Audit

Number of beds occupied on ward

1. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

2. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

3. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

4. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

5. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

6. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

7. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

8. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

9. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

10. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

11. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

12. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

13. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

14. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

15. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

16. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

17. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

18. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

19. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

20. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

21. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

22. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

23. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

24. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

25. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

26. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

27. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

28. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

29. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

30. Patient initials

Medicines reconciliation completed within (hours)

Number of unintentional/undocumented changes/omissions/additions detected?

Allergy status already documented prior to pharmacy visit?

Allergy status checked and confirmed by pharmacy?

Insulin

Subcutaneous insulin prescribed? If yes for each insulin fill in below

Insulin 1

Are units written in full?

Is the dose clear and legible?

Insulin 2

Are units written in full?

Is the dose clear and legible?

Insulin 3

Are units written in full?

Is the dose clear and legible?

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.