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Background and Importance In Norwegian guidelines, gentamicin combined with a narrow-spectrum penicillin is the first-choice antibiotic for a variety of hospital infections. Incorrect use of high risk drugs, as gentamicin, can lead to serious consequences and is therefore an important area for improvement to increase patient safety. To inform the development of a pharmacist-mediated digital screening tool for identifying inappropriate gentamicin treatments, we investigated current gentamicin use in our hospital.Aim and Objectives Investigate whether gentamicin in our hospital was used and dosed according to guidelines.Assess whether the presence of underweight or overweight status posed a risk of incorrect dosing.Material and Methods In a retrospective observational study, adult patients (n = 150) who received a total of 158 gentamicin treatments over a 3-month period were included based on clinical data from the medication management system, visualised using Microsoft Power BI software. Information was complemented through a medical record review by a clinical pharmacist.Results Most of the treatments were single doses (64%), almost a quarter (23%) comprised of two doses, while in a minority of the treatments (13%) three to seven doses were administered before gentamicin was discontinued. According to the guidelines, gentamicin was confirmed as the preferred antibiotic in most of the reviewed treatments (87%). However, in some cases, the indication was not described (8%) or gentamicin was not a proposed choice (4%) in the guidelines.We calculated dosage per kg in 128 treatments, more than half were inappropriate: the first doses of gentamicin were too low (51%), while in a smaller portion (15%) the first dose was higher than recommendations in guidelines. In a majority of the treatments of overweight patients doses were too low (48 out of 79, 61%), while most underweight patients (5 out of 6, 83%) received too high doses.Conclusion and Relevance The substantial portion of treatment that deviates from the Norwegian guidelines highlights a need for a digital screening tool that identifies the potential high risk patients on gentamicin for clinical pharmacist follow-up throughout the hospital. In addition, physicians should be educated in correct dosing of gentamicin according to height and weight.Conflict of Interest No conflict of interest