Aims: This quality improvement project aimed to improve the experience and outcomes for neurodiverse patients accessing secondary community mental health services. It focused on reducing delays in neurodevelopmental assessments, delivering timely and evidence-based interventions, and enhancing clinician awareness and skills in identifying symptoms indicative of neurodiverse conditions, particularly in patients with co-occurring mental health needs.

By integrating these goals, the project aspired to create a more inclusive and effective care environment for neurodiverse individuals.

Methods: This project involved a structured approach.

Identification of Patients: Patients with symptoms suggestive of neurodiverse conditions were identified during multidisciplinary team (MDT) meetings, followed by a review of clinical records for relevant indicators, in secondary community mental health services.

Comprehensive Assessments: Each patient underwent a full psychiatric assessment, which included clinical and semi-structured interviews informed by validated tools to ensure a thorough evaluation of neurodevelopmental symptoms.

Feedback and Evaluation: Clinician feedback and patient survey were collected to assess the project’s impact on care delivery, patient engagement, and satisfaction with the services provided.

Results: This project achieved notable results, with 18 patients referred for neurodevelopmental assessments and 15 assessments completed. Of those, 60% received a confirmed diagnosis, with 77.78% diagnosed with ADHD and 22.22% with autism spectrum disorder (ASD). All patients received individualized interventions, including psychoeducation and tailored treatment plans. ADHD patients were monitored at 2-week, 4-week, and 8-week intervals for medication management, while ASD patients were referred for psychosocial support. Additionally, four patients used an ADHD digital support tool (SilverCloud) to manage ADHD and anxiety symptoms.

However, challenges such as comorbidities (e.g., substance misuse and PTSD) made patient engagement and follow-up more difficult. Some patients also struggled to use the digital support tool due to time limitations or personal preferences.

Conclusion: This project highlighted the importance of integrating neurodevelopmental assessments into secondary community mental health services. By reducing waiting, patient outcomes and satisfaction were significantly improved. Despite challenges such as comorbidities, the project highlighted the value of providing timely and personalized care for neurodiverse individuals. These findings offer valuable insights for future initiatives, stressing the need for mental health services that are both inclusive and responsive to the unique needs of neurodiverse patients.

Aims: Specialist eating disorder units (SEDUs) are unique among psychiatric units, in that there is a high incidence of electrolyte derangements due to the pathophysiology of refeeding. This requires careful monitoring of blood parameters with frequent venepuncture which often can be difficult due to strict mealtimes and post meal supervision as well as required group attendance in the SEDU.

Audit data demonstrated that the medical team spent about 3 hours every day and therefore 15 hours per week attempting to obtain blood samples from patients due to inefficient processes. Patients were often unavailable due to other commitments and so a maximum of 4 blood tests were obtained each day.

The primary aim of the project was to reduce the amount of time spent obtaining blood samples on the SEDU. Our secondary aims were to reduce patient uncertainty around venepuncture and to improve patient satisfaction.

Methods: A ‘phlebotomy clinic’ was implemented twice a week to replace daily venepuncture. The clinic was made up of 5-minute appointments and scheduled based on the published weekly ward schedule to avoid any protected mealtimes and group activities. The clinics took place at the start of the week to allow more time for results to be analysed and actioned.

Universal consent was gained from our patient group by discussion at the community meeting. It was agreed that a list of appointments would be published on the notice board and patients would be reminded about the clinic at morning check in.

The amount of time spent obtaining blood samples was self-reported by doctors at the end of the week and patient satisfaction was graded using a qualitative questionnaire.

Results: Implementation of the phlebotomy clinic saved 13 hours of time per week. Over three separate phlebotomy clinics, the average time spent obtaining blood samples was 35 minutes with 25 minutes of admin time and an average of 6 blood samples were taken at each clinic. Patient adherence to appointment times varied between clinics with a range of 66–100% adherence and this impacted the efficiency of the clinic. Patient questionnaires demonstrated that 100% of patients preferred the new format.

Conclusion: We concluded that the implementation of a formal ‘phlebotomy clinic’ significantly improved efficiency of venepuncture on the SEDU allowing more time to be spent engaging in other aspects of patient care. In addition, patient satisfaction improved and we believe that this in turn can greatly benefit the therapeutic relationship.

Aims: This study aims to explore the risk factors, impact, and support systems related to violence against healthcare staff by mentally ill patients. It examines the psychological, physical, and professional effects on staff, while assessing the effectiveness of current reporting mechanisms. Addressing the global issue of underreporting violence against healthcare staff, the study seeks to raise awareness, promote safety, and advocate for stronger preventative measures.

Methods: This study surveyed healthcare staff across three dementia wards at Julian Hospital in Norwich, using both online and paper questionnaires.

Results: The study received 38 responses. The majority were women (23), with 15 men. A large portion of the workforce was younger, with 20 aged 20–35, 15 aged 35–50, and only 3 over 50. Racially, most were Caucasian (21), followed by African (9), Asian (5), and 3 categorized as “other”. Clinical support workers made up 31% of respondents, highlighting their frequent patient interaction. These patterns suggest that younger, female, and front-line staff, particularly clinical support workers, are more vulnerable to workplace violence.

The study found high prevalence of verbal aggression, with 55% of respondents experiencing it almost daily, 21% 2–3 times weekly, and 10% weekly. Physical violence was also significant, with 21% facing it nearly every day and 23% 2–3 times weekly.

The emotional and psychological impact varied among staff. While 45% reported no significant emotional effect, 40% experienced reduced motivation, 10% considered changing jobs, and 5% contemplated changing careers. In terms of mental health and wellbeing, 44% had no effect, 40% reported mild and 16% reported severe psychological strain.

Regarding reporting and organizational support, 75% of participants found the reporting procedure effective, though 92% agreed it was time-consuming. After incidents, 67% felt supported, while 33% did not. Most (75%) felt organizational training provided to handle violent or aggressive situations was adequate, though 25% disagreed. These results highlight areas for improvement, particularly in streamlining reporting and enhancing post-incident support.

Conclusion: The study highlights the prevalence and impact of workplace violence on healthcare professionals in mental health hospitals, with younger, female, and front-line staff being most vulnerable. Verbal aggression was reported daily by many, with physical violence also frequent. The impact varied, with some showing resilience, while others faced emotional distress and psychological effects. Although reporting mechanisms and training were generally effective, their time-consuming nature and gaps in post-incident support point to areas for improvement. Addressing these issues with targeted interventions and enhanced support systems is crucial for ensuring the safety and well-being of healthcare workers.

Aims: Efficient medical record systems are vital for improving workflow, ensuring data accuracy, and maintaining staff satisfaction. At Eastlake and Ferneley psychiatric wards, the medical record system, ‘SystmOne’ proved to be inefficient and fragmented, with essential functions scattered across interfaces. This led to excessive administrative burden, detracted from patient care, and frustrated staff. A pre-implementation survey revealed issues such as excessive time spent on documentation and difficulties locating multidisciplinary input, underscoring the need for systemic change. The aim of this project was to reduce administrative time and improve user satisfaction by 30% by December 2024 through a consolidated visualisation tool.

Methods: A before and after study was carried out and Plan-Do-Study-Act (PDSA) cycle methodology was used. A new consolidated visualisation tool was designed to streamline key workflows, including admissions, ward activities, and discharges. Healthcare professionals (doctors and nurses) working across two psychiatric wards were participants on this study. Baseline data was collected including quantitative data on time taken to do daily tasks, and number of clicks; as well as qualitative data in the form of user satisfaction surveys. Training sessions were carried out to enable the staff to proficiently use the visualisation, followed by a roll-out of the visualisation on SystmOne. Post-implementation metrics were collected, including the number of clicks, time per task, and user feedback from follow-up surveys to evaluate the intervention’s impact.

Results: The intervention resulted in a 92% reduction in clicks and a 62% reduction in time taken to do daily tasks for doctors, and an 89% reduction in clicks and 87% reduction in time for nurses. Pre-implementation, most tasks took 35–40 minutes, whereas post-implementation tasks were completed in under 5 minutes. Annually, this equated to saving 304 hours for doctors and 440 hours for nurses. Qualitative feedback emphasized ease of use, reduced errors through a traffic-light system, and improved data accessibility. Staff reported increased job satisfaction and less frustration, allowing more time for patient care.

Conclusion: The system redesign significantly enhanced workflow efficiency, data quality, and user satisfaction, with clear implications for improved patient safety and care within psychiatric inpatient wards. These findings highlight the value of streamlining documentation systems to reduce administrative burden, enhance staff well-being, and foster patient-centred care. Wider rollout of the tool is recommended, alongside iterative refinements and ongoing evaluations to ensure sustainability and adaptability to evolving clinical needs.

Aims: The association between antipsychotic medication and weight gain is widely recognised. The Royal College of Psychiatrists’ Positive Cardiometabolic Health Resource recommends lifestyle counselling as per the National Health Service Eat Well and Live Well guides, and the United Kingdom Chief Medical Officers’ Guidance on physical activity, to promote positive lifestyle behaviours and a healthy BMI in patients with psychosis. Owing to a lack of educational resources for healthcare professionals, patients at a Community Mental Health Team in Kent were not exposed to thorough lifestyle counselling. This project aimed to improve staff awareness and confidence with respect to the recommended dietary and physical activity counselling guidelines by 80% within a four-month period.

Methods: This project was structured using two Plan, Do, Study, Act (PDSA) cycles. Baseline data, sought through an initial survey (S1) consisting of Likert scale and multiple-choice questions (MCQs) assessed staff perceptions of their awareness and confidence with respect to guidelines. PDSA1 involved the display of informational posters with key lifestyle recommendations in all consultation rooms and shared areas. Upon data analysis and participant feedback, PDSA2 involved an educational session delivered to staff, covering the recommended lifestyle guidance. Two identical surveys (S2 and S3) were distributed after each intervention to assess any changes.

Results: S1 revealed considerable variation around the average staff awareness and confidence level (M=5.32, SD=3.461). Although this dropped in S2 (M=4.7, SD=3.303), an increase was observed in S3 (M=4.96, SD=2.166). The initial decrease could be explained by staff overestimation of their awareness and confidence at baseline, which may have been realised once poster resources were introduced. The following increase in mean awareness and confidence suggests a positive impact of the teaching session delivered within PDSA2.

A similar trend was observed in the MCQs. The mean percentage of correct MCQ answers in S1 was 36.0%. Despite an initial decrease to 26.0% in S2, this value increased to 38.9% in S3. This shows an improvement in the knowledge of staff and ability to recall specific lifestyle guidance.

Conclusion: Despite not achieving our initial aim, active teaching was more effective in improving staff awareness and confidence levels regarding patient lifestyle counselling, compared with passive methods such as posters. The delivery of educational sessions, coupled with the provision of supplemental informational resources for patient-facing staff, could further improve awareness and confidence by allowing healthcare professionals to apply the recommended guidance in consultations, and ensure sustainability of their knowledge.

Aims: People under 75 years in contact with secondary mental health services have a significantly higher mortality and morbidity. Psychiatric medications increase the risk of cardiometabolic syndrome, psychiatric patients present less for attention of their physical health needs and are more likely to be overweight/smoke.

The aim of the Cardiometabolic Assessment (CMA) Clinic in our community mental health team is to reduce health inequality – identifying physical health problems, escalate any issues for medical treatment/review (usually to GP) and ensure patients receive treatment or get signposted for health promotion services.

We reviewed our clinic, identifying if it was fulfilling this purpose and looked at did not attend (DNA) rates.

Audit standards were that all patients invited to the CMA clinic should attend and that the CMA clinic should appropriately escalate all patients with concerning physical observations or requiring signposting to additional services.

Methods: Retrospective audit review of 247 appointments, January–December 2023.

We assessed: DNA rates; Physical health issues identified; Appropriate escalation and/or signposting e.g. for stop smoking services or obesity.

Change was implemented:

Educating staff with group and 1:1 teaching (colleagues from primary care were invited).

Written information leaflet sent with each appointment describing importance/purpose of CMA clinic.

Developed a simple proforma based on the modified early warning scoring system for CMA staff to send to the GP.

Staff granted the ability to directly contact GP practices.

Re-audited 36 appointments in the clinic from May–July 2024.

Results: Initial audit cycle: DNA rate of 52%. 53% of physical health issues managed correctly.

Re-audit: DNA rate 42%. 90% of physical health issues managed correctly.

Re-audit showed improvements in both standards.

Conclusion: A small intervention has enabled a direct improvement in patient care.

The DNA rate remains high – potentially a more focused approach to patients attendance may be beneficial. After ongoing multidisciplinary discussions we recommend that CMA clinic staff should consider domiciliary visits for patients at high risk of cardiometabolic conditions who repeatedly fail to attend CMA.

Clinicians to use all opportunities for CMA monitoring and make every contact count for physical health including occurring during care-coordinator reviews, in depot or other clinics. This will reduce the number of times a patient needs to visit the department hopefully improving satisfaction and increasing attendance.

Continued joint working with colleagues in primary care so workload is not duplicated and all opportunities for patient contact is maximised with the aim of reducing morbidity and mortality.

Aims: Medical education is a cornerstone of the NHS, influencing the continuous improvement of patient care. This study aims to explore the experiences of psychiatric trainees and medical students within a mental health trust, identifying opportunities to enhance medical education quality.

Methods: A qualitative focus group methodology was employed to capture detailed perspectives of participants. Four separate focus groups were conducted, categorized by the level of training: medical students (n=4), foundation doctors (n=4), core psychiatric trainees (n=8), and higher specialty trainees (n=4). Participants were recruited via internal mass email. Focus groups were guided by a standardized topic guide. Data were analysed using thematic analysis.

Results: Key findings reveal shared themes of issues in induction processes, access to information, rota issues, and facilities. Additionally, the study highlighted the importance of structured support for achieving psychotherapy competencies and the necessity for both clinical and non-clinical training. There is also a significant need for better supervision, support, and appreciation.

Conclusion: The study provides insights into the experiences of psychiatric trainees and medical students, highlighting key areas for improvement. Implementing the practical recommendations can enhance medical education quality within mental health trusts, benefiting trainees, educators, and patients.

Aims: Ensuring resident doctors’ safety during lone working is crucial, due to unique risks and challenges faced when working alone. Birmingham and Solihull Mental Health Foundation Trust’s (BSMHFT) current lone working policy recommends local procedures based on risk assessment and site needs. However, gaps in implementation have raised concerns about the consistency and effectiveness of safety measures.

Aims were to:

1. Increase awareness and adherence to lone working policy amongst Resident doctors in inpatient and community settings by 20% by September 2024.

2. Standardise lone working processes across BSMHFT by September 2024.

Methods: Our quality improvement (QI) project worked alongside the Trust’s QI team, utilising improvement methodology. A baseline survey was conducted to understand issues faced whilst lone working, alongside process mapping to analyse root cause. We followed the Model For Improvement model and initiated four Plan-Do-Study-Act (PDSA) cycles for the following interventions:

Incorporated Lone Work checklist into orientation checklist for all resident doctors rotating within Trust.

Lone work presentation at induction.

Created video on lone working, alarm use and policy guidance.

Sent clinical supervisors reminders to discuss lone work procedures with their trainees.

Data was collected via surveys alongside video views and returned checklists.

Results: 4 surveys were conducted amongst resident doctors in BSMHFT.

Before interventions:

Baseline survey (24 responses): 71% conducted lone working. 29% felt informed about policies, 43% received alarms with 66% of these trained to use them.

First pulse check survey (25 responses): 8% felt very confident in lone working, 32% had alarms, and 32% were “not confident” in following trust policies.

After interventions:

Second pulse check survey (17 responses): confidence improved with 35% feeling very confident, 65% had alarms, and all could follow trust policies.

Detailed post-intervention survey (19 responses): 68% conducted lone working, 63% felt well informed and received alarms, 72% felt confident using alarms.

Feedback on interventions:

83% found the lone working video guide helpful.

68% were unaware of or had incomplete induction checklists for local lone working policies.

Conclusion: We have been able to achieve our aim of improving adherence and awareness of lone working policy amongst resident doctors by over 20% (33.83%). Alongside, there is improvement in doctors’ confidence in lone working and the number, and utilisation, of alarms issued. This cycle has highlighted ongoing challenges and a need for further PDSAs to continue to improve, for example, pathway of escalation for lone working incidents and named alarms for doctors. The second cycle commences March 2025.

Aims: The team joined the Royal College of Psychiatrists Quality Improvement (QI) Demand, Capacity and Flow (DCF) Collaborative. The aim was to increase the discharge rate to 19 per month following specialist assessment by June 2024.

Methods: Participants: NELFT Adult autism Service multi-disciplinary team (MDT), NELFT QI advisor, Directorate Business manager, referrers, autistic adult with living experience of the service and the provider improvement advisor.

Process: Using the NHS Quality Service Improvement and Redesign (QSIR) six-step approach (NHSE), the Learning Handbook (NHSE). A project driver diagram helped identify change ideas in the referral, screening, pre-assessment, assessment and post-diagnostic pathways.

Priorities: Change ideas in the screening, assessment and post-diagnostic stages were prioritised and three Plan, Do, Study, Act (PDSA) cycles. PDSA1, to increase the number of assessments conducted, PDSA2, to reduce screening time by removing first stage, PDSA3, to complete reports and discharge within 4 weeks of assessment.

Results: PDSA 1: Assessments

Data collected: assessment waiting time (years), appointments completed (Jan–Mar 2023).

Assessment waiting time from 3+ years to 2 years.

Assessments completed from 6 (Jan–Mar 2023) to 20 (Apr–Jun 2024).

PDSA 2: Screening

Data collected: time referral screening in meetings (minutes), adding to waiting list from meeting (days), adding to waiting list from referral (days), Qpack postage (days).

Referral received to client being added to waiting list in days: 42.4 to 37.5.

Average days between referral meeting and being added to waiting list: 51.5 to 1.7.

Time to screen referrals in meetings (per referral, sample of 20): 16 minutes to 10 minutes.

Referral to Qpack posted: 26 to 3 days (sample of 20).

PDSA 3: Post-Assessment

Data collected: additional appointments needed (number), time to write report (hours).

Number of additional appointments needed following assessments: 1.8 to 1.6.

Time to write reports from 5.5 hours to 4.5 hours.

Conclusion: These results show that DCF has increased across the pathways, but further PDSAs i.e. digitalising reporting need to be implemented to achieve the overall aim. The processes highlighted some of the challenges such as client complexities, maintaining staff morale and adjustment to change. There were also some unintended consequences such as the impact of improving one part of the pathway creating blockages in another.

Opportunities for learning from collaboration with key partners such as clients and referrers has been positive and inspired a more co-produced and creative approach to the methodology. The service will continue to utilise the PDSA cycles to test change new ideas and the QSIR framework to continually improve DCF.

Aims: To improve the quality of the handover process among resident doctors at Grangewood Hospital, Northern Ireland, through a digital handover system, targeting universal adoption (100%) of electronic documentation.

Methods: A digital handover system was implemented and evaluated over two months. A standardised pro forma was designed to allow for structured documentation for new and existing inpatients, covering patient demographics, legal status, clinical history, provisional diagnosis, and a management plan, including any outstanding tasks. The document was securely uploaded daily to a designated Digital SharePoint, ensuring compliance with local General Data Protection Regulation (GDPR) mandates. The digital system functioned as a dynamic and editable document and was designed to supplement verbal handover.

Data collection focused on evaluating adherence to handover completion and the presence of key clinical details: patient demographics, provisional diagnoses, brief histories, and management plans, including outstanding clinical tasks. Given the absence of a formalised handover framework prior to implementation, baseline assessments concentrated on measuring compliance and data completeness.

A driver diagram identified key enablers for successful implementation, and a Plan-Do-Study-Act (PDSA) cycle supported iterative refinements. Two structured educational interventions at Weeks 1 and 4 reinforced engagement. Additional sessions after Week 2 addressed emerging challenges.

Results: Of 50 potential handover episodes, 42 were successfully completed. Compliance rates improved from 40% in Week 1 to 80% in the final week, with an overall mean compliance rate of 84% over the 10-week period. The completeness of handover documentation averaged 76.72%, with the following component-specific inclusion rates:

Patient demographics: 68.25%.

Provisional diagnosis: 74.76%.

Brief patient history: 82.29%.

Outstanding tasks: 80.98%.

An improvement in documentation quality was observed following the second-week educational intervention, highlighting the importance of structured training.

Conclusion: Continuity of care is central to medical practice, as outlined in Good Medical Practice (2023). The digital handover system enhanced accuracy, completeness, and consistency, benefiting patient safety and workflow efficiency. While compliance rates indicate engagement, sustained adherence depends on continued education and refinement. Future efforts should focus on optimising usability and embedding digital handover into routine clinical practice to ensure long-term adoption.

Aims: Sengkang General Hospital (SGH) is one of the newest government hospitals in the city state of Singapore. This busy 1000 bedded hospital has a 14 bedded psychiatric unit managed by the Department of Psychiatry. The department has 9 specialists, 4 to 5 Junior doctors and is supported by Allied Health Professionals like Psychologists, Occupational Therapists, Medical Social Workers and Nursing Professionals. All the above-named professionals work together as a well-oiled unit caring for the mental health needs of the patients mainly in the North East of Singapore. Ward 45 in SGH where the psychiatric unit is located houses inpatients who are 18 years and above. The patients have varied diagnosis, present with different risk profiles and as expected in any inpatient unit have varied lengths of stay. The aim was to start an inpatient programme which would benefit the patients during their stay and help in their recovery as well as equip them to build on their recovery and get back to successfully living in the community.

Methods: At the outset a few sessions were arranged involving all the professionals to discuss the therapeutic needs of the inpatients and how they could be addressed. The main aim of the programme was to help in recovery and relapse prevention. A list was compiled and in subsequent sessions the different health professionals who could deliver that was then mapped out. Once this was clear the individuals took it back to their respective departments to finalise on the deliverables and scheduling. This whole process took about a month. Once we were clear on the individual roles, we submitted the manpower requirement and time requirement for the Hospital Finance to generate a service code based on which the charges could be implemented. In subsequent meetings with all the professionals the different dates on which each professional could deliver the inpatient activity was finalised. The programme went live in February 2024. After a 3 month period feedback was obtained from patients and also the professional;s involved and some minor changes were made. We have now completed a year of the programme. A sample of type of activity is given below:

Psychology:

My distraction plan (pleasurable activities + thinking of someone patient cares about).

Self-soothing plan (self-compassion).

Un/helpful thinking styles.

Sleep hygiene + plan.

Values + action plan.

Self-esteem (kindness meditation).

Coping statements.

Relaxation (deep breathing + PMR).

Occupational Therapist:

Painting.

Collage.

Craft.

Drawing.

Medical Social Worker:

Generic activities to improve interpersonal skills and functioning.

Therapeutic approaches like IPT and DBT.

Nursing:

Psychoeducation activities about their condition.

Psychoeducation around the medications the patient is on.

Personal care advice and training.

Results: The Programme was accepted and appreciated by majority of the patients. The healthcare professionals also enjoyed delivering various therapeutic aspects to the patients and took an active role to improve care of the patients. A survey was done which captures the patients’ views on some aspects of the programme by different professionals. The results have been overwhelming and a high percentage of patients have rated the programme as appropriate, useful and recommendable to others. A brief tabulation of the survey has been posted below:

Psychology: 76% of the participants found the programme useful in their treatment journey; 73% of the participants would recommend the programme to other service users.

Occupational Therapist: 89% of the participants found the programme useful in their treatment journey; 93% of the participants would recommend the programme to other service users.

Medical Social Workers: 75% of the participants found the programme useful in their treatment journey; 75% of the participants would recommend the programme to other service users.

Nursing: 63% of the participants found the programme useful in their treatment journey; 69% of the participants would recommend the programme to other service users.

Conclusion: The response to the initiative and encouragement has been overwhelming. We would like to enhance and build on the progress. Another regional hospital in Singapore has expressed interest in learning from our model and we intend to assist them in any way and collaborate and build on what we have gained. We are in the process of collecting data to see if we have made any progress on relapse prevention. Some of the things we can improve on:

The duration of the sessions as some patients stay short periods hence miss out.

Some patients who are high risk are excluded and we need to devise ways to include them.

Increasing awareness and also devise means of reducing the financial burden for participation in the programme.

Constantly look at what is delivered and how a varied and broad category of interventions can be provided (prevent repetition).

Aims: This study examines the perspectives, practices, and training needs of NHS Grampian CAMHS clinicians in addressing substance use among children and adolescents. The primary objectives are to:

Evaluate clinicians’ attitudes towards adolescent substance use.

Identify perceived barriers to effective assessment and intervention.

Inform the development of an integrated substance use pathway within CAMHS.

Methods: A cross-sectional survey was conducted between September and November 2023 using SNAP software. The survey was distributed to 48 CAMHS clinicians across NHS Grampian and included structured and free-text questions on demographics, clinical practices, perceived challenges, and training needs. Quantitative data were analysed in Microsoft Excel, while qualitative responses underwent thematic analysis.

Results: The survey captured diverse professional representation: 50% psychologists, 25% nurses, and 14.5% medical staff. While clinicians acknowledged substance use experimentation as part of normal adolescent development, they emphasized that persistent or problematic use requires structured intervention. The majority supported a multidisciplinary, multi-agency approach for better integration between mental health and substance use services.

Significant training gaps emerged: 46.9% of clinicians lacked familiarity with evidence-based interventions, while 40.8% required further training to implement them effectively. Only 10.2% reported regular use of such interventions in practice. Clinician confidence varied, with some expressing neutrality or disagreement regarding their preparedness to assess and manage problematic substance use.

Key barriers included limited resources, inadequate service integration, and challenges in engaging young people and families. Qualitative responses highlighted the need for structured training, clearer referral pathways, and enhanced service coordination. Clinicians emphasised the importance of ongoing education programmes that evolve with emerging substance use trends.

Conclusion: The findings reveal significant gaps in clinician training, confidence, and service integration. Recommendations include:

Expanding training opportunities to strengthen familiarity with evidence-based interventions.

Enhancing referral pathways to improve integration with substance use services.

Developing engagement strategies to support young people and families in accessing treatment.

These findings highlight the need to improve clinicians’ awareness, confidence and training working with young people who use substances.

Aims: Many of our patients have multiple co-morbidities in addition to their mental health diagnoses, with the two often impacting each other. Outcomes such as life expectancy in mental health patients also tend to be poorer compared with the general population. Therefore, it is vital to use the opportunity whilst patients are under our services to engage them in care for their physical health. Our quality improvement (QI) project began after reviewing home treatment team physical health policies across the UK to form a tailored local protocol, and was co-produced with our experts-by-experience. This project aimed to achieve 80% of patients under the Westminster Home Treatment Team (WHTT) with physical health monitoring completed (observations, bloods and ECGs) by Feb 2025.

Methods: For the 84 patients on our caseload from July–Oct 2024, data was manually collected from the electronic records for observations, blood tests and ECGs performed. Improvement strategies were implemented in 3–4 weekly cycles with input from our QI team’s nurses, doctors, support workers and our experts-by-experience in monthly QI meetings to ensure a patient-centred approach.

Results: Three cycles were completed with: 1) implementing a communal monitoring spreadsheet to identify patients needing checks, 2) dedicating a section for physical health in weekly MDT meetings, and 3) the formation of equipment kits for observations. The target was met for observations (50% to 90%) and bloods (20% to 81%) by the end of cycle 3, although not for ECGs at 30% to 66%, observed to likely be due to limited ECG machines available onsite. The mean time to complete observations was 7.4 days, bloods 11.2 days and ECGs 8.0 days. No patients declined observations, only 4 declined bloods and 3 declined ECGs. GPs were informed to offer checks as follow-up for any patients who did not receive them before discharge from WHTT (observations n=18, bloods n=35 and ECG n=46).

Conclusion: Offering physical health checks was generally received well by patients and should be integrated into routine patient contact within mental health pathways. Additional training for staff (e.g. phlebotomy), access to equipment and raising patient understanding of the physical health services available would further engagement. Ongoing collaboration between WHTT and GPs is needed for timely interventions so physical health is not neglected. Forming automated processes to capture the data collected manually will be critical for sustainability and identifying further service improvements.

Aims: Driving is a complex and rapidly evolving task that requires a high level of skill and the ability to simultaneously interact with both the vehicle and the external environment. Mental illness can impair these abilities, potentially compromising both the driver’s safety and the safety of others. While individuals with mental health conditions have a legal obligation to refrain from driving if their condition renders them unfit, healthcare professionals, including doctors, have a crucial role to play. They are responsible for advising patients on the potential impact of their condition on driving ability, their legal duty to inform the Driver and Vehicle Licensing Agency (DVLA), and, in certain circumstances, directly notifying the DVLA on the patient’s behalf. Unfortunately, the driving status of patients is often overlooked during both admission and inpatient stays. There is also a concerning lack of awareness among patients regarding their duty to inform the DVLA and potential driving restrictions.

To mitigate these risks, it is essential to gather relevant information about driving status on admission, during the inpatient stay, and, most importantly, to discuss this with patients and carers at the time of discharge planning. The aims and objectives of this project were to achieve a 100% rate of driving risk assessment for all patients admitted to inpatient settings and to ensure that 100% of service users receive information about DVLA guidance following a mental health illness.

Methods: This Quality Improvement (QI) project involved assessing baseline practices against the local fitness to drive policy of Leicestershire Partnership NHS Trust. Data was collected from ten inpatient wards (six general adult and four older age) for patients discharged in January 2023. Information was gathered on driving risk assessment at admission, driving status at admission, driving risk assessment during the inpatient stay, and advice on fitness to drive given at discharge. An educational training video was developed and shared with trust-wide clinicians via email in September 2024, followed by a reminder email two weeks later. Data was collected again for patients discharged in October 2024.

Results: In the first cycle (January 2023), 128 patients were included. Driving risk assessment was completed for 95% of patients at admission. Approximately 12% of patients were driving at admission. Driving risk assessment during the stay was conducted in only 11.7% of cases. Advice on fitness to drive was given in 12.5% of cases. Notably, a quarter of driving patients did not receive such advice at discharge.

In the second cycle (October 2024), 85 patients were included. Driving risk assessment remained at 94%, similar to baseline. However, the proportion of driving patients increased to 20%. Driving risk assessment during the stay improved to 19%, a 7% increase. Advice on fitness to drive at discharge increased to 21.2%, an 8% increase. Surprisingly, the percentage of driving patients receiving advice decreased from 75% to 53%.

Conclusion: While there has been some improvement in compliance with the fitness to drive policy, significant gaps remain. To address this, it is crucial to enhance awareness among healthcare professionals regarding their role in driving risk assessment and patient advice. The educational training video will be made available on the uLearn training portal. It is recommended to incorporate this training into the induction process for new employees. Regular monitoring (biannually) of practices related to the fitness to drive policy is essential to further evaluate service delivery.

Aims: Care plans are the cornerstone of Rehabilitation Psychiatry. These were not being completed collaboratively with patients during monthly ward rounds, leading to impaired communication, lack of patient involvement in risk reduction strategies, and frustration. This contributed to volatility and increased risk incidents.

This Quality Improvement Project aimed to Co-produce Care Plans with staff and patients with primary outcomes relating to reducing risk incidents and secondary outcomes aiming to improve Staff and Patient engagement with Care Plans.

Methods: Baseline questionnaires (Likert scale and open-ended questions) were conducted with clinical staff and patients to assess care plan satisfaction. Feedback revealed concerns about care plan length (average of 40–60 pages), user-friendliness, appropriateness and engagement with patient/carer views not captured conspicuously.

This feedback was discussed with the Senior Management Team and care plan survey participants. A report with graphs was sent to Maple ward staff and stakeholders and later presented at the National Steering Rehabilitation Cygnet group meeting.

A new care plan template was co-produced in two focused group meetings (8 paged). The ward round format was changed to being care plan-based, aligned with Cygnet’s rehabilitation standards. A multimedia screen was purchased to support collaborative care plan completion. The new care plan featured columns for verbatim patient views, relevant discipline feedback, goals, and evaluations. The rows included sections for Treatment (Psychology, Occupational Therapy, Nursing, Social Needs, and Medical), Safety (Risk Management Plan), Recovery (Discharge Planning), Physical Health, Well-being (Spiritual, Cultural, Protective Factors), and Monthly Patient Progress Feedback.

Results: Primary outcomes showed a substantial reduction in physical restraints (65.5%), rapid tranquillisations (90%), and physical aggression (35%). However, verbal aggression incidents increased by 311%, though they did not escalate to restraints or tranquillisations, indicating improved ward safety.

The project led to a significant positive impact: 100% of patients now read their clear, concise care plans. Secondary outcomes showed an increase in patient satisfaction with care plans (57%), staff views on care plan effectiveness (60%), and a reduction in care plan length (62%).

Conclusion: Patients, carers, families, social workers, and advocates actively collaborated with multidisciplinary staff and Community Mental Health Teams to achieve shared goals and provide real-time feedback. To support co-production initiatives, infrastructure must be in place, and processes should be streamlined to ensure efficient embedding of quality improvement learning, including policy updates.

Given the successful outcomes of the pilot, the project is being considered for national rollout across Cygnet Healthcare’s rehabilitation wards.

Aims: Medical students are known to be apprehensive about psychiatric inpatient placements. Anecdotally, they assimilate less well than other health profession students during shorter placements, and nurses and occupational therapists (OTs) may not understand their role in supervising and engaging with medical students. We applied the Model for Improvement to deliver a quality improvement (QI) project to enhance student self-rated experience on placement by exploring induction, participation in a community of practice, engagement with the broader multidisciplinary team (MDT) and consider student safety.

Methods: The project involved clinical ward staff from two inpatient wards, the Medical Education team, the QI team, medical students from GKT School of Medical Education and resident doctors. We applied the Model for Improvement using routinely collected end of placement data as a change measure for student experience, with an additional Sense of Belonging Survey. Interventions drew on the themes of improving communication, preparation, early assimilation and participation with the work of the wider team. These included early communication with the ward manager and ward administrator; provision of a guide and structured timetable; day one arrival for nursing handover at 7.30 am; week 1 prioritisation of working alongside nurses, nursing students, nursing assistants, OTs, physiotherapists and in therapeutic groups; and support from Foundation doctors.

Results: Analysis of End of Placement Survey Data showed an early sustained trend of improvement, most marked in the themes of:

The block was well organised and the team was prepared for my arrival.

Teachers were welcoming and were expecting me for timetabled sessions.

During this placement I had opportunities to learn with the multidisciplinary team.

Students participated in the OT and physio therapeutic programme in a way that had never happened before and felt positive about the experience. Nursing colleagues felt strongly medical students should understand their role in inpatient care and welcomed their involvement. Students qualitatively reported feeling more welcome by other professions, felt safer and that they got to know patients more rapidly.

Conclusion: Medical students welcome changes to placement planning to enhance their engagement and assimilation with the mental health ward MDT. Ward MDT members place importance on medical students understanding their role and contribution. With planning, student placements can enhance interprofessional learning. We suspect that better student integration enhances their safety on wards. Foundation doctors can lead placement planning and embed change sustainably. Quality Improvement methodology can be applied to enhance medical education.

Aims: Interruption of sleep-wake behavioural patterns and circadian rhythms has been associated with the development and worsening of a range of mental health disorders, including depression, bipolar disorder, and schizophrenia, and specific high-risk outcomes such as aggression and suicidality. In full knowledge of the above, we aimed to improve patients’ self-reported sleep quality in an acute male ward, by 20% by the end of January 2025.

Methods: An initial survey was conducted for patients to rate their sleep quality on a Numeric Rating Scale (1–10, where 1 = a worst night sleep and 10 = a best night sleep). This survey included close- and open-ended questions for patients to identify perceived barriers to good sleep. Responses were collected over one week from all consenting patients on the ward (10/18 patients). Insights from the survey were used to design targeted interventions addressing the key contributors to poor sleep. These interventions included: a) Offering earplugs to patients; b) Posters with QR codes for a free white noise app to mask disruptive noises; c) Sleep hygiene education through leaflets, with practical tips to improve sleep. A following survey was conducted after two weeks to measure the results of our interventions.

Results: Initial survey results included: a) 6/10 median sleep rating reported by our patients, pre-intervention; b) 5/10 of our patients reported their sleep to be disturbed by noise on the ward; c) none of our patients reported sleep to be disturbed by the temperature or lighting of the room; d) 2/10 reported psychiatric symptoms such as auditory hallucinations to disturb their sleep. Results after interventions included: a) all of our patients stated that they received the sleep hygiene booklet, were counselled about the tips, and saw the posters around the ward; b) 11/16 included in the post-intervention survey reported that they found the tips useful; c) 10/16 had used the earplugs and 7/10 of these had found them helpful; d) 1/16 downloaded and used the white noise app; e) 7/10 median sleep rating was reported post-intervention.

Conclusion: Non-pharmacological interventions such as earplugs and sleep hygiene education proved to be effective in improving patients’ quality of sleep. The development of a standardized protocol that includes these sleep-friendly practices has been implemented on the ward. Methods’ limitations such as baseline sleep medications and the complexity of contributing factors were taken into consideration.

Aims: To streamline the communication process for doctors by integrating essential contact numbers into the Accurix system, making information readily accessible and reducing time spent searching for contact details.

Methods: Pre-intervention survey among junior doctors; Integration of trust directory into Accurix; Post-intervention survey with analysis of results and feedback.

Results: Before: Ease of locating correct ward/unit numbers:

58.6% find it difficult (rating 1–2 out of 5).

34.5% neutral (rating 3 out of 5).

Only 6.9% find it easy (rating 4–5 out of 5).

Before: Current methods for finding phone numbers:

65.5% use Google.

62.1% use WhatsApp Group Chat/Word document.

51.7% use KFC Doctor Office.

After: Ease of locating correct ward/unit numbers:

Now, nearly 60% find it easy (rating 4–5 out of 5).

After: Current methods for finding phone numbers:

With 70% of people now using Accurix.

Conclusion: The implementation of our technological intervention has significantly transformed the way healthcare professionals communicate across different units, leading to improved patient care and efficiency. Prior to the introduction of the app, many clinicians faced considerable challenges when attempting to contact colleagues in other units. The reliance on outdated methods, such as word of mouth, personal contacts, or searching through Google, often resulted in delays, miscommunication, and frustration. These inefficiencies not only hindered the flow of information but also impacted patient care, as timely communication is critical.

The Accurix app, which serves as a comprehensive and up-to-date phone directory for multiple trusts, has addressed these issues head-on. Since its introduction, the majority of doctors across the trusts have adopted the app, with usage rates steadily increasing. Feedback from users has been overwhelmingly positive, with many reporting that the app has made it significantly easier to contact the right person at the right time. This streamlined communication has had a direct impact on patient care, as doctors can now quickly consult with professionals, arrange transfers, or coordinate care across units without unnecessary delays.

The reduced dependence on informal communication methods, such as word of mouth or searching for contact details online, has not only saved time but also improved the accuracy and reliability of information. This has led to a more efficient patient flow, as clinicians can now focus on delivering care rather than spending valuable time trying to track down contact information. Furthermore, the app has contributed to a more standardized approach to inter-trust communication, ensuring that all healthcare professionals have access to the same resources, regardless of their location or specialty.

Authors

Heather McAdam (presenting), Ruth Goh, Gloria Cheung, Felicity Allman, Samyak Pandey, Julia Alsop, Annabelle Hook, Jessica Randall, Benjamin Perry, Katherine Beck, David Codling, Judith R Harrison

Aims: Self-harm is increasingly prevalent among adolescents in the UK, with rising hospital admissions for those under 18. The updated National Institute for Health and Care Excellence (NICE) guidelines (NG225) for managing adolescent self-harm, published in September 2022, emphasised the need for timely, structured care, including risk assessments, psychosocial support, and family involvement. This study aimed to assess the clinical management of children and adolescents presenting to Emergency Departments (ED) for self-harm, evaluating compliance with the updated NICE guidelines across nine teaching hospitals in Scotland, England, and Wales.

Methods: This retrospective, multicentre study reviewed ED records of individuals aged 8–17 years who presented with self-harm between 7 September and 7 November 2022. Consecutive sampling was used, with data collected by medical student regional leads, who were recruited and trained through a national steering group. The leads followed a structured protocol to ensure consistency in reviewing records, focusing on risk assessments, psychosocial evaluations, consent for family involvement, and age-appropriate ward admissions. Data was centralised for analysis, where compliance with each audit criterion was assessed, and statistical analysis was conducted to identify trends and areas for improvement.

Results: A total of 328 patient records were analysed. The majority of patients were female (82.0%) and white (68.2%), with a mean age of 14.7 years (σ = 1.58). Compliance with NICE guidelines varied significantly across audit criteria. The highest compliance was for family involvement, with 73.5% of records documenting consent. However, social media interactions, a key component of risk assessment, were documented in only 21.5% of cases. Delayed psychosocial assessment was noted in 17.8% of records. Only 26.1% of 16–17-year-olds requiring inpatient care were admitted to age-appropriate wards, suggesting gaps in the provision of suitable care.

Conclusion: This audit demonstrates variability in adherence to the updated NICE guidelines across nine hospital sites. Family/carer involvement showed the highest compliance, but there were significant gaps in the use of risk assessment tools and timely psychosocial evaluations. The findings highlight the need for improvements in these areas and the importance of further training for clinical teams. The study also illustrates the value of student-led research in engaging future healthcare professionals in academic psychiatry and national data collection.

Aims: Ketamine use among young adults in England has increased significantly, with prevalence more than doubling in the past five years. Ketamine use disorder (KUD) is a disorder of regulation arising from repeated or continuous use of ketamine for at least three months. The systemic effects can include urinary, sexual, hepatic and cardiovascular dysfunction, memory impairment and mental illness. Although people who use ketamine constitute a smaller proportion of patients in addictions services compared with opioid or alcohol users, the complexity and morbidity of KUD dictates the need for interdisciplinary collaboration. In 2024, a collaborative effort between a local addiction and urology service was initiated to address KUD and ketamine uropathy (KU).

Methods: Both services presented at the local Addictions Continuing Professional Development Day to share knowledge and develop staff understanding on KUD and KU. Meetings were held to evaluate local prevalence of KUD and KU, address barriers to treatment and develop easier referral pathways into both services. Best practice guidance on KU was reviewed and a new interdisciplinary treatment model implemented. Re-strategisation required clinician time and adjustments to clinic schedules.

Results: In 2024, nine patients from Urology and 23 patients from the addiction service with ketamine use were seen. Key improvements included the establishment of a direct two-week referral pathway to Urology, development of referral and assessment proformas and initiation of monthly interdisciplinary team meetings. These changes aimed to reduce delays in initiation of treatment and improve co-ordination between services. However, the major challenge faced was a high attrition rate in the clinics.

Areas identified as requiring further attention included management of weight loss and constipation, medication for symptomatic relief of ketamine withdrawal and cravings, safe analgesic alternatives, treatment of co-occurring mental illness and trauma, safeguarding and risk considerations and psychological therapeutic options. The embarrassment of urinary incontinence was identified as a barrier to appointment attendance.

Conclusion: An interdisciplinary management approach is recommended to optimize patient care. Systemic complications of KUD and co-occurring mental illness should be treated simultaneously. Intensifying the support from Addiction Recovery Coordinators may improve attendance at appointments.

Recommendations include more health worker education and staffing, early pain team involvement and provision of harm reduction advice. Peer-informed, ketamine-focused psychosocial programmes and national psychiatry guidelines for KUD are required.

Our collaborative model demonstrates a significant step towards improving management of KU and KUD, however its impact on clinical outcomes will need further evaluation.