Run Pediatric Weight-Based Dosing Verification Audit — Free

Audit Details

Patient identifier recorded on audit form

Enter the chart or encounter identifier used for this audit. Do not enter full SSN or other unnecessary personal identifiers.

Medication order date reviewed

Record the date and time of the medication order or the chart review date, depending on audit workflow.

Medication name documented for review

Enter the medication being audited.

Auditor notes

Optional notes about the chart review context, exclusions, or follow-up needed.

Weight Documentation

A current patient weight is documented in kilograms critical (required)

Verify the chart contains a documented weight in kilograms, not only pounds or an estimated weight.

Yes No N/A

Weight source is clearly identified

Confirm the chart identifies how the weight was obtained.

Weight is recent enough for dosing decision critical (required)

Verify the documented weight is appropriate for the current encounter and medication order, per local policy.

Yes No N/A

Weight conversion from pounds to kilograms is correctly documented, if applicable

If the source weight was recorded in pounds, confirm the kilogram conversion is present and appears reasonable.

Yes No N/A

Dose Calculation and Maximum Limit Check

Ordered dose is calculated using documented kilogram weight critical (required)

Verify the order, MAR, or pharmacist verification shows the dose was derived from the documented kilogram weight.

Yes No N/A

Ordered dose is within the approved maximum dose limit critical (required)

Compare the ordered dose to the facility-approved or reference maximum dose for the medication and indication.

Yes No N/A

Dose calculation is documented or independently verifiable

Confirm the chart contains a calculation, pharmacist verification, or other traceable method that supports the final dose.

Yes No N/A

Any dose rounding remains within safe limits

If the dose was rounded for formulation or administration practicality, verify the rounded dose still falls within acceptable limits.

Yes No N/A

Order Safety and Escalation

High-alert or narrow-therapeutic-index medication received independent double-check when required critical (required)

Verify a second clinician or pharmacist verification is documented when required by policy for the medication class.

Yes No N/A

Any discrepancy was escalated and resolved before administration critical (required)

Confirm dose, weight, or indication discrepancies were addressed before the medication was administered.

Yes No N/A

Prescriber or pharmacist clarification documented when dose exceeded limit critical (required)

If the initial order exceeded the maximum dose limit, verify there is documentation of clarification, correction, or override rationale.

Yes No N/A

Get your results

Enter your email — we'll send you a PDF of your filled-out template, plus the occasional MangoScoop newsletter (templates, workflow tips, product updates). Unsubscribe anytime — link is in every email.

Email (required)

Your name (optional)

Run: Pediatric Weight-Based Dosing Verification Audit

Audit Details

Weight Documentation

Dose Calculation and Maximum Limit Check

Order Safety and Escalation

Get your results