Aims: Psychiatric patients attending acute hospitals settings in North East London are reviewed by the Psychiatric Liaison Service (PLS). Those who PLS deem to require Older Adults Home Treatment Team (OAHTT) input on discharge are re-assessed face to face by a member of the OAHTT prior to discharge from the acute hospital. This is time consuming as it requires OAHTT staff to travel to the acute hospital and re-assess the patient. This can delay discharge and the outcome of the assessment is rarely different to the decision PLS staff would have made.

The aim of our quality improvement project is to streamline the process of referrals to OAHTT and prevent duplication of work. Referrals made to the OAHTT from PLS at Queen’s Hospital, Romford (QH) and King George Hospital, Ilford (KGH) would be discussed on the phone and accepted for OAHTT follow up or admission without the need to conduct a separate assessment.

Methods: Baseline data were collected for all patients referred to the OA HTT in January 2023–Dec 2023 from QH PLS and in July 2023–June 2024 from KGH PLS. The percentage of patients who had face to face assessments by OAHTT were recorded. The trusted assessments intervention was launched in QH in January 2024, and in KGH in July 2024. Following intervention, the percentage of patients who had face to face assessments by the OAHTT were recorded.

Results: Prior to intervention, 95% of all referrals made from QH PLS to OA HTT were assessed face to face. This reduced to 25% post-intervention (data from January 2024–November 2024). Therefore, a 75% reduction in face to face assessments was achieved.

In KGH, prior to intervention, 84% of referrals were assessed face to face. Preliminary data (July 2024–November 2024) show that post intervention in KGH, 50% of referrals were assessed face to face. This is a reduction of 40%.

Conclusion: The trusted assessment model resulted in a large reduction in face to face assessments conducted by the OAHTT following referral by the PLS teams. This model appears to have achieved its aims of streamlining referrals, preventing duplication of work and improving efficiency. The next step would be to extend this model to adult HTT services and evaluate if the same benefits can be achieved.

Aims: Clozapine is a critical treatment for patients with treatment-resistant schizophrenia, requiring close monitoring through the Clozaril Patient Monitoring Service (CPMS). Access to the electronic CPMS (eCPMS) is vital for healthcare professionals on Chebsey Ward at St George’s Hospital to ensure safe prescribing, dispensing, and monitoring of clozapine. Delays in obtaining eCPMS access can disrupt patient care and treatment continuity. This Quality Improvement Project (QIP) aimed to streamline the registration process and reduce the time taken for healthcare professionals on the ward to gain access to the platform.

The primary aim of this QIP was to reduce the time required for healthcare professionals, including nurses and doctors on Chebsey Ward, to obtain access to the eCPMS website. The project sought to identify barriers to timely registration and implement strategies to expedite the process, improving workflow efficiency and patient safety.

Methods: The project was carried out on Chebsey Ward at St George’s Hospital over a four-month period. Initial testing was conducted to assess the average time taken for healthcare professionals to gain eCPMS access. Root cause analysis identified key delays, including administrative bottlenecks, lack of awareness about the registration process, and incomplete applications. Interventions included the creation of a simplified registration guide specific to the ward and closer collaboration with the CPMS registration team to expedite approvals. A post-intervention cycle was conducted to assess the effectiveness of these measures.

Results: The baseline audit revealed that healthcare professionals on Chebsey Ward took an average of seven days to obtain eCPMS access. After implementing the targeted interventions, the post-intervention cycle showed a reduction in registration time to an average of three days, representing a 57% improvement. Staff satisfaction with the registration process increased, and feedback highlighted greater clarity and efficiency in obtaining access.

Conclusion: The QIP successfully reduced the time taken for healthcare professionals on Chebsey Ward to gain eCPMS access, improving workflow efficiency and ensuring uninterrupted patient monitoring. The structured approach of process simplification and enhanced collaboration with the CPMS team contributed significantly to the improvements. Future steps include sharing the simplified registration guide to other inpatient wards at St George’s Hospital. This project highlights the importance of targeted interventions in overcoming administrative barriers to enhance patient care and safety.

Aims: The aims of the project were (i) to enhance collaboration between the multidisciplinary team working with people living with dementia such as the carers, general practitioners, pharmacists, mental health professionals and patients` families; (ii) improve the Community Mental Health Team (CMHT) response to referrals; (iii) reduce unnecessary referrals; (iv) provide psychiatric training to primary care colleagues; (v) reduce care home visits; (vi) reduce polypharmacy, especially antipsychotics in dementia; and (vii) increase the use of memory medications for dementia patients where indicated.

Methods: A pilot project was conducted with a care home specialising in dementia with a high rate of referrals to secondary mental health services. A fortnightly MDT meeting was set up which included care home staff, CMHT staff, GP staff and family members. Data was then captured from notes for analysis, with corroboration from the electronic patient record (EPR) as necessary.

Results: The project involved 64 patients with various psychiatric and dementia-related needs. The median age of the patients was 86, with a male to female ratio of 36:64. The project addressed a range of symptoms of concern, with 95% of patients exhibiting Behavioural and Psychological Symptoms of Dementia (BPSD), and the remaining 5% presenting with other issues such as seizures, elevated prolactin levels, and memory decline. Over the course of the project, there were a total of 317 patient discussions.

There was a 25% reduction in referrals to the CMHT in the 24-month period after MDT was started. Medication management was a significant focus, with 11 patients starting melatonin, 45 patients starting other medications, 22 patients starting antipsychotics, and 12 antipsychotic reviews conducted. Additionally, 10 patients had their antipsychotics stopped, 29 memantine titrations were performed, and 5 acetylcholinesterase inhibitors (AChEi) titrations were completed. Physical health monitoring, including prolactin and ECG checks, was conducted for 28 patients.

Family involvement was a key component, with 21 out of 64 patients having family members participate in the MDT meetings. Palliative care discussions were held for 5 patients, and there were 6 referrals to the Intensive Older People’s Service (IOPS) and 2 referrals to the Memory Treatment Service.

Conclusion: This pilot study demonstrated the effectiveness of a regular MDT for a care home with a high referral rate to secondary care, by reducing the number of referrals, improving communication between services and optimising the medical treatment of BPSD. This model shows promise for broader implementation to enhance the quality of psychiatric care for older adults in care home settings.

Aims: This quality improvement project (QIP) aimed to improve nursing staff confidence and understanding of diabetes/management by 40% by the end of February 2024, taking place on a dementia intensive care ward in South East London. This project was led by a medical student and FY2 doctor who noticed significant anxiety and uncertainty amongst healthcare professionals (HCPs) managing a patient’s severe type-2 diabetes, leading to disruption in care as HCPS sought repeated consultation with medics for reassurance prior to implementation of plans, creating an environment of dependency and reduced confidence making independent decisions. Barriers to delivering high-quality care for diabetes in psychiatric services are well-documented and associated with limited understanding of the condition and low confidence in management. Suboptimal management increases risk of diabetic emergencies such as diabetic ketoacidosis/Hyperosmolar Hyperglycaemic State (DKA/HHS), and long-term complications.

Methods: Three PDSA cycles were carried out:

PDSA 1: a poster displaying an individualised care plan and insulin regime, alongside an information sheet on diabetes care.

PDSA 2: a teaching session was delivered to nursing staff regarding diabetes care and recognising/managing diabetic emergencies including DKA/HHS.

PDSA 3: further teaching session incorporating feedback from PDSA 2 e.g. using worked examples for staff to apply learning.

Confidence and understanding were assessed using self-reported scales before and after intervention, alongside feedback for potential improvements to subsequent cycles.

Results: PDSA 1: Post-intervention feedback showed 47% increase in mean staff confidence in managing diabetes, and 45% increase in understanding of insulin management, exceeding the predictions for PDSA 1.

PDSA 2: Confidence levels improved by 58% and understanding of diabetes management increased by 57%.

PDSA 3: Post-intervention feedback showed mean staff scores for understanding of diabetes increased by 63%. Understanding around blood sugar checks improved an average 38% and most notably, the average score for understanding around ketone checks improved 108% following the teaching session. Confidence levels improved by 91%, and there was an 83% increase in recognition of diabetic emergencies following this presentation.

Conclusion: This QIP exceeded its aims and supports the effectiveness of posters and educational sessions in elevating confidence and understanding of diabetes and its management, for the sake of patient care. Worked examples to apply and consolidate new knowledge were the most effective intervention, and the benefits of regular teaching through presentations alongside posters as visual aids are evident. Next steps include consideration around maintaining the change and expanding at directorate/Trust level, and potential rollout for other physical health conditions.

Aims: Qatar has struggled with substance use disorders among its population. Qatar has maintained a relative political and social stability, which has informed a dramatic restructuring of its health and social care services with emphasis on being led by international best practice and primacy of patient rights. However, the rehabilitative model for substance use, which Qatar has placed emphasis on so far, has been based upon voluntary engagement of people who use substances. This has led to lack of provision of care to a significant proportion of patients with substance use disorders in addition to system-wide disagreements around models of care.

Methods: This study employed a retrospective patient record review of 163 patients admitted to the Umm Slal Treatment and Rehabilitation Center between January 2022 and October 2023. The data were systematically analysed to evaluate the effectiveness of the innovative Recovery Journey model.

Results: The majority of patients (61.3%) were aged 20–29, with 54% unemployed or students. Methamphetamine (77.3%) and cannabis (76.1%) were the most commonly used substances. Notable comorbidities included drug-induced psychosis (29.4%) and depression (19.5%). Most patients (90%) had previous treatment encounters. The Recovery Journey model, consisting of court-mandated detoxification and stabilization, residential rehabilitation, and community based continuing care, facilitated treatment completion for 91 out of 149 patients advancing from detoxification to rehabilitation. Challenges included managing complex co-occurring disorders and aligning multidisciplinary teamworking efforts.

Conclusion: The innovative Recovery Journey model at the Umm Slal Treatment and Rehabilitation Center demonstrated promising results in treating individuals with substance use disorders. While initial outcomes are encouraging, challenges related to stakeholder engagement, treatment adherence, and post-discharge care remain. This model emphasizes the importance of balancing directed care with patient autonomy and may serve as a framework for similar initiatives in the region. Further research into and adaptation of cultural contexts are essential for optimizing treatment outcomes.

Aims: NICE guidelines (NG97) emphasize the importance of assessing the anticholinergic burden of medications in older adults. Anticholinergic side effects of medications can worsen constipation, urinary retention, sedation and confusion, exacerbating cognition, falls and BPSD risks.

Medichec, a free online tool, measures medication effects on cognition and evaluates the cumulative impact. The tool provides an Anticholinergic Effect on Cognition (AEC) score for each medication, ranging from 0–3. The greater the score, the greater the need to evaluate its benefits versus risks.

This project aimed to evaluate the effectiveness of integrating the AEC score into multidisciplinary management of dementia inpatients.

Methods: In a 10-bed specialist dementia ward, AEC score was calculated weekly over four weeks for each patient using Medichec. This included 15 inpatients over 4 weeks. Medications contributing to AEC score were recorded and reviewed during the weekly ward multidisciplinary meetings. Individual plans were then made to reduce, hold, or stop medication where appropriate.

Results: Total AEC scores were between 1–7 for each patient, scoring primarily for psychotropic medications. The weekly percentage of patients with total AEC scores over 3 on the ward ranged between 10–37.5%. The overall trend in percentage of patients with a score over 3 showed a reduction from 37.5% at baseline to 20% at week 4.

There were 10 occasions where patients had an AEC score of 3+; on 90% of these occasions there was a documented multidisciplinary care plan and these 10 occasions represented 5 individual patients. Of these 5 patients, medications were adjusted for 2 patients, continued for 2 patients and not discussed for 1 patient.

The mean AEC score varied between 1.5–2.13; there was no reduction from baseline (1.89) to week 4 (1.9) however the average in week 4 was skewed by an outlying individual result of 7.

Conclusion: The weekly data collected in this audit supports a culture of avoiding medications with high anticholinergic burden for physical health reasons e.g. antimuscarinics for incontinence. Additionally, medications for insomnia, like 'Z-drugs', are not routinely prescribed. This helps lower the risks of side effects and aligns with NICE (NG97) guidelines for managing medications which can adversely affect cognition.

Medications with an individual anticholinergic score of 2+ or patients with a total score of 3+ on Medichec should trigger a review as this can have a clinically significant impact on individual patients.

Aims: High-dose antipsychotic therapy (HDAT) carries an increased risk of adverse effects, including metabolic syndrome and extrapyramidal side effects, requiring regular monitoring. However, adherence remains inconsistent due to challenges in patient attendance, staff awareness, and varying monitoring intervals. This quality improvement project aimed to determine the prevalence of HDAT use in an assertive outreach team, assess adherence to the local trust HDAT monitoring guidelines, and implement a clinician-built HDAT Calculator and Tracker to improve monitoring efficiency.

Methods: In the absence of an electronic prescribing system, monitoring was routinely done manually. Therefore, clinicians created an HDAT Calculator and Tracker using Microsoft Excel, based on local trust HDAT monitoring guidelines and the Prescribing Observatory for Mental Health (POMH) Ready Reckoner Version 11, to automatically calculate and identify patients on HDAT, flag upcoming and overdue assessments, and facilitate monitoring. Data collected included the dates and results of the most recent electrocardiogram (ECG), blood tests, quantitative antipsychotic side effect assessments, and weight.

Results: Of 105 patients reviewed, 11 (10%) were identified as receiving HDAT at the time of data collection. 5 of the 11 patients on HDAT were in an inpatient setting. ECG and blood test compliance were both 91%, with reasons for missing parameters documented in all but one instance. 2 of 11 patients were due for their annual weight assessment. Notably, gaps were identified in the documentation of quantitative antipsychotic side effect assessments, with 3 of 11 patients lacking a recorded assessment and 4 of 8 overdue for their annual review.

Clinicians identified a significant challenge in monitoring patients after HDAT initiation due to varying intervals between required assessments (e.g. 3–4 days, 1 month and 3 months post HDAT initiation) and the complexity of ensuring timely follow-up. The HDAT Calculator and Tracker offered a systematic, sustainable solution, enabling clinicians to recognise upcoming assessments and plan timely interventions. Overall, feedback highlighted reduced administrative workload and increased confidence in ensuring continuity of care and safe prescribing.

Conclusion: This project highlights the importance of structured, ongoing monitoring in psychiatric practice and presents a model for improving safe prescribing in high-risk populations. Future steps include iterative updates to the tool as new knowledge emerges, increasing HDAT monitoring awareness within the multi-disciplinary team (particularly around the adverse effects of HDAT), joining up care with local physical health clinics, embedding the tool into routine clinical practice and integrating it with electronic patient records and prescribing systems currently under development.

Aims: Mental Health and Neurodevelopment Resource Group (MHNRG) are planned to replace Mental Health Clustering. However, they are broad diagnostic groupings which will potentially have limited benefit in relation to evaluating outcomes, health inequalities, pathways, and interventions. In addition to mandatory completion of MHNRG, local services have the option to collect additional categorical data which led to the introduction of Working Diagnoses.

This is a pilot study to trial Working Diagnoses to test its functionality and feasibility.

Methods: The aim of the Working Diagnoses is to create an accessible form on the electronic patient record allowing assessors to select a list of up to four working diagnoses via a drop-down menu. Following consultation with clinicians from differing psychiatric specialities, a list of 53 separate working diagnoses were agreed upon which were individually mapped to their respective ICD–11 diagnostic codes and Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) to make it future proof.

The pilot was conducted within the local Crisis Resolution and Home Treatment and Primary Care Mental Health teams. A live and secure Microsoft Excel document with a list of the working diagnoses through a drop-down menu was created. Assessors consisting of both doctors of various grades and psychiatric nurses within the teams were briefed on the aims and objectives of the pilot study.

At this stage, it is not intended for the diagnostic data to flow into the Mental Health Services Data Set (MHSDS).

Results: 127 patients referred to the teams between November to December 2023 were included in the pilot study and allocated their working diagnosis; 66 received one diagnosis, 52 received two and 9 received three diagnoses and none received four.

All presentations were able to be satisfactorily described by the Working Diagnoses options. The general feedback from assessors who participated in the study reported that it was simple and easy to use despite having limited formal training.

Conclusion: We believe that mental health services require granular details of a person’s presentation if we are to effectively commission, transform and manage our services. Though other options could be utilised, implementing a limited categorical diagnostic list appears to be an acceptable, effective, and efficient method of gathering the information that has been missing in mental health services locally.

The next steps will be to trial this to other services within the wider trust.

Aims: Kent and Medway NHS and Social Care Partnership Trust (KMPT) had been providing fewer Electroconvulsive Therapy (ECT) treatments per capita compared with the national average. Following a reduction in patient numbers after the COVID-19 pandemic, the KMPT ECT Suite aimed to offer both initial and maintenance therapy. This required increasing the number of sessions per day to enhance clinic capacity by 20% to accommodate the reintroduction of a maintenance slot.

The project aimed to enhance the ECT clinic’s capacity by 20%, from 6 to 7 patients per session, in order to reintroduce the maintenance slot. The goal was to provide continuity of care, especially for patients who relapse during specific periods, such as the winter or festive seasons.

Methods: A quality improvement approach was utilized, starting with a process map and Gemba walk to observe the day-to-day operations of the ECT suite. Both assessments revealed smooth clinic operations with no major issues. Data review showed that 25% of clinics ran at full capacity, suggesting there was room to trial the reintroduction of the maintenance slot with current staffing levels.

The project used the Plan-Do-Study-Act (PDSA) methodology to trial the maintenance slot. The plan involved offering 5 inpatient slots, 1 community slot, and 1 maintenance slot per month. The maintenance slot was trialled once a month, with the aim to reduce readmissions for specific patient groups. The trial ran from October 2023 to March 2024. During this time, the team was able to accommodate 7 patients per session, but increasing the number to 8 proved difficult. However, after an agreement from the Senior Leadership Team (SLT), the clinic extended its hours to accommodate up to 8 patients per session.

Results: Results showed that each ECT session, including treatment and recovery, took approximately 39 minutes. Clinics averaged 180 minutes per session, with 5 patients per session, although the clinic capacity was 6. Despite fluctuations in patient numbers, 25% of clinics reached full capacity.

Conclusion: Data analysis from the trial period demonstrated that the team could accommodate the increased workload for a short period. Given that 25% of clinics already operated at full capacity, further efforts to increase ECT uptake may require a review to assess the sustainability of the maintenance slot. Feedback from staff confirmed that 7 patients per session could be managed with current staffing, provided transportation was efficient. The team also began recording safety huddle notes, enhancing data-driven decision-making and tracking attendance strictly.

Aims: Effective monitoring of children and young people (CYP) with eating disorders (ED) is vital to prevent complications such as malnutrition, electrolyte imbalances, and refeeding syndrome. Assessments at the Northamptonshire Healthcare NHS Foundation Trust Children and Young People Community Eating Disorder Service (NHFT CYPCEDS) & Leicestershire CAMHS Eating Disorder Team (LPT CAMHS EDT) revealed poor coordination between primary care, the clinics, and paediatric hospitals, coupled with limited staff knowledge of physical complications in ED and their management. This contributed to delayed and substandard referrals, high-acuity cases, and increased paediatric admissions. Reliance on GPs, owing to capacity issues, resulted in inconsistent and subpar physical monitoring. Therefore, we aimed to improve physical health monitoring and management for CYP with known ED in Northamptonshire and Leicestershire.

Methods: CYPCEDS established a dedicated physical health department, introducing regional clinics in Northamptonshire to improve accessibility. SOPs were developed to streamline physical health management, including refeeding protocols and escalation pathways, while a MEED-based physical health template was integrated into the Trust’s software. A physical health-focused referral letter and the Early Risk Management (ERM) Guide were provided to primary care, explaining ED, its red flags, and key helplines. Staff training workshops were conducted, and innovations like point-of-care machines were implemented. Collaboration with LPT CAMHS supported shared learning. The QIP’s impact was evaluated through audits of paediatric admissions, referrals, and physical health templates, and staff and patient feedback.

Results: Electronic physical health template ensured consistent baseline assessments for all new referrals and monitoring during follow-ups. High-acuity referrals were addressed within 24 hours by the Service, while physical health nurses and structured referral pathways reduced the psychiatrists’ workload, improving waitlists and caseload management. Refeeding monitoring improved, with most blood work done in-service using point-of-care technology, reducing reliance on external providers like GPs. Patient feedback highlighted better accessibility and satisfaction, with remote clinics boosting attendance. Staff confidence in managing physical health complications increased, and primary and tertiary teams felt well-supported by joint pathways.

Conclusion: The QIP addressed gaps in physical health care for CYP with ED in the region by establishing physical health departments, improving monitoring, standardizing assessments, training staff, optimizing resources, and enabling timely escalation. These improvements led to better patient outcomes, reduced physical acuity, and fewer hospital admissions. Referrals were streamlined, and collaboration between primary, tertiary services, and LPT ensured high-quality care across the region. Future plans include monitoring patient outcomes, creating an SOP repository, and piloting a GP early warning system.

Aims: Accurate implementation and marking of the ACE-III (Addenbrooke’s Cognitive Examination) within memory assessments is vital in informing clinical diagnoses. The 100-mark cognitive test is subject to various nuances in its marking criteria that can easily be overlooked or misinterpreted.

Given noticeable discrepancy in staff completion, we aimed to review the accuracy of scoring of the ACE-IIIs completed by the team. We sought to identify the domains with the greatest variability in scoring, hypothesising that this would be the visuospatial domain, and feed this back as a teaching session with view to improving future accuracy in completion.

Methods: 50 patients were identified from the Wyre Forest Older Adult Community Mental Health Team who had recently (last six months) undergone an ACE-III examination, split equally between the geographic East and West of the region (as covered by different consultant psychiatrists).

Independent reviewers reviewed each ACE-III against the 2017 scoring guide. Any ambiguous cases were decided by consensus. Certain aspects of the ACE-III cannot be objectively verified retrospectively and require contemporaneous observation, therefore these questions were excluded from the analysis.

Results: 45 of the 50 patients had a valid ACE-III available for review. Only 44% (20/45) assessments had no identifiable marking errors.

As hypothesised, the highest failure rates occurred in the visuospatial domains, with incorrect marking in the “copying a cube” in 20% (9/45) and “clock drawing” in 18% (8/45).

Moderate failure rates were observed within the language section with “sentence writing”, being inaccurately marked in 9% (4/45) and the visuospatial task of the “infinity diagram”, with issues in 7% (3/45).

Several of the attention, memory and fluency-specific tasks saw a mistake in at least one patient.

The mistakes were generally evenly spread across patients with no single ACE-III examination accounting for a disproportionate number of errors.

Conclusion: Uniformity in application and marking of the ACE-III requires revision with the team in order to achieve consistency. Even marginal inaccuracies in scoring could result in an under- or over-estimation of cognitive ability and influence clinicians’ interpretation and subsequent diagnosis.

In the teaching session, the team reflected on the results and their experiences, and collectively decided on further improvement measures:

1) in-house simulation ACE-III completion with a volunteer administrator, the team lead as patient, and remaining team observing,

2) to include a bi-annual team re-training with the ACE-III training video as a refresher, and

3) for re-evaluation in approximately six months’ time to monitor improvement.

Aims: Individuals with severe mental illness (SMI) face a significantly reduced life expectancy, primarily due to preventable physical health conditions. This project aimed to enhance the timeliness and comprehensiveness of physical health checks for inpatients in an acute psychiatric ward. An initial audit cycle identified gaps, prompting targeted interventions, with subsequent re-audit assessing their impact.

Methods: The first audit cycle (March 2023) reviewed adherence to physical health assessments, including physical examinations, observations, height and weight measurements, ECGs, blood tests, and cardiometabolic checklist completion. Interventions implemented included daily reviews in the Multi-Disciplinary Team (MDT), integration into daily job lists, and master list documentation. These measures reduced delays in completing assessments.

The second cycle (November 2023) involved 35 inpatients over four months. Interventions included the introduction of a whiteboard for task tracking, post-MDT reviews, staff reminders, and induction sessions emphasising physical health monitoring. Colour coding was introduced to enhance task visibility and efficiency. Specific patient needs, such as those with heart failure and left bundle branch block (LBBB) or end-stage renal disease (ESRD) requiring dialysis, were incorporated into tailored care plans.

Results: The second cycle demonstrated that, overall, there were visible improvements in clinical practice. The whiteboard intervention significantly improved the timeliness and completion rates of physical health checks. Key findings included:

Physical examinations: Success rates increased from 93% to 100%.

BMI measurements: Reduced delays and increased completions.

Physical observations: Maintained at 100% completion.

Challenges included gender-based refusals for ECGs and reluctance from patients with eating disorders to undergo BMI measurements. These findings highlight the importance of personalised approaches to monitoring and addressing barriers to compliance.

Conclusion: Implementing a whiteboard for tracking physical health checks demonstrated substantial improvements in timeliness and completion rates through simple, cost-effective interventions. Despite challenges, this project underscores the potential of structured systems to enhance physical healthcare for patients with SMI. Scaling and expanding these strategies hospital-wide may contribute to addressing health disparities and improving outcomes for this vulnerable population.

Aims: This Quality Improvement Project (QIP) aimed to assess the impact of incorporating the Seizure Quality Rating (SQR) scale into ECT dose titration practices. The objective was to optimize treatment by improving seizure quality assessment and reducing cognitive side effects associated with higher electric doses, ultimately enhancing patient outcomes.

Methods: The QIP was conducted at the ECT clinic of Surrey & Borders Partnership NHS Foundation Trust. The SQR scale evaluated seizure quality using parameters such as EEG and visual seizure duration, mid-ictal amplitude, interhemispheric coherence, postictal suppression, and peak heart rate. Patients were categorized into two groups:

Pre-SQR (Standard Group): Treated between May 1, 2023, and October 30, 2023, with dose titration based on seizureduration.

SQR (Post-Intervention Group): Treated between December 1, 2023, and May 31, 2024, with dose titration guided by the SQR scale.

Inclusion criteria were depressive disorders (e.g. recurrent depression, bipolar depression), excluding primary psychotic disorders. Outcomes measured included the number and dose of treatments, Clinician’s Global Improvement (CGI) scores, and subjective memory reports (patient-rated).

Results: The SQR group (n=7) received lower mean electric doses (622 mC) compared with the pre-SQR group (n=11; 705 mC) while maintaining comparable therapeutic outcomes. Both groups required a similar number of treatments (mean: 12 sessions). CGI improvement scores (CGI-I) and subjective memory ratings post-ECT showed no significant difference between the groups. These results suggest that the SQR scale may support safer dosing without compromising clinical efficacy.

Conclusion: The integration of the SQR scale into ECT practice demonstrated a promising trend toward optimizing treatment by reducing electric doses while maintaining clinical effectiveness. This structured approach offers the potential to minimize cognitive side effects, particularly in vulnerable populations such as the elderly. These findings underline the broader implications of incorporating data-driven tools like the SQR scale into routine ECT protocols across various trusts to enhance precision, safety, and patient outcomes on a wider scale. Future recommendations include gathering patient feedback to assess the cognitive and mood benefits of lower doses, conducting further research with larger cohorts to validate the findings, and embedding the SQR scale into standard ECT guidelines to promote consistency and improve treatment outcomes.

Aims: Inappropriate or incomplete referrals for memory assessment were a recurrent issue within our Old Age Psychiatry community multidisciplinary team (MDT) triage meetings. These referrals often lacked essential information, such as duration of cognitive concerns, patient consent, results of confusion screen blood tests, clarity on the presence of delirium versus long-standing cognitive concerns, ECG and imaging findings, or results of a cognitive screen. Some referrals were minimal, providing only the phrase “memory assessment please”, leading to inefficient use of resources, delays in assessment, and unnecessary correspondence with referring teams. Since memory assessments involve detailed 60-minute home visits by experienced nurses, followed by consultant evaluation, optimizing referral quality was imperative to reduce inappropriate referrals and improve service efficiency.

Methods: A retrospective analysis of referrals from wards and clinics to our weekly MDT triage meeting was conducted over a two-month period (July 1–August 31, 2024). Referrals were assessed for the presence of key information required for triage, including patient consent, confusion screen blood results, cognitive screen findings, imaging results, and clarity on the nature of the cognitive concern. Following this analysis, we collaborated with clinicians from Old Age Psychiatry, Liaison Psychiatry, Geriatrics, and administrative staff to design a standardized one-page referral form. The form, adapted from an existing referral template in use elsewhere in Scotland, was tailored to include all critical elements necessary for triage decisions.

Results: Implementing the new referral form led to a marked improvement in the completeness and quality of referral information. Key details, such as cognitive screen results and delirium assessments, were routinely included. This reduced the need to search clinical notes during MDT meetings, saving significant time for the 30–40 mental health professionals present. Additionally, there was a substantial reduction in follow-up emails and phone calls to clarify referrals. The streamlined process improved triage efficiency, decreased inappropriate referrals, and shortened waiting times for patients requiring assessment.

Conclusion: Introducing a standardized referral form significantly improved the quality and efficiency of referrals for memory assessments. By ensuring all essential information was provided upfront, we optimized resource use, minimized delays, and enhanced communication between teams. The referral form remains a living document, with ongoing review to ensure its continued relevance and effectiveness.

Aims: This project emerged in response to surveys conducted in 2022–23, which revealed first on-call doctors at NHCFT, perceived they were required to operate beyond their competency levels. Recognising this could negatively affect both patient safety, and training experience of resident doctors, we sought to improve their confidence and competence through structured support, education, and resource development.

The project’s aim was to ensure that no first on-call doctor would feel that they were working beyond their competency.

Methods: Cycle-1: The project began with anonymous baseline surveys using Hewson Confidence Tool, grade-specific focus groups which revealed a lack of knowledge in both clinical and practical aspects, increased stress due to untriaged workloads, and feelings of insufficient support from senior staff which contributed to widespread sense of being overwhelmed and impacted confidence and competence. Primary intervention included targeted on-call teaching sessions focussing on areas such as the role of on-call resident doctors, management of common tasks, seclusion reviews, legal frameworks, and escalation pathways.

Cycle-2: Observing the positive impact on doctors’ self-reported competency and confidence levels in the first PDSA cycle, Cycle 2 began with stakeholder engagement through listening events with first on-call doctors. We held discussions with key leaders, Director of Medical Education, Associate Director of Nursing, Deputy Associate Director of Physical Healthcare, ECG Trainer, Physical Healthcare Nurse, and Ward managers.

Subsequently, we designed and delivered a bespoke ‘First On-Call Workshop for Resident Doctors', held as two 90-minute sessions in September 2024. The workshops used interactive tools, case-based scenarios, and audio-visual aids on psychiatric medication side effects, managing psychiatric emergencies, risk assessment, escalation pathways, legal procedures e.g., Section 5(2), demonstration videos for ECG and catheterization, along with site orientation videos.

Results: Cycle-1: Results displayed a 7% increase in confidence and competence.

Cycle-2: Outcome measures displayed positive qualitative feedback and an increase in confidence in quantitative feedback by 17% in handling common on-call tasks and clinical scenarios.

For sustainability, online resources and tools, i.e., workshop materials, videos, and podcasts, were made accessible and included in Resident Doctors’ Survival Guide. Senior medics are now equipped with resources to facilitate these workshops, ensuring the project’s longevity.

Conclusion: This project contributed to enhancing the competence and confidence of first on-call doctors, thereby improving patient safety, and fostering a supportive learning environment within NHCFT. This initiative has underscored the importance of structured educational interventions and collaborative support systems in promoting both trainee and patient well-being.

Aims: Adults with severe mental illness face a significantly higher risk of morbidity and premature death from preventable physical health conditions, with life expectancy reduced by 10–20 years compared with the general population. Early identification and management of physical health issues in mental health settings are crucial to reducing these disparities. We designed a Quality Improvement Project (QIP) focused on enhancing physical health outcomes through a ward-based multidisciplinary educational intervention on an acute male psychiatric unit in London.

Methods: We conducted an initial questionnaire to determine the MDT’s general knowledge level around physical health. We also surveyed the MDT on which teaching topics would be most relevant and interesting. The first audit cycle evaluated the MDT’s knowledge in physical health and baseline confidence on specific physical health topics. Our intervention involved a six-week, ward-based short course on physical health for mental health professionals taught by the ward’s resident doctors. A re-audit measured post-intervention improvements in topic specific confidence and knowledge.

Results: Fourteen members of the MDT completed the initial knowledge questionnaire, which, along with our survey, helped identify common gaps in knowledge and guided the selection of teaching topics for our intervention. The selected topics were: (1) Identifying and Escalating Abnormal Vital Signs, (2) Managing an Acutely Unwell Patient, (3) Commonly Used Psychiatric Drugs and Side Effects, (4) Clozapine, (5) ECGs, and (6) Medical Emergencies in the Psychiatric Setting. Before and after each teaching session MDT attendees were asked to complete a questionnaire assessing their knowledge and confidence on the given topic. On average, each session was attended by six MDT members. Baseline confidence in individual topics varied but improved following the intervention. Post-session knowledge scores were higher compared with pre-session assessments, demonstrating the effectiveness of the teaching sessions.

Conclusion: Ward-based interventions are effective in bridging gaps in physical health knowledge and improving confidence among MDT members. As learning is a continuous process, single teaching sessions may not be sufficient. On our ward, our QIP has led to the continuation of MDT teaching sessions by resident doctors. To further expand the impact of our QIP, we plan to extend MDT teaching to other wards within our Trust. To support this, course materials and summary infographics have been made available online, ensuring accessibility for our MDT and other wards looking to implement similar initiatives.

This work was carried out under the supervision of Dr Sarah Parry (Psychiatry Registrar) and Dr Jonathan Beckett (Psychiatry Consultant).

Aims: Constipation is a common problem in psychiatric patients and can have serious consequences. Patients taking antipsychotics with anticholinergic properties are at higher risk of constipation. The risk is further increased in older adults due to reduced mobility and polypharmacy. To treat constipation, patients should have their bowel movements monitored and preventative laxatives considered. We faced similar challenges and this project was undertaken following a Serious Untoward Incident due to constipation related complications,

This quality improvement project aimed to increase detection, recording and management of constipation on an 18 bedded older adult inpatient ward. Thus, preventing complications like delirium, faecal impaction and bowel obstruction.

Methods: For this QI project, we used the Model for Improvement (MFI) framework, which involves defining the aim, measuring progress, and identifying changes that lead to improvement, along with the Plan-Do-Study-Act (PDSA) cycle. Bowel monitoring was initiated using the Bristol stool charts, with staff training and awareness sessions. Data collection was conducted for all 18 patients. In the second half of 2023, charts were integrated into MDT discussions, and further staff training was provided. In 2024, the bowel charts and Norgine risk assessment tool were used, a patient tutorial session provided, with data collected for all 18 patients and staff awareness assessed through questionnaires.

Results: Bowel monitoring and documentation significantly improved throughout the course of three audit cycles. In the first cycle, total number of days for all 17 patients that bowel movement was recorded was just 5 in 2 weeks and only 2 bowel charts uploaded onto the system. In the second cycle of 18 patients, 173 days recorded and 16 charts uploaded. In the third cycle of 18 patients, 151 days recorded with an average Norgine score of 7.056 and all charts uploaded. Thus, frequency of monitoring increased by 66.55% in the second cycle but then decreased by 8.73% in the third cycle although continuing to show improvement from the first.

Conclusion: This project aimed to improve bowel assessment in an inpatient mental health ward for patients on antipsychotics. Using the MFI framework, the data shows significant improvements in bowel monitoring and documentation over three cycles. Consistent uploading of bowel charts onto RIO and Norgine score assessments reflect a commitment to high standards in patient care. Improved bowel monitoring can reduce constipation, prevent complications and save costs through reduced laxative use and shorter hospital stays. This scientific approach underscores the importance of diligent monitoring in enhancing patient outcomes.

Aims: The Royal College of Psychiatrists (RCPsych) recommends that psychiatric trainees receive one hour of 1:1 supervision per week, with clinical supervisors allocated 0.25 PA (programmed activity) protected time per trainee weekly. The GMC National Training Survey 2023 found that 86% of trainees reported positive feedback on clinical supervision, though the survey was not psychiatry specific. Locally, the Resident Doctors Forum raised concerns about some trainees not receiving the recommended supervision time, prompting the introduction of a new supervision form.

Aims were to identify and assess barriers to providing regular supervision to support the professional development of psychiatrists in training within Nottinghamshire Healthcare NHS Foundation Trust.

Methods: A questionnaire was developed based on the “Enablers and Barriers to Effective Clinical Supervision in the Workplace: A Rapid Evidence Review” to identify barriers to effective clinical supervision. It was emailed to all lead clinical supervisors in Adult Mental Health, with a two-week response deadline. The feedback was analysed using a mixed methods approach, combining quantitative and qualitative analysis.

Results: The survey received a 30% response rate (21 out of 70 eligible trainers), with a distribution reflecting the grades of resident doctors in the trust: 34% supervising HST, 34% supervising CT, 19% supervising FY, and 13% supervising GPVTS.

Key findings include: 67% of trainers felt their clinical workload allowed sufficient time for supervision, but 81% sometimes had to cancel due to clinical commitments. Trainers with sufficient time for supervision typically had protected time formally agreed in their job plans (85%).

80% of trainers faced cancellations due to trainee unavailability (e.g., shift work, staff shortages), and 10% felt supervision was hindered by inadequate resources, such as lack of private spaces.

Awareness of the RCPsych supervision guidance was low (33%), and 50% were not familiar with or did not use the local supervision form. Opinions on the form were divided: half found it helpful, while the other half saw it as additional workload.

Major barriers to effective supervision included intense clinical workload, time pressure, staff shortages, managing multiple trainees, and trainee unavailability due to on-call or leave commitments.

Conclusion: Suggested actions to address these barriers include:

Distributing the RCPsych guidance and Supervision Form to all trainers.

Encouraging supervisors to schedule supervision mid-week to avoid conflicts with on-call shifts.

Supervisors should discuss protected time in their job plans with clinical directors and work with medical education to find private workspaces for supervision.

Aims: Rosewood Mother and Baby Unit (MBU) provides inpatient psychiatric care to women with severe mental illness in Kent, Surrey & Sussex (KSS) in UK. Analysis of admission data to the MBU in 2022 highlighted inequalities in the admissions process. A quality improvement project was undertaken to improve equity of access for women irrespective of their ethnicity, location or age.

Methods: We collated data on admissions to Rosewood MBU, including demographics, origin of referrals, diagnosis, length of stay, parity, Mental Health Act status, previous MBU admissions and safeguarding concerns. In the 2024 cohort, additionally, we looked at suspected or confirmed neurodevelopmental disorders such as ASD or ADHD and deprivation decile to establish the socio-economic status of admitted patients.

The project group undertook consultations with referrers, inpatient/community teams and other stakeholders to understand barriers to referrals from various counties, for women of black and ethnic minority backgrounds and under-18s. We implemented measures such as improving ethnicity recording, building partnerships with community groups to raise awareness and build trust, offering appropriate training for staff working with young and ethnically diverse mothers, providing easy access to information about referrals pathway and role of MBU to referrers and families.

Results: In 2022, the duration of admission was less than 2 months for 64% of patients, which increased to 77% in 2023 and 70% in 2024. Psychotic illness was the most common diagnosis for patients admitted in 2022 and 2024, while anxiety-related illness was most common in 2023.

In 2022, 10% of admitted patients were of black, Asian or mixed backgrounds, which increased to 33% in 2023 and 36% in 2024. In 2023 and 2024, there were 2 referrals and 1 admission of women under the age of 18, compared with no referrals in 2022.

In 2024, mean age of mothers admitted was 30.6 years with a range between 19 and 40 years. 18% of patients had suspected or confirmed diagnosis of Autism Spectrum Disorder or Attention Deficit Hyperactivity Disorder. In the same year, 39% of admissions had lower socio-economic status with deprivation decile between 1–4.

Conclusion: Overall, this project demonstrates a positive trend with improved access for under-18s and women of black, ethnic minority and mixed ethnic population groups across the 3-year span. Further work is needed to improve access for women living in more deprived areas and to recognise and support women with neurodevelopmental disorders in the perinatal period.

Aims: Raising concerns is a vital component of optimising patient safety and improving training experiences. However, resident doctors within an acute mental health trust have expressed difficulties in raising such concerns. A quality improvement (QI) project was initiated to improve the self-reported likelihood of resident doctors raising patient safety and training concerns. We developed a pulse survey to capture this data and identify barriers to raising concerns, to thus inform and evaluate change ideas.

Methods: Over 17 months, a monthly pulse survey was distributed to all resident doctors within Birmingham and Solihull Mental Health Foundation Trust to ascertain their likelihood of raising both training and patient safety concerns using a Likert scale. Respondents were also asked to indicate the effectiveness of existing support systems for raising concerns. A free text box was available for respondents to detail other barriers or concerns. Demographic information was also collected and analysed. Data on the self-reported likelihood of raising concerns were plotted on run charts, with analysis in relation to the implementation of change ideas, to identify their effectiveness. Data on perceived barriers was utilised to inform change ideas.

Results: The mean survey response rate was 6.9 (range 1–21.4). Neither the likelihood of resident doctors raising concerns about patient.safety or training showed significant improvement, as evidenced by run charts. Barriers to raising concerns included the exception reporting system and feeling that no effective action would be taken. Residents were less likely to raise a concern if the severity was perceived as low. Over time the perception of the trust intranet as a supportive tool in raising concerns increased.

Conclusion: Although no significant changes were identified in resident doctors’ likelihood of raising concerns, the pulse survey provided valuable insight into what barriers still exist in our Trust for residents wanting to raise concerns. The feedback provided informed multiple change ideas that were implemented including modifications to the representative structure, improvements to the resident doctor meeting intranet page, and adaptations to the incident reporting system. Recommendations have also been made for future QI projects. The frequently changing workforce and low response rates meant quantitative data on the self-reported likelihood of raising concerns was limited. However, evaluation of specific change ideas showed a positive impact. Increased motivation of resident doctors to engage in QI projects was another noticeable achievement.