Audit cycle of documentation in laser hair removal

Lasercare clinics are one of the largest providers of skin laser treatment in the United Kingdom, in both private sector and National Health Service. Laser hair removal is performed by trained nurses following written protocols. Choice of laser and fluence is tailored to Fitzpatrick skin type. We audited and re-audited documentation of six criteria in patients receiving laser hair removal (signed consent, Fitzpatrick skin type, use of appropriate laser, appropriate fluence, patient satisfaction and objective assessment) across 13 clinics at different points in time. Data were obtained on 772 treatments. Overall findings revealed excellent documentation of consent, use of appropriate laser and fluence (median 100%), good documentation of skin type (median 90%) and poor documentation of patient satisfaction and objective assessment (median 67% and 53%, respectively). Comparison between baseline and repeat audit at 6-8 months (nine clinics) showed significant improvement across clinics in these latter two criteria [patient satisfaction: odds ratio (OR) 0.38, 95% confidence interval (CI) 0.15-0.78, P=0.01; objective assessment: OR 0.23, 95% CI 0.07-0.50, P=0.0003 (Mantel-Haenszel weighted odds ratios)]. We conclude that quality of documentation was generally and consistently high in multiple clinics and that re-auditing led to significant improvement in poor scores. This simple measure could easily be implemented more widely across many disciplines.