Aims: Individuals with psychiatric disorders face a significantly higher risk of cardiovascular disease and other medical conditions, leading to increased morbidity and premature mortality compared with the general population. This disparity may also be partly due to diagnostic overshadowing. Effective communication between clinical settings is essential for patient safety and continuity of care whilst delays or inaccuracies in information sharing can have serious consequences.

This study aimed to evaluate the quality and timeliness of communication between an acute inpatient psychiatric unit, Hallam Street Hospital (HSH), Sandwell, Black Country Healthcare NHS Foundation Trust, and an emergency department, Midlands Metropolitan University Hospital (MMUH), West Midlands, to identify gaps and improve transitions of care.

Methods: A retrospective study was conducted between November 2024 and January 2025 reviewing inpatients transferred from HSH to MMUH. Patient records from the corresponding electronic systems were analysed (Rio (HSH) and Unity (MMUH)) to determine whether:

A handover document containing relevant clinical information was provided upon transfer to MMUH.

A discharge summary including a management plan was available upon patient’s discharge to HSH.

Results: Twelve patients were referred from HSH to MMUH during the study period with three (25%) requiring re-attendance. A limitation of this study was its small sample size due to the recent transition of the handover system.

Ten patients (83%) were accompanied by staff, while one (8%) attended alone, one (8%) accompanied by family.

Four patients (33%) were sent to MMUH with a handover document. Only one (8%) had been scanned onto Rio. None were available for viewing on Unity.

Nine patients (75%) returned to HSH with discharge summaries, however only five (42%) had been uploaded onto Rio.

The discharge summaries generally contained adequate details on the patient’s hospital course and management plan, aligned with NICE guidelines.

Conclusion: The audit highlighted a lack of a standardised protocol for written handover during patient transfers. While discharge summaries were electronically sent to GPs, a dedicated copy for HSH records was not consistently generated. Clinicians relied heavily on verbal handovers provided by accompanying staff or the patients themselves, increasing the risk of miscommunication and errors.

To enhance patient safety and continuity of care, we propose developing a standardised transition-of-care protocol, ensuring systematic documentation, and conducting a re-audit to assess improvements in practice.

Aims: The relationship between mental illness and substance misuse is well established. Early identification through drug testing can inform more holistic management plans. This audit aims to check the compliance of the current practice on acute psychiatric wards with the Trust policy for drug screening, it also aims to draw conclusions, and recommend changes to increase the compliance and benefits from implementing the policy.

Methods: Data was collected retrospectively from two adult acute psychiatric wards, including a sample of 20 male and 20 female patients admitted in 2024.

The parameters assessed were:

The presence of any documentation regarding drug testing on admission.

If the drug test was offered, accepted or refused, and if the results were documented.

If the positive results were acted on, such as referrals to substance misuse services.

Results: Any documentation related to drug screening was present in 23 out of 40 patient records (57.5%).

This indicates that nearly half of the patients admitted lacked proper documentation of whether a drug test was indicated, considered, offered, or completed.

21 out of 40 patients (52.5%) were offered a drug test.

In 4 cases, drug screening was recommended as part of the plan but was not offered or followed through. Reasons for this were not recorded.

Among the 21 tests offered, 15 patients (71.4%) completed the test. 8 (53.3%) were positive and 7 (46.7%) were negative.

6 patients (28.6%) refused UDS, but the reasons for refusal were not documented.

5 out of 8 patients with positive drug test results were referred to the substance misuse service.

Conclusion: This audit highlights inconsistencies in drug testing practices on inpatient wards, particularly regarding documentation, offering of tests, and follow-up on the results.

Recommended changes are as follows:

Drug screening should be offered to all inpatient groups, results should be acted on appropriately.

Improving documentation: The inpatient teams to ensure documenting if drug testing has been or should be offered, if it was accepted or refused, its results, and if positive, the follow-up plans.

By implementing those changes, drug testing can become a more effective tool for identifying and managing substance misuse, ultimately improving patient outcomes.

Findings and recommendations for change are being circulated in the Trust, and a re-audit following the implementation of recommendations will be undertaken after 3 months to evaluate the effectiveness of changes and ensure continuous improvement.

Aims: The aim of this audit was to evaluate and enhance referral practices from general practitioners (GPs) to the Balbriggan Community Mental Health Team (CMHT), Dublin. Appropriate referrals are crucial for effective mental health care. The initial audit, conducted in mid-2024, sought to identify barriers to successful referrals, particularly regarding psychotherapy initiation and medication management. Following these findings, guidelines were developed and disseminated to GPs to improve the referral process. A follow-up audit was then conducted to assess the impact of these interventions on referral practices and identify any remaining challenges.

Methods: An audit cycle was conducted, comprising a retrospective initial audit followed by a prospective follow-up audit. The initial audit reviewed 110 referrals from 1 May to 1 August 2024, while the follow-up audit analysed 77 referrals from 1 September to 30 November 2024. Following the initial audit, local guidelines were created and shared with GPs on 19 August 2024, focusing on appropriate referral procedures, psychotherapy initiation, and medication management. Data collection focused on referral acceptance rates, reasons for rejection, and the initiation of psychotherapy and psychotropic medication. The effectiveness of the guidelines was also evaluated.

Results: The results of the audits showed significant improvements in referral practices. In the initial audit, 110 referrals were reviewed, resulting in 60 accepted (54.5%) and 50 rejected (45.5%). Key barriers included 16% of patients not receiving psychotherapy and 11% receiving suboptimal medication dosages. Additionally, 9% of referrals were declined due to non-initiation of psychotropic medications, indicating GPs’ hesitancy to refer patients without prior treatment.

In contrast, the follow-up audit, which reviewed 77 referrals, showed a marked increase in acceptance rates, with 71 accepted (92.2%) and only 6 rejected (7.8%). However, 14% of patients still did not receive psychotherapy, suggesting persistent hesitancy among GPs. Notably, the percentage of rejected referrals for ADHD/ASD assessments increased from 21% to 33%, indicating that misalignment between GP expectations and CMHT services remains a challenge.

Conclusion: This audit demonstrates the importance of effective communication and collaboration between GPs and the CMHT in enhancing referral practices. The implementation of guidelines led to improved referral acceptance rates. However, challenges still exist regarding psychotherapy initiation and specific service offerings, particularly for ADHD/ASD assessments. Ongoing monitoring and education for GPs are essential to sustain these improvements and ensure optimal patient access to mental health care.

Aims: Delirium is defined as the acute confusional state common in the elderly patient population of hospitals. Alongside existing diagnosed and undiagnosed dementia, it is a common cause of cognitive impairment in the elderly. This project aimed to evaluate the care patients with delirium and dementia received by analysing interventions made by both the referring party and the liaison team as per the local and national guidelines.

Methods: The retrospective audit included 39 referrals made to the psychiatric liaison service (PLS) for delirium and/or dementia over three months in patients aged 65 and older. The data was collected from electronic health records to assess parameters such as diagnostic tools used (e.g., ‘4AT Rapid Clinical Test for Delirium’, ‘PINCH ME’ a mnemonic for delirium risk factors including Pain, Infection, Nutrition, Constipation, Hydration, Medication, Environment), cognitive testing, medication reviews, and team actions.

Results: This study found ongoing positive practices and areas for improvement in diagnosing and managing delirium and dementia in older adults. Among the 39 patients, 43.6% had a pre-existing diagnosis of dementia, and 28.2% were admitted with acute confusion. While diagnostic blood work, medication reviews, and collateral histories were frequently performed by the referring team, only 51.3% of patients were referred to the Delirium and Dementia (DAD) team. The use of the ‘PINCH ME’ mnemonic was limited, with just 28.2% of cases incorporating it.

After referral, most patients had a history taken, a mental state examination (MSE) conducted, and collateral information gathered by PLS; however, only 10.2% of cases included the use of the mnemonic. Antipsychotics were prescribed in 30.7% of cases. At the point of discharge, 82.1% of cases had follow-up arranged by PLS, with 35% of patients referred to memory clinics for continued care.

Conclusion: This audit reveals areas for improvements in the assessment and management of delirium and dementia in hospitalized older adults. Recommendations have been made based on this data to help improve use of 4AT, PINCHME mnemonic and referral process.

Educational initiatives and increased collaboration with the Delirium and Dementia team have been introduced to improve early recognition, standardize care, and align practices with current guidelines. Further study will be conducted to explore its effect as part of a quality improvement project.

Aims: The Mental Welfare Commission (MWC) has provided information outlining good practice for consent to treatment in relation to The Mental Health (Care and Treatment) (Scotland) Act 2003. Patients prescribed psychotropic medications beyond two months of initial detention under the Mental Health Act require a statutory T2 or T3 form, depending on the patient’s ability and willingness to consent to treatment. Without a valid form being in place, there is no legal authority to continue to administer medication.

A MWC report in February 2024 highlighted a number of concerns around the use of community Compulsory Treatment Orders (cCTOs). One of the recommendations from this report was the need to ensure audit processes are in place with regards medical treatment given under cCTOs. This initial audit cycle was commissioned in response to the report and aimed to determine whether T2/T3 forms were (i) in place, (ii) valid and (iii) concordant with what the patient was being prescribed in the community.

Methods: Administrative staff from psychiatric subspecialties within NHS Lanarkshire were contacted to gain access to spreadsheets detailing patients detained under a cCTO, as well as online files containing electronic copies of their T2/T3 certificates for review. Patients who were detained under a cCTO at the time of data collection were included (July 2024–October 2024). Review of the patients T2/T3 forms and electronic medical records took place to record whether they were (i) in place, (ii) valid and (iii) reflective of what was currently being prescribed.

Results: 89 patients were identified as being on cCTOs. 3 of those did not have T2 or T3 forms in place yet, all for valid reasons.

For the forms that were in place, 96.5% were considered valid though only 65.9% were concordant with what the patient was being prescribed in the community.

Conclusion: Almost all patients had appropriate T2/T3 forms in place, suggesting the administrative system in place to manage this is working well.

There were significant discrepancies between what medication had been authorised under T2/3 forms and what the patient was prescribed which will require further review by individual teams.

Recommendations include sharing of the findings, as well as the MWC Good Clinical Practice guidelines, with Responsible Medical Officers and General Practitioners to increase awareness of the need for medication regimes to be compliant with the relevant T2/T3 forms. Additionally, ongoing audit within psychiatry units on an annual basis to improve practice in this area is required to maintain and improve standards.

Aims: Delirium is a serious condition affecting hospitalised and long-term care patients. Adherence to NICE guidelines is essential for timely identification and management. This audit aimed to evaluate compliance with NICE guidelines on delirium prevention, diagnosis, and management within a secondary care setting. Specific objectives included assessing whether new patients were screened for delirium risk factors, ensuring that at-risk patients were reviewed within 24 hours, confirming the use of the ‘4AT’ assessment tool where required, and verifying the provision of patient information leaflets.

Methods: A retrospective audit was conducted on all inpatients at Kingsley Ward from 21/10/24 to 01/11/24. A total of 18 patients were included in the sample. Data were extracted from the in-house assessment database and electronic system. Key compliance measures included documentation of delirium risk assessments within 24 hours of admission, regular reviews in morning clinical meetings, appropriate use of the ‘4AT’ tool, and provision of patient information leaflets. Compliance was assessed based on recorded documentation in the electronic records.

Results: Overall compliance with NICE guidelines for delirium management was 89.1%, demonstrating significant assurance. Key areas of adherence included timely screening at admission and appropriate documentation of delirium assessments. Majority of the criteria achieved a 100% compliance score. However, inconsistencies were identified in clinical documentation, particularly regarding the recording of delirium status. Compliance with Criterion 7.3: “During daily clinical review meetings each patient will be discussed by the MDT to review whether they have developed any signs of delirium”, was 88.1%, slightly below the expected standard. Challenges included multiple authors entering data inconsistently in meeting records, leading to variations in documentation quality.

Conclusion: The audit demonstrated high compliance with delirium management guidelines, but areas for improvement remain. To enhance documentation accuracy, a single designated person should complete the log of clinical morning meetings daily, or a verbal handover should be provided when multiple authors are involved. Increased staff awareness and training on the importance of accurate delirium documentation is recommended. Additionally, a dedicated delirium section should be incorporated into the meeting documentation proforma to standardise reporting. By addressing these areas, further improvements in adherence to NICE guidelines and overall patient care quality can be achieved.

Aims: Individuals with a severe and enduring mental illness may pose a significant risk to themselves and others when they drive, particularly if in a state of relapse. The DVLA provides guidance for driving for individuals with mental disorders. It provides guidance for medical professionals caring for such patients to determine during their assessments the potential for safe driving and restrictions, if any. Patients admitted to a psychiatric ward who drive should be informed of the DVLA guidance and any restrictions on driving prior to discharge and such discussions should be documented in the inpatient’s medical record. This audit aimed to assess compliance of mental health professionals on the general adult inpatient wards with DVLA guidelines regarding patients about driving restrictions and whether such discussions are documented in the inpatient’s medical record.

Methods: A total of 58 patient discharges from three of the general adult inpatient wards in the Trust constituted the sample to be audited. An audit tool was designed to assess whether there was documentation of the following for each patient: mental disorder diagnosis, driving status, type of vehicle driven, patient informed that their mental disorder may affect their ability to drive safely, and advice on driving restrictions as stipulated by the DVLA. The patient’s electronic patient record was used to obtain all data retrospectively.

Results: All patients had their mental disorder diagnosis documented. Only 5 of the 58 patients had their driving status documented. None of the 58 patients had type of vehicle driven documented. None of the 58 patients were informed that their mental disorder may affect their ability to drive safely. None of the 58 patients were provided with advice on DVLA driving restrictions at the point of discharge from hospital.

Conclusion: This audit highlighted consideration of driving status and need for advice on driving restrictions at the time of discharge from the general adult inpatient ward as currently being an area of poor clinical practice despite the safety implications to both the patient, those they get in a car with and other road users. A recommendation was made for the Trust’s admission clerking to include a section on driving status and type of vehicle driven. A second recommendation was for doctors working on the general adult inpatient wards to be aware of DVLA guidance for individuals with mental disorder and the importance of discussing driving status during weekly ward reviews, especially at the time of discharge.

Aims: Individuals with a severe and enduring mental illness (SMI) are at increased risk of poor physical health and demonstrate a higher premature mortality rate and reduced life expectancy of 15 to 20 years, compared with the general population. Despite being at increased risk of physical health comorbidities, individuals with an SMI are less likely to engage with physical health assessment and less likely to engage with required monitoring of any physical health comorbidity in the primary care setting. Admission to a psychiatric ward provides an opportunity to “screen and intervene”. Mersey Care NHS Foundation Trust has a policy for physical health assessment and monitoring for patients following admission to the ward. This audit aimed to assess level of compliance with the policy on the Trust’s general adult inpatient wards.

Methods: The patient list for nine of the general adult inpatient wards in the Trust was obtained, forming a sample of 160 inpatients. The electronic patient record for each inpatient was reviewed to determine whether an admission clerking form had been completed within 24 hours of admission, as recommended in the Trust’s policy, and whether a physical examination had been completed within 24 hours of admission, as recommended in the Trust’s policy. The level of completeness of the physical examination was also reviewed.

Results: 124 (78%) of the 160 inpatients had had an admission clerking completed within 24 hours of admission to the ward. Only 83 (52%) inpatients had a physical examination completed within 24 hours of admission to the ward. Of the 83 inpatients, 71 (86%) had a cardiovascular examination completed, 75 (90%) had a respiratory examination completed, 69 (83%) had a gastrointestinal examination completed, and only 63 (76%) inpatients had a neurological examination completed.

Conclusion: This audit highlighted that current practice indicates need for improvement, both from a patient safety and quality of patient care perspective. There is a need for increased emphasis on ensuring that any new admission is clerked in, and a physical examination is completed to determine that the patient is medically fit enough to remain on the ward and whether any physical health interventions are required on admission. The physical examination should be a complete one, particularly with psychotropic medication having the potential to cause neurological side effects. There should be a daily review of any patients who decline a physical examination on admission, with attempts made to engage them and complete this task as promptly as possible.

Aims: Individuals with severe and enduring mental illness are at increased risk of poor physical health and demonstrate reduced life expectancy of 15 to 20 years, compared with the general population. Despite being at increased risk of physical health comorbidities, such individuals are less likely to engage with physical health assessment and with required monitoring of any physical health comorbidity in the primary care setting. Admission to a psychiatric ward provides an opportunity to “screen and intervene”. Mersey Care NHS Foundation Trust has a policy for physical health assessment and monitoring following admission to the ward. This audit aimed to assess level of compliance with the policy on the Trust’s general adult inpatient wards.

Methods: The patient list for nine general adult inpatient wards in the Trust was obtained, forming a sample of 160 inpatients. Each inpatient’s electronic patient record was reviewed to determine whether the blood tests recommended in the Trust’s physical health policy were taken within 24 hours of admission and whether an ECG was done within 24 hours of admission, as recommended in the Trust policy. We also determined whether any female patient of reproductive age had a urine pregnancy test done on admission and whether a urine drug screen had been done if there was a suspicion of, or known use of, any illicit substances.

Results: 89 of the 160 (56%) inpatients had a full blood count done on admission. 90 (56%) inpatients had urea and electrolytes done, 93 (58%) had liver function tests done, 90 (56%) had thyroid function tests done, 83 (52%) had an HbA1c level done, 89 (56%) had a random serum total cholesterol level and random lipid profile done. 86 (54%) of the 160 inpatients had an ECG done on admission. Of the 69 female inpatients, only 15 (22%) had a urine pregnancy test done. Only 31 (19%) of the 160 inpatients had a urine drug screen done.

Conclusion: This audit highlighted that current practice indicates need for improvement. There needs to be increased awareness of which blood tests are required following admission. This could be achieved during the junior doctor Trust induction. There is also a need to make nursing staff aware of the need for female inpatients of reproductive age to be offered a urine pregnancy test. There should be a daily review of any patients who decline any physical health investigations on admission, with attempts made to complete these as promptly as possible.

Aims: Women with mental illness face increased sexual and reproductive health risks, including trauma, sexually transmitted infections (STIs), reproductive-associated diseases, and contraceptive challenges. In 2024, Mersey Care NHS Foundation Trust ratified its clinical policy for physical health care. The authors assessed compliance with annual physical health checks (APHCs), sexual health assessments, and their communication in discharge summaries. The aims of this audit were to identify gaps and develop improvement strategies for the Trust’s general adult female inpatient wards.

Methods: A retrospective audit design was used with convenience sampling based on the data collection day. Compliance was benchmarked against NICE guidelines and the Trust’s Clinical Policy SD29 (target 100%). Data were extracted from electronic patient records for APHCs, sexual and reproductive health screenings, and evidence of actionable findings in discharge summaries. If no valid APHC was available, the most recent assessment was searched for. Topics were “covered” if decision-making processes were documented.

Results: Sixty-two female patients from four general adult inpatient wards were identified. Mean age was 42 years (19–70 years). Mean admission length was 50.82 days (1–339 days). Mental health diagnoses included schizoaffective, psychotic, anxiety, depressive, neurodevelopmental, and personality disorders. 60% of inpatients were detained under Section 2 of the Mental Health Act 1983, 19% under Section 3, and 21% were voluntary.

Regarding APHCs:

94% valid (none fully complete).

Four patients without a valid form; two had documented reasons and one offered follow-up.

All national cancer screening programmes were covered in 55% of age-eligible patients (6% declined).

55% covered sexual health history (3% declined).

22% covered menstrual history.

12% covered obstetrics and gynaecology history (3% declined).

Regarding inpatient screening:

90% lacked documented contraceptive discussions beyond oral contraception on admission.

Pregnancy tests: 48% on admission, 15% during admission, 13% documented reason for non-completion; 25% non-completion in over 45s likely due to undocumented menopausal status.

STI screening considered in 13% of cases.

Sexual health counselling offered to 11%. Four out of seven inpatients accepted.

One patient had a positive STI screen in a previous admission.

Conclusion: Despite high APHC completion rates, gaps in sexual health screening and in documentation were identified. Key improvements include better integration of sexual health within assessments, increased review of reproductive health needs, and more consistent STI screening. The authors suggest exploring staff awareness, regional staff teaching, updating policy guidance, and increasing policy distribution. Future audits should evaluate intervention effectiveness, ensuring comprehensive care for this vulnerable patient population.

Aims: Handover is ‘the accurate reliable communication of task-relevant information across shift changes or between teams thereby ensuring continuity of safe and effective working’. Handover is of critical importance; this ensures high quality care of our patients. Therefore this audit Aims:

To explore the compliance rates for completing handover in the junior doctor on-call rota in Blackburn Area.

To explore the current practice of whether handover is completed in person, whether it is documented or whether these are done together.

To use this audit to implement changes to improve the current handover practice.

Methods: A form was printed and put in the on-call room, doctors coming into handover were requested to tick if they received handover face to face, written, both, or none, on that particular shift.

If a doctor forgot to fill the form, they were followed up by email.

The data was collected over a three-week period covering 57 shifts changeover.

Data analysis was qualitative and quantitative.

Results: 57 shifts changeover, over 21 days.

(14%) 8 shifts changeover with no handover done at all.

(28%) 16 shifts changeover only with complete handover (in person and written).

(23%) 13 shifts changeover with only in person handover with no documentation.

(35%) 20 shifts changeover with only written handover with no in person handover completed.

Conclusion: This audit was able to look into the purpose it was designed for. It identified an area of improvements to work on, to achieve good practice and to maintain patient’s safety. One of the findings of this audit, is that on some occasions, doctors have indicated they have received a written handover, however it was not found in the assigned handover teams channel, therefore, it is possible that the handover was sent in another way, i.e. in private chat in teams or emails etc. This audit has concluded the importance of keeping handover in one assigned place, so records can be easily accessible to other team members when needed.

Recommendations were made by meeting the locality college tutor, discussion was carried around notifying all doctors in training about the importance of handover in induction meetings and reminder emails. A poster was also designed and put in doctors’ on-call room.

This audit is to be repeated for monitoring purposes. with a recommendation of having senior doctors involvement in monitoring.

There have been some limitations in doing this audit, for instance, the handover for twilight shifts could have been only partial when completed and this audit did not go into details whether full handover was received from all wards or not. This audit also did not look into the quality of the handover itself – whether details are clear and information needed is provided.

Aims: To measure the extent to which management of depression in children and adolescents compares with standard guidelines.

To enhance the quality of care and improve management practices for depression in children and adolescents.

Methods: Source of data: Electronic patient records.

Audit time frames:

Initial audit: 01/01/2017–31/01/2024.

Re-audit: 01/06/2024–31/01/2025.

Retrospective data.

Inclusion Criteria: Children and adolescents from the Taf Ely area within the Rhondda Cynon Taf Council, Wales diagnosed with depression and started on antidepressants between January 2017 and January 2025 in Tonteg Hospital were studied.

Exclusion Criteria: Patients prescribed antidepressant medication without a diagnosis of Depression.

Results: Demographics: In both the initial audit and the re-audit, females outnumbered males. The age range was 13–18 years.

Findings: In the initial audit, 82.6% (38/46) of the patients had other diagnosis (e.g., anxiety, eating disorders, PTSD). This was 54.5% (6/11) in the re-audit. There were no comorbid cases of bipolar disorder and psychosis.

Psychological therapy was provided to 63% (29/46) of patients before initiating antidepressants in the initial audit, improving to 82% (9/11) in the re-audit.

100% of the patients were prescribed a single antidepressant medication in the initial audit and re-audit. Fluoxetine and sertraline were the only prescribed antidepressants. No other psychotropic medication was prescribed.

Conclusion: The findings are not different with regards to the prevalence of depression in males compared with females. There is a higher prevalence of depression in females in both audit and re-audit.

In the re-audit, there is an 82% compliance with the latest NICE guidelines for the treatment of depression in children and adolescents. This is an improvement from the initial audit which showed a 63% compliance.

Following the initial audit, it was recommended that psychotherapy must be considered before starting any child with a diagnosis of depression on an antidepressant medication. Also, this information must be included in letters sent to the GP. These recommendations were effectively implemented, contributing to improved compliance in the re-audit.

Aims: Medication errors at the interface of care (admission, transfer and discharge) are a leading cause of patient morbidity and mortality. For this reason, the Scottish Patient Safety Programme and National Institute for Health and Care Excellence (NICE) have highlighted the need for accurate medicines reconciliation, and set a 95% standard that all medicines should be reconciled within 24 hours of the patient’s admission. This audit intended to assess quality of completion of Medicines Reconciliation forms and identify any potential barriers to completion. The objectives of this audit were to assess current adherence to local Medicines Reconciliation guidelines across General Adult Psychiatry Wards 19 and 20 in University Hospital Hairmyres (UHH) and identify any potential factors which may be contributing to Medicines Reconciliation forms not being completed appropriately.

Methods: An audit of Medicines Reconciliation form completion for admissions to Wards 19 and 20 in UHH was carried out retrospectively for all (24 no.) patients admitted from 10/11/2023–12/12/2023 using electronic case notes. Other systems, including the software for online prescribing and TrakCare were also used. Each section of the proforma was assessed and information recorded in an Excel spreadsheet as well as information about whether this was completed in the first 24 hours of admission. Following this, a summary document with the latest guidelines and the link to an e-learning module were distributed amongst the Resident Doctors, and raised at the monthly Resident Doctor’s meeting. The form completion was then re-audited for patients admitted from 11/3/24–11/4/24 (34 no.).

Results: In the first cycle of the audit, only 70% of patients had their form completed within 24 hours of admission, which then improved to 100% in the second cycle. Another section with poor compliance in the first cycle was the section confirming that 2 sources of information had been used (66% completed), which also increased to 100% in the re-audit. In terms of the other parameters assessed, there were improvements in all 12 areas.

Conclusion: The audit was straightforward to carry out and yielded valuable insights to improving inpatient psychiatry care. However, the results may have been influenced by individual variability, given the involvement of multiple doctors in the clerking process for new admissions. The findings highlight the importance of regular training and reinforcement of local guidelines to enhance patient care. Nonetheless, there remains an opportunity for further work in this area, including regional audits and updates to local guidelines.

Aims: Physical health monitoring and assessment in psychiatry is fundamental to holistic care provision, and NEWS2 provide an objective, standardised pathway that aids the timely detection of clinical deterioration. This subsequently facilitates appropriate clinical review and care escalation.

This audit based on an older adult functional psychiatric ward aimed to evaluate the adherence to NEWS2 protocols in the following domains:

Monitoring frequency.

Clinical responses to NEWS2.

Methods: A thorough review of NEWS2 documentation for 24 patients on Beech Ward at Rochford Hospital over the same time period of 3 weeks was completed. Of these patients, 12 were present for this same time period, and 3 of these patients were omitted due to frequent refusal of clinical observations. This review yielded 476 NEWS2 entries from 9 patients between ages 68–86, with a gender ratio of 4:5 male to female and admission durations from 44–355 days. The aggregate score for each NEWS2 entry was collated, and the appropriateness of monitoring frequency was assessed by directly comparing the documented monitoring frequency to the Royal College of Physicians’ recommended monitoring frequency. To evaluate the appropriateness of clinical responses to the aggregate score, care escalation documentation for each NEWS2 entry alongside corresponding clinical documentation of patient reviews by nursing staff and doctors were assessed.

Results: This study yielded 476 NEWS2 entries – 42% demonstrated appropriate monitoring frequencies, with most adherence to 12-hourly routine monitoring due to NEWS 0 (81%). The remaining 58% of entries evidenced monitoring frequencies which deviate from standard recommendations, with all of these observations monitored at frequencies less than the recommended minimum. Recommended minimum 1-hourly observations were monitored up to 12-hourly, minimum 4-hourly observations were monitored up to 30-hourly, and minimum 12-hourly observations were monitored up to 48-hourly. Inappropriate clinical responses to patient escalation were secondary to incomplete documentation of care escalation, and lack of escalation to the medical team for clinical review in light of a score of 3 in a single parameter.

Conclusion: In conclusion, these findings highlight the need for better adherence to recommended monitoring frequencies to promote patient safety and care, as evidenced by the deviation in monitoring intervals. Clinical nursing responses to NEWS2 were appropriate, however, completeness of documentation is imperative to ensure care escalation is not overlooked. This has prompted discussions with the multidisciplinary team regarding adherence to NEWS2 documentation recommendations, and intradepartmental teaching sessions outlining clinical handover and indications for care escalation.

Aims: Seclusion, under the Mental Health Act (MHA 1983) Code of Practice, is the supervised confinement of a patient to manage severe risks. The Mental Health Law Governance Group commissioned a clinical audit to assess compliance with the Trust’s Seclusion Policy and MHA Code of Practice, prioritised in the 2024–2025 Audit Programme.

Aim and objectives were to improve the management of patients undergoing seclusion at North Staffordshire Combined Healthcare NHS Trust (NSCHT), and to assess compliance with seclusion standards and identify actions for improvement where necessary.

Methods: All seclusions were identified by the Mental Health Law Team (n=46) from January 2023 to February 2024. Data were collected using a template based on standards and analysed with SPSS by the Clinical Audit Department.

Results: Seclusions mostly occurred within the first week of admission, mainly in patients with bipolar disorder or paranoid schizophrenia, with over half detained under Section 2 of the MHA. The majority were authorised by the Nurse in Charge, with incident forms completed in 83% and de-escalation attempted in 87%. NEWS (National Early Warning Score) was incomplete in 82% at seclusion initiation. The Site Manager was informed in all cases, but timings were unclear in 93.5%. The doctor was notified in all but one case (67% within 30 minutes).

100% had medical reviews, with 39% within one hour and 29% after 120 minutes. In 96% of cases, reviews were repeated before Multi-disciplinary Team (MDT) meetings, with half occurring every four hours. Nursing reviews occurred in all cases, with half conducted every two hours and two nurses involved in two-thirds of cases.

Internal and external MDTs took place in 63% and 72% of cases, respectively. Internal MDTs occurred in 17% of cases in the first 24 hours, and external MDTs in 46%. External MDTs were repeated every 24 hours in 83%. In 46% of cases, both internal and external MDTs were conducted, but 11% had neither. Night-time reviews were suspended in 14 cases, as 10 patients were asleep, leading to review deferral.

The reason for ongoing seclusion was stated in all but one case. Termination reasons were reported in 91% of cases, with 78% showing required steps undertaken.

Conclusion: This audit identifies strengths in authorisation, reporting, and de-escalation, with areas for improvement in review timing, NEWS assessments, and MDT consistency. Recommendations, shared with stakeholders, are in progress, including staff training, policy updates, automated reminders, enhanced documentation, Non-touch NEWS and virtual MDT meetings, to be monitored in the re-audit.

Aims: Over the recent years hospital admissions for eating disorders have been on the rise and RCPsych identified this is partly attributable to lack of guidance and training amongst healthcare professionals in recognition of the, often missed, alarming signs.

The Medical Emergencies in Eating Disorders guidelines (MEED) have been introduced to enable assessment and risk stratification of patients with an eating disorder based on a number of physical health parameters to aid emergency management. The complex interplay between physical and mental health of eating disorder patients highlights the importance of good documentation and assessment of clinical factors which would help in seeking appropriate specialist input.

The aim of the audit is to determine if young people admitted to The Cove with a diagnosis of eating disorder have clear documentation on their notes which include physical health parameters in accordance with MEED.

Methods: Data was collected retrospectively from electronic notes of service users with a diagnosis of eating disorder (n=20) admitted to a CAMHS unit over a 30-month period. This baseline audit addresses documentation of evidence of physical health parameters.

Results: The baseline audit focused on documentation of physical health parameters during the period of admission. A high assurance of 80% and above was recorded for: weight for height, heart rate, ECG and blood investigations at The Cove during this audit cycle. A limited assurance whereby the compliance was 70–75% was noted for monitoring of core temperature. There was some underperformance, such as, in documentation of SUSS test and/or hydration status.

Conclusion: The baseline audit achieved an overall compliance of 69%, providing not a high assurance in the monitoring and documentation of physical health parameters on the electronic notes. The compliance calculations were based on a small cohort of service users.

The MDT would need to consider implementing a template that would cover the parameters expected by the MEED guidelines. Following implementation of the tool a re-audit would be performed in due course.

Aims: A CMHT office should provide a comfortable, supportive, and therapeutic environment for staff and visitors. It should be accessible and welcoming, it should support the development and maintenance of good relationships, recognition of boundaries and make staff and service users feel physically and emotionally safe.

A CMHT office should enable people to communicate effectively, especially those with differing abilities, cultural differences and languages and it should encourage involvement.

Welsh Government commissioned NHS Wales’ Joint Commissioning Committee and RCPsych Wales to audit all CMHTs in Wales against these principles.

Methods: A 109-point specification focused on the environment of care was developed. All points were classed as either ‘desirable’, or ‘essential’, based on legal or regulatory requirements, potential impact on staff safety, effectiveness, or the possible impact on service user safety, outcomes, inclusion or experience.

The specification was split into 10 areas: Build & Maintenance; Enabling Access; External Areas; Internal Areas; Experience, Privacy & Dignity; Equity; Supporting & Protecting Staff; Clinical Care; Health & Social Care Integration; and Community Links.

The specification was designed so the review team could allocate one of three indicative ‘positions’ in response to each question, corresponding to whether a particular aspect of the CMHT office was:

‘Poor/substandard/not present’,

‘Adequate/reasonable/acceptable’ or

‘Good/effective/present’.

A single auditor was used for site visits to support comparative evidence gathering. All Health Boards agreed to participate, and all 45 CMHT offices in Wales were subject to a site visit. During these site visits the environment was assessed, documentation reviewed, and staff interviewed.

Results: Across the 109 point specification, there were stark findings.

Examples of ‘more than two-thirds’:

89% of CMHT office external areas were tidy.

89% of CMHT offices were less than 5 minutes walk from a bus stop.

Examples of ‘less than a third’:

24% of CMHT offices had the facility to dispense medications.

22% of CMHT offices parking areas were secure.

Examples of Inequalities in Care:

20% of CMHT offices provided no disabled parking for service user.

2% of CMHT offices had BSL proficient staff and/or access to VSL technology.

Conclusion: This audit highlights effective joint working between RCPsych Wales and NHS Wales’ Joint Commissioning Committee. It further highlights that:

Strategic investment is necessary to enhance the CMHT environment in Wales,

Investment must seek to address inequalities in care that are experienced due to the design and state of environments.

Aims: Non-attendance at initial assessment appointments in perinatal services can delay crucial care and negatively affect maternal and infant health outcomes. The Tri-Borough Perinatal Service, covering Ealing, Hounslow, and Hammersmith and Fulham, aims to maintain a non-attendance (DNA) rate of 15% or lower. This study assessed DNA rates for initial assessments and explored demographic and socioeconomic factors to identify potential predictors of non-attendance.

Methods: Retrospective data from 369 patients scheduled for initial assessments between August and October 2024 in the Tri-Borough Perinatal Service were analysed. After excluding duplicates and incorrectly labelled DNAs, 283 patient records remained. Demographic variables considered included age, ethnicity, self-referral status, need for a translator, disability status, and receipt of benefits. Socioeconomic deprivation was assessed using the Index of Multiple Deprivation (IMD) Rank, based on the English Indices of Deprivation 2019. Statistical analyses, including Chi-square test and binary logistic regression, were conducted to identify significant associations between these factors and DNA rates. A p-value of <0.05 was considered statistically significant.

Results: The overall DNA rate for initial assessments was 35.3% (n=100), which exceeds the gold standard. The average age of patients was 30 years. Most patients (94.7%) were referred by an external body (e.g. midwife, GP, health visitor), 16.6% required a translator, and 15.2% had a known disability. 101 patients (35%) were recorded as receiving benefits, although this was not recorded for 30 patients (10.6%). Ethnicity was not significantly related to DNA rates (p=0.062), with White British patients comprising 16.3% (n=46) of the sample, however 18% (n=51) of ethnicity data was missing due to not being recorded. DNA rates were significantly affected by appointment location (p=0.035), with the highest rates observed for physical centre appointments (40.0%), compared with home visits (20.7%) and remote appointments (25.9%). Socioeconomic deprivation, as measured by the IMD Rank, was a strong predictor of DNA rates (p<0.001), with higher deprivation correlating with higher non-attendance.

Conclusion: Socioeconomic deprivation and appointment location were found to be key factors influencing non-attendance, with higher DNA rates observed in more deprived areas and for physical centre appointments. These findings suggest that further improvement studies will be necessary to explore interventions such as alternative appointment formats and targeted support for patients from disadvantaged backgrounds, which may help reduce non-attendance and improve engagement with the service.

Aims: To identify a set of appropriate standards against which to evaluate all seclusion rooms across Humber NHS Foundation Trust.

To identify thematic issues relating to seclusion rooms that need addressing.

To make evidence-based recommendations to improve the standard of seclusion rooms throughout the sites.

Methods: We arranged to attend each clinical area in person to assess the seclusion area against a defined checklist.

Considerations were made to the time and day of attendance as well as if any areas were in use. Should they be in use we determined we would assess the area at the time of seclusion review if it would not be at detriment to the patient.

If an area was used for long-term seclusion, review would be omitted.

Results: Of audited areas, none were 100% compliant.

Of the areas with dedicated seclusion rooms, none had an actual bed in the room, but all were equipped with mattresses.

Compliance is not at 100% for blind spots.

No clear bedding was available in a high number of rooms.

The lights and heating appear to pose some issues in several of the seclusion areas.

Four wards, Mill View Lodge, Mill View Court, Maister Lodge and Maister Court have no dedicated seclusion rooms. Despite this there have been incidents on three of those four wards, requiring a patient to be secluded before being transferred to an appropriate suite. From looking at the data for these areas, none are 100% compliant with the recommendations and as such mean that a safe and appropriate seclusion cannot be conducted.

Conclusion: Through this audit we highlighted that there are key concerns across all areas of the Trust in regard to the standardisation of the seclusions rooms.

Most of the identified issues were considered 'easy fixes’ that had not yet been raised as an issue and arrangements with estates could be made to rectify them.

Unfortunately we identified three areas that did not have dedicated seclusion suites but did have seclusion policies that could be operated. Patients were being secluded in general areas in these locations, leading to increased risk for staff and patients alike. Recommendations have been made to the Trust in various clinical network meetings that these clinical areas should either have a dedicated suite made available, which is compliant with the recommendations, or that the Trust is to create a new Standard Operating Procedure (SOP) detailing how a patient needing seclusion in these areas is to be managed until an appropriate seclusion suite is identified for them.

Aims: A primary audit revealed widespread non-compliance with NICE Quality Standard (QS174) in patient handovers between the emergency department and a psychiatry inpatient unit. This second audit evaluated whether the issue was specific to one ward and/or emergency department or if it was prevalent across the trust.

Methods: 9 wards across 3 locations within the same trust were sampled. For each ward, online case notes from 5 patients transferred to the emergency department between April and September 2024 were reviewed, identified by selecting the most recent admissions and working backward until 5 cases were obtained. Cases were assessed for (a) handover documentation, (b) discharge summary availability, (c) required actions for the psychiatry ward, and (d) nature and implementation time of these actions. Results were analysed using Microsoft Excel.

Results: 45 patient case notes were reviewed. 62% (n=28) did not have a handover documented which followed the NICE definition of Situation Background Assessment Recommendation (SBAR) and 28% (n=8) had no discharge summary. 5 patients had no discharge summary and no documented handover. 56% (n=25) of patients returned with actions for the ward, and 20% (n=5) of these had actions delayed, which included medication changes (antibiotics). All but one ward identified potential issues with handovers, both between physical and mental health trusts and within the mental health trust itself.

Conclusion: The results of this extended audit show improvement from previous findings but still highlight significant concerns. It is possible that the number of cases reviewed were too small to detect the extent of the issue within wards. Nevertheless, the audit highlights ongoing communication issues between physical and mental health services, requiring further investigation. It also identifies the need for improvement in internal communication, as some patients with discharge summaries still experienced delayed actions.

The identification of problems across multiple sites also suggest audits of other mental health trusts would be worthwhile to establish if this is a national problem.

Quality improvement work is being undertaken to better understand and address the specific challenges faced by wards and emergency services that are affecting handovers of care across different locations within the trust. This will allow us to improve patient safety across the trust.