Background Patient safety is the utmost concern for clinicians and the Trust. CNST (clinical negligence scheme for Trusts) is designed to ensure high quality is embedded in organisational governance, patient care and safety. Achieving high standards will benefit the patient safety and decrease the premium paid.

Method Since January 2009, the authors reviewed and updated many guidelines and devised carbon copy proformas to assist in management documentation and audit data collection in CNST Standard 2 (Clinical Care) and Standard 3 (High Risk Conditions).

Proformas were developed for Caesarean Section, operative vaginal delivery (OVD), perineal trauma (PT), risk assessment for venous thrombo-embolism (VTE), major post partum haemorrhage (PPH), shoulder dystocia, severe pre-eclampsia/eclampsia. Continuous audits for the above are conducted and discussed in the perinatal care forum every 2 months.

A template has been created incorporating data for all other direct and indirect clinical care. A retrospective multidisciplinary data collection and audit presentation is done every 6 months.

Lessons and improvements are regularly disseminated in multidisciplinary and specialty meetings.

Result Implementation of workable solutions resulted in improved documentation following use of proformas. Proforma based continuous audits showed improvement from a range of 40–100% to 79–100% in all the criteria. Free text review based six monthly audits have did not reveal similar improvements.

Conclusion Marked improvement was noted in the involvement and understanding of CNST among all staff groups involved in patient care with a sense of ownership. Improvement in patient care is a reflection of high quality performance and is one of our steps forwards towards creating world-class maternity services.