Neonatal Gentamicin Care Bundle Compliance Chart
ADVERTISEMENT
1
2Neonatal gentamicin care bundle compliance chart
• Complete a SEPARATE form for each dose of gentamicin
administered
• Circle the appropriate answer
Patient ID: _____________________________________________________
Date: __________________________________
Time drug administered: __________________
Care bundle elements:
1. Use of the 24-hour clock format and blocking out of
unused time slots when prescribing
Y / N
2. No interruptions during preparation and administration
of gentamicin
Y / N
3. Use of the double-checking prompt
Y / N
4. Gentamicin dose given within 1 hour of prescribed dose
time
Y / N
___________
Compliant with all four elements of the care bundle
Y / N
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Education