National Audit Projects (NAPs)

NAPs study rare but potentially serious complications related to anaesthesia

The National Audit Projects (NAPs) are internationally recognised as important reports with potentially significant impact on anaesthetic practice and patient outcome. The topics selected for each NAP must be important to patients and anaesthetists, and be incompletely studied in incidence or nature.

NAP Logo Web Strip

The NAPs are "internationally important reports with a potentially significant impact on patient outcome and experience during and after anaesthesia and surgery" (Moppett, 2013). In addition to 'shining a light' on the topic, the NAPs include recommendations for clinical practice and research. The NAPs are intended to examine, report on and drive improvements in practice.


The NAPs collect data for a full calendar year on their respective areas of focus. The College is indebted to the legion of NAP Local Coordinators who report each case that meets inclusion criteria which occurs in their hospitals across the year of data collection. These Local Coordinators also coordinate baseline and activity surveys in their hospitals. The Local Coordinators are the backbone of every NAP and the involvement of 100 per cent of eligible NHS hospitals is a testament to their commitment.

The majority of the NAPs have also involved collaborations and partnerships between various anaesthesia-related organisations. This principle of collaboration was begun with the RCoA working with the National Confidential Acute Pain Critical Incident Audit (NCAPCIA) for NAP3 and includes:

The CR&I would like to acknowledge that many other organisations have also contributed significantly to the development and delivery of NAPs through their important contributions on the relevant steering groups.


There have been seven National Audit Projects to date, with an eighth in planning stages:


Complications of Regional Anaesthesia


Perioperative cardiac arrest



Anaesthesia, Surgery and Life-Threatening Allergic Reactions


Accidental Awareness During General Anaesthesia in the United Kingdom and Ireland


Major Complications of Airway Management in the United Kingdom


Major Complications of Central Neuraxial Block in the United Kingdom


Supervisory Role of Consultant Anaesthetists and Place of Mortality and Morbidity Review Meetings

External Review

In 2013, Professor Iain Moppett (prior to his involvement with the CR&I) conducted an external review of NAP3 and NAP4, to which the HSRC (now CR&I) Executive Management Board published an official response

Professor Moppett found that the NAPs were very well run, and well received by anaesthetists in the UK and the various specialist societies. Although his report made some recommendations for improvement these did not detract from the general extremely high standard of the projects. The NAPs were found to represent excellent value for money to the RCoA, anaesthetic specialist societies and the wider NHS.

Would you like to find out more about the latest NAP?
Please visit the NAP7 web page for more information and detailed study documentation.

The National Audit Projects have been led by Prof Tim Cook, Director of the National Audit Projects since NAP3.

For any NAP-related queries, please email NAP Coordinator Laura Cortés at