Audit

Ward/Unit:

Date of Audit:

Antimicrobial 1

Consultant Name:

Patient Hospital Number:

Name of Prescribing Doctor:

1.1. Indication Documented on drug chart:

1.2. Therapy duration/stop date/review date documented on drug chart:

1.3. If indication was documented, was it done by a pharmacist:

1.4. If duration/review date was documented, was it done by a pharmacist:

Antimicrobial 2

Consultant Name:

Patient Hospital Number:

Name of Prescribing Doctor:

2.1. Indication Documented on drug chart:

2.2. Therapy duration/stop date/review date documented on drug chart:

2.3. If indication was documented, was it done by a pharmacist:

2.4. If duration/review date was documented, was it done by a pharmacist:

Antimicrobial 3

Consultant Name:

Patient Hospital Number:

Name of Prescribing Doctor:

3.1. Indication Documented on drug chart:

3.2. Therapy duration/stop date/review date documented on drug chart:

3.3. If indication was documented, was it done by a pharmacist:

3.4. If duration/review date was documented, was it done by a pharmacist:

Antimicrobial 4

Consultant Name:

Patient Hospital Number:

Name of Prescribing Doctor:

4.1. Indication Documented on drug chart:

4.2. Therapy duration/stop date/review date documented on drug chart:

4.3. If indication was documented, was it done by a pharmacist:

4.4. If duration/review date was documented, was it done by a pharmacist:

Antimicrobial 5

Consultant Name:

Patient Hospital Number:

Name of Prescribing Doctor:

5.1. Indication Documented on drug chart:

5.2. Therapy duration/stop date/review date documented on drug chart:

5.3. If indication was documented, was it done by a pharmacist:

5.4. If duration/review date was documented, was it done by a pharmacist:

Antimicrobial 6

Consultant Name:

Patient Hospital Number:

Name of Prescribing Doctor:

6.1. Indication Documented on drug chart:

6.2. Therapy duration/stop date/review date documented on drug chart:

6.3. If indication was documented, was it done by a pharmacist:

6.4. If duration/review date was documented, was it done by a pharmacist:

Antimicrobial 7

Consultant Name:

Patient Hospital Number:

Name of Prescribing Doctor:

7.1. Indication Documented on drug chart:

7.2. Therapy duration/stop date/review date documented on drug chart:

7.3. If indication was documented, was it done by a pharmacist:

7.4. If duration/review date was documented, was it done by a pharmacist:

Antimicrobial 8

Consultant Name:

Patient Hospital Number:

Name of Prescribing Doctor:

8.1. Indication Documented on drug chart:

8.2. Therapy duration/stop date/review date documented on drug chart:

8.3. If indication was documented, was it done by a pharmacist:

8.4. If duration/review date was documented, was it done by a pharmacist:

Antimicrobial 9

Consultant Name:

Patient Hospital Number:

Name of Prescribing Doctor:

9.1. Indication Documented on drug chart:

9.2. Therapy duration/stop date/review date documented on drug chart:

9.3. If indication was documented, was it done by a pharmacist:

9.4. If duration/review date was documented, was it done by a pharmacist:

Antimicrobial 10

Consultant Name:

Patient Hospital Number:

Name of Prescribing Doctor:

10.1. Indication Documented on drug chart:

10.2. Therapy duration/stop date/review date documented on drug chart:

10.3. If indication was documented, was it done by a pharmacist:

10.4. If duration/review date was documented, was it done by a pharmacist:

Antimicrobial 11

Consultant Name:

Patient Hospital Number:

Name of Prescribing Doctor:

11.1. Indication Documented on drug chart:

11.2. Therapy duration/stop date/review date documented on drug chart:

11.3. If indication was documented, was it done by a pharmacist:

11.4. If duration/review date was documented, was it done by a pharmacist:

Antimicrobial 12

Consultant Name:

Patient Hospital Number:

Name of Prescribing Doctor:

12.1. Indication Documented on drug chart:

12.2. Therapy duration/stop date/review date documented on drug chart:

12.3. If indication was documented, was it done by a pharmacist:

12.4. If duration/review date was documented, was it done by a pharmacist:

Antimicrobial 13

Consultant Name:

Patient Hospital Number:

Name of Prescribing Doctor:

13.1. Indication Documented on drug chart:

13.2. Therapy duration/stop date/review date documented on drug chart:

13.3. If indication was documented, was it done by a pharmacist:

13.4. If duration/review date was documented, was it done by a pharmacist:

Signature of person completing audit: _____________________________________________________________________________

Name of person completing audit:

Antimicrobial 14

Consultant Name:

Patient Hospital Number:

Name of Prescribing Doctor:

14.1. Indication Documented on drug chart:

14.2. Therapy duration/stop date/review date documented on drug chart:

14.3. If indication was documented, was it done by a pharmacist:

14.4. If duration/review date was documented, was it done by a pharmacist:

Antimicrobial 15

Consultant Name:

Patient Hospital Number:

Name of Prescribing Doctor:

15.1. Indication Documented on drug chart:

15.2. Therapy duration/stop date/review date documented on drug chart:

15.3. If indication was documented, was it done by a pharmacist:

15.4. If duration/review date was documented, was it done by a pharmacist:

Antimicrobial 16

Consultant Name:

Patient Hospital Number:

Name of Prescribing Doctor:

16.1. Indication Documented on drug chart:

16.2. Therapy duration/stop date/review date documented on drug chart:

16.3. If indication was documented, was it done by a pharmacist:

16.4. If duration/review date was documented, was it done by a pharmacist:

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.