There were three main interventions: a VRIII Prescribing Checklist (online supplemental appendix 1), education of junior doctors and ward staff, and eMeds system updates. The Prescribing Checklist contains a list of the indications for perioperative VRIII and a step-by-step guide through the prescribing tasks that must be completed to safely commence VRIII. This was developed in a collaborative approach by doctors and pharmacists based on local National Health Service Trust and JBDS-IP guidelines.6 It was created to function as a concise summary of the lengthy JBDS manual and made pragmatically relevant for our local doctors. The overall goal was to reduce prescribing errors—both those due to missing key steps and those due to lack of logistical ‘know-how’. Laminated copies of the Prescribing Checklist were displayed prominently in the ward junior doctor’s office and on drug trolleys. The project was also presented at various local meetings including junior doctor induction, ward safety meeting and our departmental clinical governance meeting (in order to raise general awareness of the importance of adhering to perioperative VRIII guidelines and the Prescribing Checklist). The final area of intervention was an eMeds update. Changes included: (1) insertion of a reinforcing message about making appropriate changes to the patient’s insulin and other regular diabetes medicines when prescribing VRIII, (2) automating the addition of rescue medication on selection of the ‘refer to paper chart’ dummy drug and (3) rephrasing biphasic insulin descriptions to reduce confusion with other intermediate-acting insulins. The interventions were designed and implemented over a 3-month period from December 2021 to February 2022.