AMS Audit

Aso, Aurelia S.

HRN: 28-60-31 Sex: Female

Patient Encounter

AMS Audit List

Audit Date

Antimicrobial

Start Date

End Date

Route

Dose

Frequency

Indication Documented

CEFAZOLIN 1GM (VIAL)

Loading Dose ANST

Nonhealing Wound Right Foot

Checking Initial Appropriateness

CEFAZOLIN 1GM (VIAL)

Nonhealing Wound Right Foot

Checking Initial Appropriateness

CLINDAMYCIN 150MG/ML, 4ML (AMP)

Nonhealing Wound Right Foot

Checking Initial Appropriateness

PIPERACILLIN + TAZOBACTAM 4.5G (VLS)

Non Healing Wound

Checking Initial Appropriateness

LEVOFLOXACIN 500MG (TAB)

Checking Initial Appropriateness

PIPERACILLIN + TAZOBACTAM 4.5G (VLS)

T/C HAP; Nonhealing Wound

Checking Initial Appropriateness

PIPERACILLIN + TAZOBACTAM 2.25G (VIAL)

Nonhealing Wound

Remove - Pending Acceptance

GENTAMICIN 40MG/ML, 2ML (AMP)

CAP MR, Indected Wound Right Ankle

Checking Initial Appropriateness

PIPERACILLIN + TAZOBACTAM 2.25G (VIAL)

Nonhealing Wound

Checking Initial Appropriateness

MUPIROCIN 2%, 15G (TUBE)

Nonhealing Wound

Checking Initial 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