Medication Administration Audit Checklist Form
Complete this Medication Administration Audit Checklist Form to review and document compliance with medication administration procedures.
Date of Audit
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Auditor Full Name
*
First Name
Last Name
Department/Unit
*
Please Select
Emergency
Intensive Care
Surgical Ward
Medical Ward
Pediatrics
Other
Medication Administration Step Observed
*
Please Select
Preparation
Identification
Administration
Documentation
Was the correct patient identified before medication administration?
*
Yes
No
Not Applicable
Were hand hygiene protocols followed?
*
Yes
No
Not Observed
Were the 5 Rights of medication administration observed? (Right patient, drug, dose, route, time)
*
Yes
No
Partially
Any deviations or errors observed?
*
None
Minor
Major
Corrective actions taken (if any)
General comments or observations
Submit Audit
Should be Empty: