To explore the experiences and attitudes of psychiatrists to a new electronic patient records system. A questionnaire was emailed to 115 psychiatrists across the South London & Maudsley National Health Service Foundation Trust.

The total response rate was 66% (senior house officers 75%, specialist registrars 57%, consultants 56%). Technical problems, difficulty with patient confidentiality, administrative burden and impact on clinical work were identified as concerns. However, psychiatrists recognised the potential benefits and the majority did not wish to return to using paper records.

Electronic patient records are rapidly being integrated into the daily practice of psychiatrists. More administrative assistance and specific training should be provided to support clinicians who use this system.

An increasing number of mental health trusts in the UK are replacing the geographically sectorised model of service delivery with a functional one. We conducted a qualitative study of staff perception concerning this reorganisation in our Trust, to inform effective change management locally and elsewhere.

Perceived benefits were quick decision-making, positive risk management and improvement in clinical leadership. Dedicated consultant time would lead to improvements in junior doctor training. Concerns included lack of continuity of care, disagreement between teams and de-skilling of staff. Communication was seen as the key to overcoming these difficulties.

Detailed communication from management about the practicalities and reasons for change could facilitate effective transition.

To review the clinical and managerial impact of flooding on a community mental health team (CMHT) for older adults by prospectively recording all flooding related events met by the CMHT.

Of 348 individuals known to the CMHT, 87 lived in flood affected areas. In nine patients symptoms deteriorated. There were two new referrals as a direct consequence of the flooding. Flood effects can be grouped into: new mental illness, management problems, CMHT workload, and secondary benefits.

The immediate and delayed problems caused by flooding to the elderly with mental illness and dementia include unmasking cognitive impairment and provoking exacerbations in depressive and anxiety disorders. Personal evacuation plans should be used when moving individuals with marked cognitive impairment to avoid difficulties with identification. Overcrowding of care homes used to temporarily accommodate additional residents can contribute to behavioural changes and psychological symptoms in those with pre-existing dementia.

To investigate non-adherence to substitute opioid treatment, using a cross-sectional study design, with 630 patients from three London community drug services. Adherence was measured as the number of doses collected from the pharmacy as a proportion of the total number of doses stipulated on the prescription during a 28-day period and was further investigated through laboratory urine drug screens.

Overall, 30.5% (n= 191) of individuals failed to pick up at least one dose of medication from the pharmacy over 1 month, but only 1.6% (n= 10) missed 50% or more of their doses. Non-adherence was associated with supervised consumption, more frequent pick-up, shorter duration of treatment, younger age, a lower dose of methadone and a recent urinalysis result positive for opiates.

Treatment services need to monitor levels of adherence to treatment and develop strategies to improve it so that treatment can be optimised effectively.

The local experience of having to take over the care of patients newly moved to the Bristol area revealed the lack of clear information on their complex needs. Official guidelines do not exist, therefore a consensus list of expected handover information was produced. the records of two patients were analysed in each of the six teams that agreed to be audited. A standardised handover form was devised and introduced (Part 1). Part 2 of the audit was performed 18 months after the implementation of changes to practice.

Part 1 revealed that diagnosis (11/12) and medications (12/12) were the best-documented items during handover correspondence. Follow-up duration (3/12), crisis plan (3/12), professionals involved (0/12) and risk assessment (3/12) if documented were done so only for patients with complex needs. Part 2 showed improved documentation of information (11/11 for the first two items and 10/11 for the remainder).

Absent or concealed information in patient notes may contribute to disruption to the continuity of care following patient transfers. the use of a succinct, structured and easily distinguishable handover form in patient records may facilitate communication between professionals.

To explore why and how on-site urine drug testing is performed in in-patient settings. Data were collected by questionnaire in four acute psychiatric wards.

The most commonly cited reasons for testing were suspected drug use and as a routine part of the admission procedure. On-site testing was typically favoured over laboratory methods owing to the rapid turnaround of results and ease of use. In 81% of cases the result of the tests had no effect on immediate management. the majority of staff had not received formal training in their use.

Clinical use of on-site drug tests does not reflect their established limitations. Guidance is required to direct staff in the use of this commonly used assessment tool.

The brevity of training and assessment for independent nurse prescribers has caused some concern. We aimed to validate an Objective Structured Clinical Examination (OSCE) for potential nurse prescribers in dementia. Nurses' performance after 12 days of training for potential prescribers was compared with that of doctors of different grades.

The performance of doctors, but not nurses, correlated with years of experience. Many nurses, especially those working in memory clinics, scored better than junior doctors.

This OSCE provides evidence of potential prescribers' competency for employers. This could make a significant contribution to maintaining high standards of patient safety with nurse prescribing. This may also be an appropriate addition to the assessment of specialty trainees as well as for revalidation.

As part of a pilot project, one of the authors spent 3 months undertaking clinical work, teaching and research in a large psychiatric hospital in Accra, Ghana. the other acted as a UK-based mentor. Both report on the training value of the experience.

It was possible to assimilate into the local healthcare system and effect some modest but sustainable changes. the experience broadened the trainee's understanding of psychiatry, cultural influences and healthcare systems, while also developing autonomy and resilience.

The post is now an option available to trainees on the rotation. Projects in training and service delivery to benefit the host institution have been identified.