OBJECTIVE Medical terminological systems (TSs) play an increasingly important role in health care by supporting recording, retrieval and analysis of patient information. As the size and complexity of TSs are growing, the need arises for means to audit them, i.e. verify and maintain (logical) consistency and (semantic) correctness of their contents. This is not only important for the management ...

BACKGROUND The general medical council stipulate all intimate examinations should be chaperoned, and their identity documented within patients' notes. We decided to audit our surgical unit for compliance to these guidelines. METHODS A prospective audit before and after intervention was performed. Patients undergoing an intimate examination on the surgical assessment unit over five working day...