Peer Review - Chart Audit Form (Avenia)

Peer reviews should assess the appropriateness of each medication, as determined by the needs and preferences of the person, determine whether contraindications and side effects were identified and addressed, necessary monitoring protocols were implemented, and if there was simultaneous use of multiple medications including polypharmacy and co-pharmacy.

Peer Review - Chart Audit Form (Avenia Behavioral Health Management)

Peer reviews should assess the appropriateness of each medication, as determined by the needs and preferences of the person, determine whether contraindications and side effects were identified and addressed, necessary monitoring protocols were implemented, and if there was simultaneous use of multiple medications including polypharmacy and co-pharmacy.
Individual's Name (Patient):(Required)
MM slash DD slash YYYY
Practioner's Name:(Required)
Ellen Lewis, NP-C, RN
Supervising MD's Name:(Required)
Russell Brown, MD

Audit

Indicate the quality of care received by the individual (patient) in the areas below based upon your review of the clinical record.
1_a. Diagnosis substantiated by recorded data.
2_a. Practioner orders reflect dosage adjustments and combinations consistent with patient safety and accepted evidence-based guidelines.
3_b. Evidence of practitioner's involvement in multidisciplinary treatment planning process.
4_a. Initial therapy was with monotherapy, or if dual therapy used, rationale and monitoring for adverse usage of dual therapy is documented.
5_a. Content of progress notes reflects clinical observations including the individual's (patient's) condition and results of therapy.
6_a. Monitoring of medication's effect on the individual (patient) included assessments based collabrative observations including individual's (patient's) own perception of its effect.
7_a. Documentation reflects practitioners rational for clinical decision-making, to include medication level changes, discharge, planning, etc.
8_a. Practitioner's typing is legible.
9_a. Informed consent for medication completed with accordance with policy.
10_a. Did the review identify the use of multiple simultaneous medications and medication interactions?
11. Did the review identify the use of multiple simultaneous medications and medication interactions?
Select one.
MM slash DD slash YYYY