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Procedural sedation and analgesia (PSA) is a vital skill for physicians working in an emergency centre (EC). For doctors working in the African setting, dealing with high patient loads and limited theatre availability, knowledge and proficiency in PSA is a highly valuable and necessary skill. The aim of this study was to audit the practice of PSA in the EC of Steve Biko Academic Hospital. Methods: This was a cross-sectional descriptive audit. Procedures conducted under PSA were identified. An audit of clinical notes and interviews with staff was conducted. Data were analysed using the STAT 12 package. The results were presented as adherence statistics with reference to the PSA guidelines of the Emergency Medicine Society of South Africa (EMSSA). Results: This audit indicated that documentation of informed consent prior to PSA was poor in this hospital’s EC. No evidence of informed consent was found in any audited cases. Adherence to the other aspects of PSA was also fairly average (below 50% in most). The mean adherence scores for these components were as follows: pre-procedure preparation and equipment check 46.19% (95% CI 36.62–55.76), documented patient pre-evaluation 50.99% (95% CI 46.78–55.18), monitoring during procedure 39.22% (95% CI 34.68–43.75), post procedure monitoring 37.99% (95% CI 32.78–43.20), and overall documentation of procedure 40.69% (95% CI 37.85–43.52). Analysis of adherence to the guidelines between different ranks of doctors demonstrated that the registrars in EM were, in general, more compliant. Conclusions: This audit identified documentation of informed consent as a major shortcoming in the practice of PSA in this EC. There is also room for improvement in most of the other aspects that were assessed. As part of the clinical audit cycle, the results of this study will be used to initiate changes to increase adherence to the guidelines.