AMS Audit

Lozada, Reynaldo T.

HRN: 11-63-02 Sex: Male

Patient Encounter

AMS Audit List

Audit Date

Antimicrobial

Start Date

End Date

Route

Dose

Frequency

Indication Documented

PIPERACILLIN + TAZOBACTAM 4.5G (VLS)

Checking Initial Appropriateness

NYSTATIN 100,000IU/ML, 30ML SUSPENSION (BOT)

Checking Final Appropriateness

MUPIROCIN 2%, 15G (TUBE)

Decubitus Ulcer

Waiting Final Action

CLINDAMYCIN 150MG/ML, 4ML (AMP)

Decubitus Ulcer

Waiting Final Action

CIPROFLOXACIN 500MG (TAB)

Waiting Final Action

SILVER SULFADIAZINE 1%, 25G CREAM (TUBE)

Apply On Affected Area

DECUBITUS ULCER

Checking Initial Appropriateness

AMIKACIN 250MG/ML, 2ML (VIAL/AMP)

Sepsis Sec To Sacral Decubitus Ulcer

Checking Initial Appropriateness

LEVOFLOXACIN 500MG (TAB)

Checking Initial Appropriateness

GENTAMICIN 40MG/ML, 2ML (AMP)

Checking Initial Appropriateness

SILVER SULFADIAZINE 1%, 25G CREAM (TUBE)

Decubitus Ulcer

Waiting Final Action

PIPERACILLIN + TAZOBACTAM 4.5G (VLS)

Checking Final Appropriateness

SILVER SULFADIAZINE 1%, 25G CREAM (TUBE)

Checking Final Appropriateness

AMS Audit Form

Start Date: End Date:

Indication:

Prophylaxis Empiric Culture-directed Empirical Escalation Empirical de-escalation Empiric then culture-directed

Type of Infection:

Urinary tract Pneumonia URTI Bloodstream Bone & joint Skin & soft tissue Intra-abdominal Eye, ear, nose, throat, & mouth Cardiovascular Reproductive tract Central nervous system

Febrile neutropenia Disseminated systemic infection Unspecified sepsis Multiple infections (tick all sites) Prophylaxis

Compliance to guidelines:

Compliant to guidelines Non-compliant to guidelines Guideline not available

Initial appropriateness:

Yes No

If inappropriate:

No infection Wrong choice Wrong route Wrong dose

Final appropriateness:

Yes No

Overall appropriateness:

Yes No