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Domain 2: Safety and Quality

Domain 2: Safety and Quality

For Domain 2, a Quality Improvement Activity is required once in a 5-year revalidation cycle and a Review of Significant Events is required for every appraisal.

In this section you will find a range of tried and tested tools which can help you to provide supporting information relating to Quality Improvement Activities.

There are also some worked examples in prescribing and referrals which you may find helpful.

You may provide as many Quality Improvement Activity (QIA) reviews as you wish, but you are required to provide details of a Quality Improvement Activity (QIA) once in a 5-year revalidation cycle.

Additionally, multi-source feedback (MSF) and patient survey questionnaires (PSQ) are also considered examples of QIA, which are both required once in a 5-year revalidation cycle (though not necessary in the same appraisal year).

In addition you must provide ten SEA reports in the 5 year cycle. These can include Child Protection reports.


  • A review of:
    • the frequency of prescribing in relation to your clinical contacts compared with your peers - "I prescribe X items per 100 consultations, the average in our service is Y and the range is between A and B"
    • the frequency with which you prescribe "off formulary" and the reasons for this
  • A review of 50 acute prescriptions: do they comply with good practice and demonstrate good record keeping?
  • Management plan proforma: this focusses on your use of a prescribing protocol or guideline with a single patient or group of patients with the same problem (perhaps asthma), to see whether you have followed the good practice guidance
  • Case report proforma: this allows you to reflect on a patient who presents a difficult prescribing problem that you might have recorded in your log book


(Please note that prescribing data is also a convenient source of audit data)

  • Preparatory personal checklist at the start of a shift in a new post or primary care treatment centre.
  • Audit of  acute prescriptions: antibiotics or analgesics are suggested as suitable topics (see Quality of Work Reflection Proforma below)
  • Clinically challenging situations. Reflective case reports on:
    • Deaths in the OOH period: both sudden and anticipated deaths
    • Patients with a mental health problem whose behaviour causes major concern
    • Situations involving personal risk
    • Probity: intimate examinations, concerns about children at risk
  • Audit your use of investigations and locally performed tests - in some centres this is extensive, in others very limited


  • Referral letters (1): review of ten referrals - referral rate, reasons for referral, potential alternatives AND
  • Referral letters (2): review of the outcome from five referrals

SEA including Child Protection

See the SEA section from the main toolkit for suggestions: this really DOES require working with somebody else, and most OOH organisations run SEA meetings. If all else fails you might use a case report proforma. Importantly the SEA should involve you and have personal relevance to you as a participant, not simply as an issue for the OOH service.  Remember you should be able to learn and modify your own practice as a result of the SEA.

Related Documents

Quality of Work Reflection for OOH doctors (D1)

This template is designed to aid Out of Hours doctors to reflect on the quality of their work.

Date updated: 27/04/2021

Size: 83456 - KB

Type: doc

This page was last updated on: 06/01/2023