AMS Audit

Paglinawan, Vilma G.

HRN: 29-11-48 Sex: Female

Patient Encounter

AMS Audit List

Audit Date

Antimicrobial

Start Date

End Date

Route

Dose

Frequency

Indication Documented

CEFTRIAXONE 1G (VIAL)

Checking Initial Appropriateness

CLINDAMYCIN 150MG/ML, 4ML (AMP)

Checking Initial Appropriateness

PIPERACILLIN + TAZOBACTAM 2.25G (VIAL)

Skin And Soft Tissue Infection

Checking Initial Appropriateness

PIPERACILLIN + TAZOBACTAM 2.25G (VIAL)

Checking Initial Appropriateness

PIPERACILLIN + TAZOBACTAM 2.25G (VIAL)

Every After HD Days

Checking Initial Appropriateness

LEVOFLOXACIN 5MG/ML, 100ML (VIAL)

Checking Initial Appropriateness

LEVOFLOXACIN 5MG/ML, 100ML (VIAL)

Checking Initial Appropriateness

MUPIROCIN 2%, 15G (TUBE)

Apply On Affected Areas

Checking Initial Appropriateness

SILVER SULFADIAZINE 1%, 25G CREAM (TUBE)

Checking Initial Appropriateness

SILVER SULFADIAZINE 1%, 25G CREAM (TUBE)

Checking Initial Appropriateness

SILVER SULFADIAZINE 1%, 25G CREAM (TUBE)

Apply To Affected Area

Checking Initial Appropriateness

SILVER SULFADIAZINE 1%, 25G CREAM (TUBE)

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