AMS Audit

Gallardo, Baby Boy .

HRN: 27-66-93 Sex: Male

Patient Encounter

AMS Audit List

Audit Date

Antimicrobial

Start Date

End Date

Route

Dose

Frequency

Indication Documented

AMPICILLIN 1GM (VIAL)

Checking Initial Appropriateness

CEFUROXIME 750MG (VIAL)

Checking Initial Appropriateness

CEFTRIAXONE 1G (VIAL)

Checking Initial Appropriateness

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

Checking Initial Appropriateness

PIPERACILLIN + TAZOBACTAM 2.25G (VIAL)

Checking Initial Appropriateness

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

Checking Initial Appropriateness

CEFTAZIDIME 1GM (VIAL)

Checking Initial Appropriateness

GENTAMICIN 40MG/ML, 2ML (AMP)

Checking Initial Appropriateness

GENTAMICIN 40MG/ML, 2ML (AMP)

Checking Initial Appropriateness

LEVOFLOXACIN 5MG/ML, 100ML (VIAL)

Checking Initial Appropriateness

FLUCONAZOLE 2MG/ML, 100ML (VIAL)

Checking Initial Appropriateness

LEVOFLOXACIN 5MG/ML, 100ML (VIAL)

Checking Initial Appropriateness

MUPIROCIN 2%, 15G (TUBE)

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