The case records of patients receiving ECT at King Khalid University Hospital over a 10-year period were reviewed for all aspects of ethical and technical administration of ECT. The audit of 127 patients showed some deficiencies in the early years: no seizure monitoring, no training or education for staff (particularly psychiatrists and anaesthetists), and the use of atropine as a premedication for all patients. Recently, regular education and staff training have been organized and seizure timing regularly monitored. Use of an ECT machine with EEG monitoring and the systematic and scaled monitoring of complications is recommended. Results show the necessity of ECT auditing, including an unbiased external audit for effective monitoring of the practical administration of ECT. Similar audits in other mental health institutions in Saudi Arabia are recommended.