tick all that apply):

Comments:

Anti-Microbial 4

MRN Number

Consultant

Anti-Microbial:
Type of Infection:

Has the prescription been changed?

If changed:

Duration (administered before change):

How Changed:

If NOT changed:

Duration (administered so far):

Is there documentation in the medical notes

If yes (tick all that apply):

Comments:

Anti-Microbial 5

MRN Number

Consultant

Anti-Microbial:
Type of Infection:

Has the prescription been changed?

If changed:

Duration (administered before change):

How Changed:

If NOT changed:

Duration (administered so far):

Is there documentation in the medical notes

If yes (tick all that apply):

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.