Weekly Controlled & Emergency Drug Audit
Auditor:
*
First Name
Last Name
Witness:
*
First Name
Last Name
Clinic:
*
Please Select
Houston1
Humble
Spring
Tomball Suite 1
Tomball Suite 2
Crash Cart Audit Data
*
Rows
Expired?
Adequately Stocked
Comments
Heparin
Yes
No
N/A
Yes
No
Lidocaine
Yes
No
N/A
Yes
No
Furosemide
Yes
No
N/A
Yes
No
Diphenhydramine
Yes
No
N/A
Yes
No
Atropine
Yes
No
N/A
Yes
No
Dopram
Yes
No
N/A
Yes
No
Epinephrine
Yes
No
N/A
Yes
No
Revertidine
Yes
No
N/A
Yes
No
Glycopyrrolate
Yes
No
N/A
Yes
No
Naloxone
Yes
No
N/A
Yes
No
Dosing Chart
Yes
No
N/A
Yes
No
Laryngoscope
Yes
No
N/A
Yes
No
Trach Tubes (All Sizes)
Yes
No
N/A
Yes
No
Stylet for Trach Tube
Yes
No
N/A
Yes
No
Catheters
Yes
No
N/A
Yes
No
Butterfly Catheters
Yes
No
N/A
Yes
No
Injection Ports
Yes
No
N/A
Yes
No
Syringes (1mL & 3mL)
Yes
No
N/A
Yes
No
Needles
Yes
No
N/A
Yes
No
Medical Tape
Yes
No
N/A
Yes
No
Vet Wrap
Yes
No
N/A
Yes
No
Alcohol
Yes
No
N/A
Yes
No
Clippers
Yes
No
N/A
Yes
No
Tourniquet
Yes
No
N/A
Yes
No
Flash Light
Yes
No
N/A
Yes
No
Calculator, Pens, Notepad
Yes
No
N/A
Yes
No
Have any shortages or soon to expire drugs been ordered/resolved?
*
Please Select
Yes
No
Controlled Drug Audit Data:
*
Rows
DaySmart Total
Actual
KDB
Ketamine
Butorphanol
Buprenorphine Inj
Buprenorphine Oral
Euthasol
Diazepam
Fentanyl
Zorbium Pink
Zorbium Green
KDB Variance
Ketamine Variance
Butorphanol Variance
Buprenorphine Inj Variance
Buprenorphine Oral Variance
Euthasol Variance
Diazapam Varience
Fentanyl Variance
Zorbium Pink Variance
Zorbium Green Variance
Are there any significant variances?
*
Please Select
No
Yes
Have you alerted the management team and veterinarian?
*
Please Select
Yes
No
Who, when, and how did you notify?
*
Notes:
Auditor's Signature
*
Continue
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