Compliance with the RCOG's guidelines on medical record keeping in female sterilisation: a complete audit cycle

Female sterilisation is a major cause of litigation, accounting for 25% of all claims notified to the Medical Defence Union, suggesting that the practice surrounding female sterilisation is less than perfect. Inadequate documentation has been identified as the major cause for complaints and litigation. RCOG published guidelines have emphasised the need for adequate documentation during preoperative counselling. This retrospective audit was carried out with the primary objective to determine whether RCOG's guidelines had been adhered to. Failure to comply with the RCOG guidelines in our study highlights the fact that awareness of published guidelines may not be enough to improve the quality of documentation. This evidence would strongly support the use of a standardised proforma that would improve the quality of documentation during preoperative counselling.