An audit of ECT practice against Royal College of Psychiatrists guidelines was conducted within a health authority with a known high rate of electroconvulsive therapy (ECT) administration. The audit was conducted in two phases and included a retrospective case note review, plus concurrent observation of ECT practice. An education and training programme designed to correct practice deficiencies was implemented between the phases. ECT practice was generally of good standard. The training programme led to some changes in clinical practice. In particular there was a significant reduction in sub‐optimal ventilation and a significant reduction in unsatisfactory seizures. Introduction of a formal privileging system is a potential strategy for improving practice further.

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