Peanuts trial - drug accountability form


PEANUTS trial: PErioperative ANtibiotic Use in the Treatment of acute calculous cholecystitiS; a randomized controlled,
open, parallel, non-inferiority multicenter trial
. Trialnr: NL38015.100.11
Single pre-operative prophylactic dose (cefazoline 2000mg intravenous) Drug accountability form
Investigators: Dr. D.Boerma
K.Kortram: k.kortram@antoniusziekenhuis.nl // 020 4444444 // sein 7310 // 06 18720896
V.Kornmann: v.kornmann@antoniusziekenhuis.nl // 06 51454145
Local investigator(s): .


For each administered dose!
Date and Time
Batchnr.
Patient (study) number
sign 1
sign 2
(= charge nr = LOT nr)
Ward doctor
Ward nurse
(or: pharmacist)
(or: pharmacist-assistant)
Date/Name/Sign Monitor:__________________________________________________________________________________ Date/Name/Sign Pharmacist:_______________________________________________________________________________
PEANUTS trial: PErioperative ANtibiotic Use in the Treatment of acute calculous cholecystitiS; a randomized controlled,
open, parallel, non-inferiority multicenter trial
. Trialnr: NL38015.100.11
Postoperative: Metronidazol 500 mg intravenous (3dd) Drug accountability form
Investigators: Dr. D.Boerma
K.Kortram: k.kortram@antoniusziekenhuis.nl // 020 4444444 // sein 7310 // 06 18720896
V.Kornmann: v.kornmann@antoniusziekenhuis.nl // 06 51454145
Local investigator(s): .


For each administered dose!
Postoperative
Batchnr.
Patient (study) number
sign 1
sign 2
day and date
(= charge nr = LOT nr)
Ward doctor
Ward nurse
(or: pharmacist)
(or: pharmacist-
assistant)

Date/Name/Sign Monitor:__________________________________________________________________________________ Date/Name/Sign Pharmacist:_______________________________________________________________________________
PEANUTS trial: PErioperative ANtibiotic Use in the Treatment of acute calculous cholecystitiS; a randomized controlled,
open, parallel, non-inferiority multicenter trial
. Trialnr: NL38015.100.11
Postoperative: Cefuroxime 750mg intravenous (3dd) Drug accountability form
Investigators: Dr. D.Boerma
K.Kortram: k.kortram@antoniusziekenhuis.nl // 020 4444444 // sein 7310 // 06 18720896
V.Kornmann: v.kornmann@antoniusziekenhuis.nl // 06 51454145
Local investigator(s): .


For each administered dose!
Postoperative
Batchnr.
Patient (study) number
sign 1
sign 2
day and date
(= charge nr = LOT nr)
Ward doctor
Ward nurse
(or: pharmacist)
(or: pharmacist-
assistant)

Date/Name/Sign Monitor:__________________________________________________________________________________ Date/Name/Sign Pharmacist:_______________________________________________________________________________

Source: http://www.cholecystitis.nl/peanuts/downloads/Drug_accountability_form.pdf

David a

DAVID A. YEAGER, DPM, FASPS, FACFAS Practice Information: KSB Foot and Ankle Center/ Wound Care Center Dixon, IL 61021 Residency Director of KSB Hospital; Podiatric Medicine and Surgery Residency with Reconstructive Rearfoot/Ankle Surgery Clinical Assistant Professor in the Department of Family and Community Medicine at the University of Illinois College of Medicine at Rockford C

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