Dental Prescription Audit template

Use this Dental Prescription Audit Checklist to review antibiotic indication, drug selection, dosage, duration, and documentation to assess compliance with evidence-based prescribing guidelines.

Download as free PDF

GET A DEMO
SIGN UP TO USE TEMPLATE
SIGN UP

Dental Prescription Audit template



Patient And Medical History Review

1. A thorough and current medical history is documented in the patient record.


Photo Comment

2. Known drug allergies are recorded, including the nature of the allergic reaction for each allergy listed.


Photo Comment

3. Any reported penicillin allergy has been assessed or flagged for further evaluation, with findings documented.


Photo Comment

4. A history of previous adverse reactions to antibiotics (e.g., Clostridioides difficile infection) is documented.


Photo Comment

5. Relevant comorbid conditions that may affect antibiotic prescribing (e.g., immunosuppression, pregnancy, renal impairment) are noted.


Photo Comment

6. Current medications are recorded and checked for potential interactions with the prescribed antibiotic.


Photo Comment

7. Any recent antibiotic use by the patient in the past three months is documented.


Photo Comment

8. The patient's medical history was reviewed immediately prior to prescribing, not carried over from a previous visit without update.


Photo Comment
Clinical Examination And Diagnosis

1. An intraoral and extraoral hard and soft tissue examination was completed and documented.


Photo Comment

2. Appropriate radiographs were obtained and reviewed prior to prescribing.


Photo Comment

3. Endodontic testing of the affected tooth was completed where indicated (percussion, palpation, probing depths, vitality testing).


Photo Comment

4. A definitive clinical diagnosis was reached and recorded before the prescription was issued.


Photo Comment

5. The diagnosis is consistent with the clinical and radiographic findings documented in the record.


Photo Comment
Indication For Antibiotic Use

1. The clinical record documents the signs or symptoms that indicated antibiotic use.


Photo Comment

2. Definitive, conservative dental treatment (e.g., pulpotomy, extraction, incision and drainage) was prioritised over antibiotic prescribing where immediately available.


Photo Comment

3. If definitive treatment was not performed, the record documents why and whether referral was arranged.


Photo Comment

4. Antibiotics were not prescribed solely to manage pain or as a substitute for definitive treatment.


Photo Comment

5. Antibiotics were not prescribed for oral viral infections, fungal infections, or trauma-related ulcerations.


Photo Comment

6. Where relevant, non-antibiotic pain management options (e.g., ibuprofen, acetaminophen) were considered and documented.


Photo Comment

7. Antibiotics were prescribed only where clinical signs of systemic involvement were present (e.g., fever, malaise, diffuse swelling) or a clinically justified exception is recorded.


Photo Comment

8. If delayed prescribing was used, the rationale and patient instruction are documented.


Photo Comment
Drug Selection

1. The antibiotic prescribed is consistent with applicable evidence-based prescribing guidelines for the diagnosed condition.


Photo Comment

2. A first-line agent (e.g., amoxicillin or phenoxymethylpenicillin) was selected where clinically appropriate.


Photo Comment

3. Clindamycin was avoided unless no suitable alternative was available, with the reason documented.


Photo Comment

4. Where a penicillin allergy was reported, an appropriate alternative was selected based on allergy history.


Photo Comment

5. The prescribed antibiotic is appropriate for the patient's age, weight, and relevant medical conditions.


Photo Comment

6. The antibiotic spectrum is appropriate for the likely causative organisms in the diagnosed condition.


Photo Comment
Dosage, Duration, And Frequency

1. The prescribed dose is consistent with current guideline recommendations for the diagnosed condition.


Photo Comment

2. The course duration is the shortest effective length (3 to 7 days for otherwise healthy adult patients with dental infections).


Photo Comment

3. The prescribed frequency is consistent with the pharmacokinetic requirements of the antibiotic selected.


Photo Comment

4. The prescription does not exceed the duration or dose recommended by applicable guidelines without documented clinical justification.


Photo Comment
Documentation And Recordkeeping

1. The clinical diagnosis is documented clearly and linked to the prescription in the patient record.


Photo Comment

2. The rationale for prescribing antibiotics (or for not performing definitive treatment) is recorded.


Photo Comment

3. The treatment plan, including any planned definitive treatment or referral, is documented.


Photo Comment

4. Patient communication regarding antibiotic use, expected outcomes, and adverse effects is recorded.


Photo Comment

5. The patient was informed about symptoms that indicate a lack of antibiotic efficacy or a need to seek further care.


Photo Comment

6. The prescribing clinician is clearly identified in the record.


Photo Comment

7. The prescription details (drug, dose, frequency, duration) match what is documented in the clinical record.


Photo Comment
Prophylaxis Cases

1. The patient has a documented qualifying medical condition that indicates antibiotic prophylaxis.


Photo Comment

2. The planned procedure involves manipulation of gingival tissue, the periapical region of teeth, or perforation of the oral mucosa, consistent with prophylaxis criteria.


Photo Comment

3. The prescribed antibiotic agent is appropriate for the qualifying condition per current prophylaxis guidelines.


Photo Comment

4. The prescribed dose and timing are correct (single dose administered 30 to 60 minutes before the procedure).


Photo Comment

5. Prophylaxis was not prescribed for patients with prosthetic joints without documented clinical justification or specialist recommendation.


Photo Comment

6. The clinical record documents the basis for the prophylaxis decision, including the qualifying condition and procedure.


Photo Comment
Stewardship And Team Practice

1. Antibiotic prescribing decisions are consistent with the practice's current prescribing policy or referenced guidelines.


Photo Comment

2. Communication with the patient about antibiotic resistance and responsible use is evidenced in the record or practice protocol.


Photo Comment

3. Where the case involved a referring specialist, prescribing responsibilities were clearly allocated and documented.


Photo Comment

4. Any deviation from first-line guideline recommendations is accompanied by a documented clinical reason.


Photo Comment

5. The prescribing clinician has access to current prescribing guidelines within the practice.


Photo Comment

6. The case outcome (resolution, follow-up, referral completion) is documented where applicable.


Photo Comment

Is this sample what you are looking for?
Sign up to use & customise this template, or create your own custom checklist:

Checklist by GoAudits.com – Please note that this checklist is intended as an example. We do not guarantee compliance with the laws applicable to your territory or industry. You should seek professional advice to determine how this checklist should be adapted to your workplace or jurisdiction.

Easy inspection app for your digital checklists

  • Conduct inspections anytime, anywhere - even offline
  • Capture photos as proof of compliance or areas needing attention
  • Instantly generate and share detailed reports after the inspections
  • Assign & track follow-up tasks, view historical trends on a centralized dashboard
GET A DEMO
START FREE TRIAL
GoAudits care app