Inclusion criteria
- •Adults aged 16 years or older, unless locally adapted
- •Patients prescribed a systemic antibiotic (oral or IV) during the audit period
- •Antibiotic course expected to continue for at least 48 hours at the time of first dose
- •Patients admitted to hospital or reviewed in an acute assessment setting during the audit period
- •Patients managed in the selected wards, units, departments or pathways
- •Electronic, paper or hybrid records depending on local setup
Exclusion criteria & limitations
- •Patients under 16 years old unless locally adapted
- •Antibiotics given for a single dose only (e.g. single-dose surgical prophylaxis)
- •Topical or purely inhaled antibiotics
- •Patients receiving long-term suppressive antibiotic therapy managed by a specialist team
- •End-of-life care where antibiotic review has been consciously deferred and documented
- •Duplicate admissions or duplicate records
- •Records outside the selected audit period
- •Records unavailable for review
- •Records where local governance approval is required but has not been obtained
- •Direct patient identifiers must not be entered into the tool
Audit criteria (24)
Aligned with NICE NG15, UKHSA Start Smart – Then Focus and local antimicrobial policy. Compliance is calculated using Yes and No responses only; Not applicable and Unable to determine are excluded from the denominator.
- C1Indication for antibiotic documented on the prescription.Target ≥ 95% · auto-computed from submissions
- C2Antibiotic review completed at 48–72 hours from first dose.Target ≥ 90% · auto-computed from submissions
- C3CARES decision (Continue / Amend / Refer / Escalate / Stop / Switch) documented at review.Target ≥ 90% · auto-computed from submissions
- C4Review completed within the 48–72 hour window.Target ≥ 90% · auto-computed from submissions
- C5Allergy status documented on the prescription.Target ≥ 95% · auto-computed from submissions
- C6Duration or planned stop / review date documented.Target ≥ 90% · auto-computed from submissions
- C7Cultures / relevant samples obtained before first antibiotic dose where clinically appropriate.Target ≥ 85% · auto-computed from submissions
- C8Source control considered and documented where relevant.Target ≥ 85% · auto-computed from submissions
- C9Microbiology / laboratory results reviewed and acted on.Target ≥ 90% · auto-computed from submissions
- C10Antibiotic regimen adjusted per culture / sensitivity where relevant.Target ≥ 85% · auto-computed from submissions
- C11IV-to-oral switch considered where clinically appropriate.Target ≥ 85% · auto-computed from submissions
- C12Dose appropriate for renal / hepatic function and weight.Target ≥ 90% · auto-computed from submissions
- C13Empirical antibiotic choice in line with local antimicrobial guideline.Target ≥ 90% · auto-computed from submissions
- C14Sepsis pathway followed where clinically applicable.Target ≥ 95% · auto-computed from submissions
- C15Microbiology / infection specialist advice sought where required by policy.Target ≥ 90% · auto-computed from submissions
- C16Monitoring plan (bloods, response, side effects) documented.Target ≥ 85% · auto-computed from submissions
- C17OPAT / ambulatory antimicrobial pathway completed where indicated.Target ≥ 85% · auto-computed from submissions
- C18Critical care escalation completed where indicated.Target ≥ 90% · auto-computed from submissions
- C19Clinical response to antibiotic therapy documented.Target ≥ 85% · auto-computed from submissions
- C20Discharge summary documents the antibiotic course, indication and stop date.Target ≥ 90% · auto-computed from submissions
- C21GP / community handover of the antimicrobial plan documented where relevant.Target ≥ 85% · auto-computed from submissions
- C22Patient information / advice on antibiotics documented where relevant.Target ≥ 75% · auto-computed from submissions
- C23Reason for delayed or missed 48–72h review documented where applicable.Target ≥ 85% · manual review
- C24Any antimicrobial safety concern was escalated or actioned where identified.Target ≥ 100% · manual review