Antibiotic Stewardship Tracking Log

Monthly log for tracking antibiotic starts in a nursing home, including indication, McGeer or Loeb criteria review, duration, and pharmacist or medical director review.

Log Details

• Log Month
  Select any date within the month being reported; the month will be used for monthly tracking.
• Facility or Unit
  Enter the nursing home facility name or unit where the antibiotic was started.
• Submitted By
  Name and role of the staff member completing this log entry.
• Antibiotic Start Date
  Date the antibiotic was started.

Antibiotic Start Details

• Antibiotic Name
  Enter the medication name. Avoid including unnecessary patient identifiers.
• Indication for Start
  Briefly document the clinical indication or suspected infection being treated.
• Prescriber Type
• Is this a new start or a restart?

Criteria Review

• Criteria Used for Review
  Select all criteria frameworks used to evaluate the antibiotic start.
• Were criteria met?
• Criteria Details
  If criteria were not met or only partially met, summarize the gap or rationale.
• Suspected Infection Site

Duration and Review

• Planned Duration (Days)
  Enter the planned number of treatment days.
• Actual Duration Completed (Days)
  Enter the completed duration if treatment has ended.
• Pharmacist Review Completed?
• Medical Director Review Completed?
• Review Notes
  Document recommendations, follow-up actions, or reasons for exceptions.

Follow-Up and Attestation

• Is follow-up required?
• Follow-Up Owner
  Name or role responsible for follow-up, if needed.
• Follow-Up Due Date
• Attestation
  By submitting, you confirm the log entry is accurate and will be retained in the stewardship audit trail.