AMS Audit

Saladaga, Baby Girl .

HRN: 28-71-28 Sex: Female

Patient Encounter

AMS Audit List

Audit Date

Antimicrobial

Start Date

End Date

Route

Dose

Frequency

Indication Documented

AMPICILLIN 250MG (VIAL)

T/c Neonatal Sepsis

Checking Initial Appropriateness

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

T/C Neonatal Sepsis

Checking Initial Appropriateness

MUPIROCIN 2%, 15G (TUBE)

Checking Initial Appropriateness

CEFTAZIDIME 1GM (VIAL)

Neonatal Sepsis

Checking Initial Appropriateness

CLINDAMYCIN 150MG/ML, 4ML (AMP)

Neonatal Sepsis

Checking Initial Appropriateness

FLUCONAZOLE 150MG (CAP)

Neonatal Sepsis

Checking Initial Appropriateness

FLUCONAZOLE 2MG/ML, 100ML (VIAL)

Neonatal Sepsis

Checking Initial Appropriateness

CLINDAMYCIN 300MG (CAP)

Neonatal Sepsis

Checking Initial Appropriateness

CLINDAMYCIN 300MG (CAP)

Neonatal Sepsis; Neonatal Pneumonia

Checking Initial Appropriateness

FLUCONAZOLE 50MG (CAP)

Neonatal Sepsis

Checking Initial Appropriateness

FLUCONAZOLE 50MG (CAP)

Neonatal Sepsis

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