Antimicrobial Stewardship Audit

Audit template for reviewing antimicrobial prescribing practices, including indication, agent selection, duration, de-escalation, and culture review.

Audit Context

• Patient or case identifier recorded
  Record the chart number, encounter ID, or audit case reference used for this review.
• Antimicrobial regimen reviewed
  Document the antimicrobial agent(s), dose, route, and frequency being audited.
• Review date and reviewer documented
  Enter the date/time of the stewardship review and the reviewer name or role.
• Review type identified
  Select the audit context for this review.

Clinical Indication

• Documented indication present
  A specific infection or prophylaxis indication is documented in the chart or order.
• Indication is clinically appropriate
  The documented indication is supported by signs, symptoms, labs, imaging, or procedural context.
• Therapy is treatment rather than unnecessary prophylaxis
  Confirm the antimicrobial is justified as treatment, targeted prophylaxis, or guideline-supported prophylaxis.
• Source of infection identified when applicable
  If relevant, the suspected or confirmed source is documented (for example: urinary, respiratory, skin/soft tissue, intra-abdominal, bloodstream).

Agent Selection and Regimen

• Agent selection aligns with likely or confirmed pathogen
  The chosen antimicrobial is appropriate for the suspected organism(s), infection site, and local guidance.
• Spectrum is as narrow as clinically appropriate
  Broad-spectrum therapy is avoided when a narrower agent would provide adequate coverage.
• Dose, route, and frequency are appropriate
  The regimen matches patient factors such as renal/hepatic function, weight, severity of illness, and site of infection.
• Allergy or intolerance considerations addressed
  Documented allergies, prior adverse reactions, and intolerance history were considered in agent selection.
• Therapeutic duplication absent
  No unnecessary duplicate antimicrobial coverage is present unless specifically justified.

Duration and Stop Date

• Planned duration or stop date documented
  A clear stop date, planned duration, or review date is documented in the order or progress note.
• Duration is consistent with guideline or indication
  The planned duration is consistent with the infection type, source control status, and clinical response.
• IV-to-PO conversion considered when clinically appropriate
  Oral step-down was considered when the patient was hemodynamically stable, improving, and able to absorb oral therapy.
• Therapy reassessment documented within expected timeframe
  The regimen was reassessed at an appropriate interval for ongoing need and duration adjustment.

De-escalation and Culture Review

• Cultures obtained before antibiotics when clinically indicated
  Appropriate cultures or diagnostic specimens were collected before antimicrobial initiation when feasible and indicated.
• Culture and susceptibility results reviewed
  Available microbiology results were reviewed and documented in the stewardship assessment.
• Therapy de-escalated when results supported narrowing
  Broad therapy was narrowed, stopped, or adjusted based on culture, susceptibility, or clinical data when appropriate.
• Negative or contaminant cultures prompted reassessment
  If cultures were negative or suggested contamination, the need for continued therapy was reassessed and documented.

Documentation and Stewardship Notes

• Stewardship recommendation documented
  Document any recommendation to continue, stop, narrow, switch to oral therapy, or obtain additional diagnostics.
• Recommendation communicated to care team
  Confirm the recommendation was communicated to the responsible clinician, pharmacist, or team.
• Follow-up plan documented
  Record any required follow-up, such as repeat review date, lab monitoring, or culture follow-up.