To evaluate the current use of the GASS scale in monitoring patients on antipsychotic depot medications at Guildford CMHRS, we conducted a comprehensive assessment and compared it with trust guidelines. The guidelines recommend GASS scale completion at specific intervals: 12 weeks and 6 months post-initiation, annually thereafter, and at each dose titration.

We conducted a review of patient depot charts and SystmOne notes for individuals on antipsychotic depot medications, in accordance with trust guidelines. Cases were randomly selected from the total number of patients on these medications. Following the initial audit, which was shared at Guildford CMHRS, a recommendation was made for staff to utilize the GASS Scale during outpatient appointments and document scores on both charts and SystmOne. A follow-up audit after six months was performed to evaluate any improvements.

In the initial audit of 60 cases receiving antipsychotic depot injections, GASS was conducted in 8 cases (26.6%), with 7 cases (23.3%) completed within the last year. In the re-audit of 58 cases, GASS was completed in 16 cases (55.17%), all within the last year.

The re-audit highlights a notable increase in completion rates, yet opportunities for improvement persist. Additional suggestions for enhancing completion encompass regular refresher courses on Trust Guidelines, ensuring Pharmacy Team adherence to guidelines for patients on antipsychotics, and motivating medics and nursing staff to complete and document the GASS Scale. Consistent re-auditing is recommended for continuous improvement.

To improve the overall experience of IMG Doctors at BSMHFT. To demonstrate this, we targeted an increase in percentage of doctors rating their experience as excellent in our survey.

Employing the “Model for improvement”, we co -produced all aspects of project with subject matter experts (IMGs).

• • What are we trying to accomplish? We co-produced process map/aim.

• • How will we know that a change is an improvement? Co-produced survey, circulated monthly, data collected and analysed.

• • What change can we make that will result in an improvement: Co-produced change ideas from process map, survey data and weekly meetings. Commenced testing some change ideas in this phase.

  Other QI tools utilized include Driver diagram and family of measures.

• • Change strategies (PDSA cycles):

  These include:

• ◦ IMG specific session at Trust Induction. 15 minutes slot allocated to introduce project and encourage involvement.

• ◦ IMG whatsapp group.

• ◦ IMG Forum.

• ◦ Dedicated Email Inbox.

• ◦ Learning/career progression sessions.

• ◦ Social events.

• ◦ IMG representative.

Outcome measure (Aim) - 5 months of survey data obtained. An average of 10 IMGs responded to monthly survey. Data presented on statistical process chart (SPC) revealed a median value of 33% of respondents (IMGs) rated their experience as excellent.

Process measures –

• • Trust Induction – 2 PDSA cycles completed. 15 IMGS joined the Whatsapp group following induction sessions. 24 IMGs joined the IMG mailing list.

• • Whatsapp group – Completed 9 PDSA cycles. Average of 3 IMGs joined per week. 69 members at present. Data indicates informal posts, planned activities, information sharing, and spontaneous queries encouraged engagement.

• • IMG Forum – one PDSA cycle completed. 20 IMGs attended. Feedback was obtained and 63% of respondents rated the effectiveness of the session as excellent.

• • Social event – one event arranged; 16 IMGs attended.

From this phase of the QI project, we have been able to foster an increased sense of community peer support and camaraderie amongst IMGs. This is highlighted by increased numbers in WhatsApp group, mailing list and attendance at events.

The change ideas positively impacted participation, engagement, and satisfaction with the project providing a previously unavailable psychological safe space.

33% of respondents rated their overall experience as excellent from the monthly surveys that were sent out.

In terms of next steps, we aim to implement other change ideas and aim to increasing respondents’ rating as excellent to 50% by December 2024.

STOMP (stopping the over-medication of people with a learning disability, autism, or both) is a national project launched by NHS England in 2016. The objective is to curb the excessive use of psychotropic medication in individuals with a learning disability, autism, or both to manage behaviour that challenges. This means ensuring that medications are prescribed at the lowest effective dose for the shortest duration of time, and aiming to discontinue if appropriate.

We aim to broaden the implementation of the STOMP initiative to a relatively new residential nursing home in Northern Ireland that is home to individuals with learning disabilities and complex care needs. The residents are discussed at monthly MDT meetings attended by psychiatry, positive behaviour support (PBS) practitioners, activities coordinators, and nursing home managers.

The inclusion criteria for STOMP are 1. Diagnosis of learning disability, autism, or both, 2. Currently taking psychotropic medication primarily for behaviour that challenges and 3. No diagnosis of severe and enduring mental illness. Five patients were eligible for STOMP.

Outpatient letters and medication prescriptions from the time of admission were compared with the most recent outpatient letters and medication prescriptions.

The five residents were on a range of psychotropic medications including antipsychotics, antidepressants, benzodiazepines, and antihistamines. Following STOMP implementation there was a reduction in psychotropic medication for 80% of the residents.

Patient 1: Reduction in antipsychotic from 75% BNF max daily dose to 40%.

Patient 2: Previously on two antipsychotics with combined use of 75% BNF max daily dose – both medications now discontinued.

Patient 3: Reduction in antipsychotic from 69% max daily BNF dose to 50%, PRN antihistamine discontinued.

Patient 4: PRN antipsychotic discontinued from 15% max daily BNF dose, benzodiazepine use reduced by 5%.

Patient 5: Antipsychotic use increased from 25% max daily BNF dose to 33%.

There was a reduction in psychotropic medication in 80% of the residents. This is an encouraging finding and shows that the STOMP initiative can be expanded to include residential nursing homes. Despite relatively limited resources for STOMP implementation in our local service, we have shown that by keeping the STOMP ethos at the centre of our thinking during monthly MDT meetings involving nursing home management, PBS practitioners, psychiatry, and activities coordinators, we can make sustained reductions in psychotropic prescribing.

All medical staff working within NHS psychiatric hospitals in the UK are required to complete mandatory life support training. However, there is no such mandatory requirement for associated training around the effective use of the emergency medical equipment used during medical emergencies on inpatient psychiatric wards. This quality improvement project focused on developing a sustainable educational intervention aimed at all staff types within one London inpatient psychiatric hospital. Staff of all grades and roles encountered frequent difficulties and delays in relation to the emergency medical bags and equipment, including issues around skill and confidence.

A survey was initially sent to medical and nursing staff working on an inpatient psychiatric unit, which highlighted participants’ lack of confidence in using the equipment. It emerged that staff exclusively handled the emergency medical equipment during relatively rare emergencies. This resulted in unfamiliarity with the equipment and consequent difficulties in using it competently. A novel educational intervention dedicated to upskilling staff with emergency medical equipment was created, focusing on contents and use of individual equipment within the medical emergency bag. Pre- and post-intervention quantitative feedback regarding confidence and familiarity was obtained using feedback forms containing Likert scales. Qualitative feedback was also obtained.

More than six training cycles, each consisting of at least five training sessions, have now been completed with both qualitative and quantitative measures of improvement captured. Individuals noted on average a 31.62% (±3.605%) improvement in self-reported confidence and familiarity with equipment. The most frequently identified positive themes were that the intervention familiarised staff with equipment and was educational, whilst the most frequent suggestion for improvement were requests for additional sessions. From single idea to sustainable quality improvement, the team broadened and gained stakeholder support including clinical and nursing directors, pharmacy, junior doctors, nurses, and matrons.

The intervention has achieved sustainability and is being explored in other partnership psychiatric hospitals. Despite reported increased confidence in handling the emergency equipment, there is ongoing need to develop, maintain and practice these skills, across both the nursing and medical staff, to achieve better outcomes for psychiatric inpatients. Trainee psychiatrists intend to develop the project further, and the training will be incorporated as a mandatory requirement. The project links to the quality standards for mental health point 12 of the Resuscitation council UK. Next stage developments of the project include linking to feedback from emergencies as well as incorporating into existing simulation training.

To audit compliance with electronic admission documentation relating to substance use.

The initial admission forms in the electronic records of all current patients on the male ward were reviewed (n = 12). The information in core admission document was compared with other substance abuse history information on records.

Seven of the twelve patients were asked about substance misuse during their admission review. 5 patients were not asked. One of these patients had no history of substance use but his alcohol use history was also unclear in other records. 9 patients had at the very least met the ICD–10 criteria of harmful use of alcohol. 11 patients had at the very least met the ICD 10 criteria for harmful use of illegal substances. Two patients had excessive amount of alcohol use to the point of dependence since teenage. Mean age of onset of both substance and alcohol use was 11, with range of 0 to 20. The most commonly misused substances were alcohol and cannabis (11 out of 12 patients). Eight patients had abused drugs other than cannabis. All but one of these then progressed to using other substances. The reasons for using substances and attitudes to substance and alcohol use were not explored in admission assessment in most cases.

Admission assessment to a rehabilitation ward is also an opportunity to screen for any barriers to recovery as well to use brief motivational interviewing intervention if appropriate clinically. There is a need to improve the quality of our admission assessment in relation to substance use history.

Most of our patients had a very early onset of alcohol and substance use, as young as age 8. Apart from one outlier, all had started using substances and alcohol by age 15. This raises concerns regarding missed early prevention and safeguarding opportunities.

Missing data is a challenge that most researchers encounter. It is a concern that continues to be analyzed and addressed for solutions. Missing data occurs when there is no data stored for certain variables relating to participants. In health surveys, when participants answer in the form of “I don't know” or “I'd prefer not to answer”, these responses can, in many cases, be categorized as missing data responses from a participant in a specific category or question.

The eight-item Patient Health Questionnaire (PHQ-8) is an essential tool in healthcare and clinical settings to assess an individual's mental health, specifically related to symptoms of depression. The items are scored on a scale from 0 to 3 with the total score obtained by summing the scores for each item. Higher PHQ-8 scores indicate the presence of depressive symptoms.

We used empirical data from a previous study on depression symptoms in patients with coronary heart disease to study the effect of considering the answers “I do not know” and “I prefer not to answer” as missing values when estimating the percentage of depression using PHQ-8. Moreover, we studied the effect of the complete case analysis and multiple imputation on parameter estimates and confidence intervals. The outcome of this study aims to shed light on the development of missing data procedural knowledge and provide methodological support for public health decision-making when data with missing values are collected.

Furthermore, this study aims to prevent the exclusion of missing data rather than to generate data.

A simulation study with 1000 replicates was performed. Four common statistical machine learning methods for handling missing values were included in this study. These are K-Nearest Neighbor (KNN), K-Means, Classification and Regression Trees (CART), and Random Forest (RF) imputations. Five clusters were used for KNN and K-mean. Likewise, five multiple imputations were used for the CART and RF methods. The simulation was based on publicly available data with available PHQ-8 data for 1096 subjects. In the simulation study and for each replication, multivariate missing values were generated using the missing-at-random (MAR) assumption with 10%, 20%, 30%, 40%, and 50% proportions of missingness. The percent of depression was calculated using the PHQ-8 questionnaire and a comparison was made between estimated actual depression, complete-case analysis, KNN, Kmean, RF, and CART, respectively.

The Median age of the subjects was 69 (interquartile range: 61–67) and more males (72.9%) than females were included in the data. The estimated actual depression was 16.8, whereas the estimated percentage of depression varies between 6.9–13.5, 16.2–16.7, 16.3–16.7, 16.6–16.7 and 16.7–16.8 for the complete case, KNN, Kmean, RF and CART respectively.

The results of this simulation study show that missing PHQ-8 data are best handled by applying multiple imputations based on CART or RF. However, using K-Means or KNN leads to a good estimate of the true percentage of depression. Furthermore, the results of this simulation study show that complete-case analysis leads to biased estimates of the true percentage of depression. Nevertheless, further investigation is needed to address the problem of missing PHQ-8 data under the assumption of missing not at random.

UCL 5th year medical students undertake 3-week North London Mental Health Partnership inpatient psychiatric wards placements.

Before this project the management of these placements was at the discretion of individual ward teams. A varied, and potentially unsatisfactory, medical student experience resulted.

This project sought to implement a structured approach to placements.

Ward teaching best practice was, for the purposes of this project, considered to be (i) sending students a welcome email prior to placement, (ii) issuing placement timetable, (iii) using tutorial materials for onward tuition.

Project aims: 75% of wards sending welcome email, 75% issuing timetables, 75% using tutorial materials, 75% of students stating placement exceeded expectations.

This project consists of 1 PDSA cycle.

Prior to project baseline measures of ward teaching best practice were collected. The project started at the commencement of 2022/2023 academic year; duration: 12 weeks. The intervention was that inpatient medical teams were supported to send an introductory email to each student cohort, provide a placement timetable, and use supplied tutorial materials.

Questionnaires were emailed to inpatient medical teams at 6 and 12 weeks and to medical students at the end of placements. Medical team questionnaire covered engagement with best practice teaching. The student questionnaire addressed placement experience.

Outcomes at project conclusion:

• • 33.3% of wards sent introductory email.

• • 66.7% of wards issued a placement timetable.

• • 16.7% of wards used tutorial materials.

• • Less than 75% of student reported that the placement exceeded expectations.

The medical inpatient teams did not engage with this project as hoped. Feedback suggested reasons:

• • Lack of knowledge about the project.

• • Time pressures.

• • Perceived lack of medical student engagement.

• • Team had preferred teaching practices.

Despite this intervention, student inpatient placement experience remains varied.

It may have been optimistic to expect medical teams to change their established practice regarding medical students with only very modest additional support.

Some teams are enthusiastic and thoughtful about student teaching. Other are less so; this may be associated with temporary staff.

Following PDSA cycle 1 no further cycles were attempted as outcome suggested an alternative approach is required.

Possibilities for further PSDA cycles include:

• • Supporting placements via regular teaching-focused ward team meetings where expertise can be shared.

• • Appointing ward teaching fellows.

• • Explicitly rewarding inpatient teams displaying teaching excellence.

This service improvement project seeks to empower individuals diagnosed with Functional Neurological Disorders (FND) by delivering comprehensive information, facilitating informed choices about their care, and encouraging an active role in managing their health.

Information was gathered relating the concerns and expectations of FND patients upon receiving a diagnosis or attending the neuropsychiatric clinic at a regional neuroscience centre. The identification of a patient information leaflet as a valuable resource became apparent. Consequently, a meticulously designed leaflet was developed to educate patients about their condition, providing useful tips and resources. The content of the leaflets underwent a thorough series of reviews, incorporating input from various professionals within the multidisciplinary team, with additional consideration given to feedback from service users. To assess the impact of this intervention, feedback is required from both clinicians and end-users.

The patient information leaflet contains information designed to enlighten patients about their condition, incorporating psychoeducational content on self-help strategies and available treatment modalities. It also highlights support resources available to them. The leaflet can be conveniently stored in the neurology and neuropsychiatric clinic areas for easy clinician access and distribution to relevant patients. Additionally, it is available in PDF format, enabling clinicians to print it in satellite clinics, and medical secretaries can email it to patients along with clinic letters as directed by the clinicians. Initial feedback from patients and clinicians has been overwhelmingly positive, with many considering it an essential intervention.

This service improvement, realized through a relatively modest intervention, can lead to a substantial impact on patient care and satisfaction. Providing patients with pertinent information is crucial for fostering informed decision-making and empowering them to take an active role in their care. Especially for conditions historically stigmatized and misunderstood, it is imperative to disseminate up-to-date information, establishing a reliable and endorsed source to dispel stigma for both patients and their families.

Discharge letters to general practitioners (GPs) are pertinent in summarising patients' care in secondary healthcare settings and communicating follow-up management plans for continuity of care. 26 GPs from 13 GP surgeries in the West Midlands thought that discharge letters lacked important information and standardisation. We developed a quality improvement (QI) project to standardise GP discharge summaries within the liaison psychiatry services for older people in Nottinghamshire Healthcare NHS Trust. We aimed to ensure that 100% of GP discharge letters are written in a standardised format and meet the mandatory subheadings within six months.

A comprehensive literature search was performed, and we invited six GPs across Nottinghamshire to comment on the quality of anonymised discharge summaries written by our colleagues. After discussing the findings with our stakeholders, we developed a new discharge summary template with the subheadings of ‘Reason for Liaison Psychiatry Involvement’, ‘Summary’, ‘Diagnosis (if applicable)’, ‘Risk Formulation’, and ‘Treatment or Plan of Action’.

We held a team meeting and distributed a guidance document with scoring criteria for each subheading for our clinical colleagues to practise for two weeks. Subsequently, 75 discharge summaries were randomly selected and independently scored across seven weeks by an internal team member and an external QI data analyst to improve inter-rater reliability. 98 discharge summaries written six weeks before the new letter template was introduced were retrospectively scored for baseline measurement.

At baseline, the discharge summary scores ranged between 6 and 20 (out of a maximum of 20), depending on the individual completing them. The mean score was 12.3.

The implementation of the new discharge summary template improved the mean score to 19.0, irrespective of the author. The mean score was consistent across seven weeks.

Most of our colleagues did not face significant challenges in learning a new style of writing and for some, a standardised template reduced administrative time. The same GPs reviewed the new set of anonymised discharge summaries and were satisfied with the new summary format.

Formulating a standardised discharge summary template which adhered to professional guidelines was pivotal in improving the quality of GP discharge summaries. GP involvement throughout the project convinced stakeholders and colleagues to commit to a new writing template and tremendously helped achieve our project aim.

Presentations of severe Eating Disorders (ED) to the Tertiary Eating Disorders Specialist Service (TESS) in Lanarkshire have increased in recent years. Our criteria has also expanded to include severe Avoidant-Restrictive Food Intake Disorder (ARFID), increasing demand for a multidisciplinary team (MDT) approach for patients at high physical risk with less typical ED presentations. Medical Emergencies in Eating Disorders (MEED) recommends MDT working and development of pathways to support these patients.

The “EDIT subteam” was thus developed in March 2023, comprising: TESS psychiatrist, TESS GP, dietician, assistant practitioner, and TESS psychologist.

For TESS patients at high physical risk, high risk of hospitalisation, and who would benefit from a trial of “stepping up” treatment, we aimed to employ coordinated MDT intervention to 1. optimise community treatment, 2. regularly review risk and 3. reduce need for hospital admission.

Each patient was discussed at a weekly MDT meeting attended by EDIT subteam, where risk assessment and management plan was agreed.

6-month review was conducted using meeting minutes, staff survey and group discussion, with consideration given to: number of patients prevented from requiring hospital, number of patients admitted to hospital and consideration if different levels of intervention could have prevented this, staff satisfaction and review of the MDT complement.

22 patients – 17 female, 5 male – were included on EDIT for the first 6 months. At point of step-down from EDIT, 13 had ongoing TESS community input, 5 were admitted to hospital, 3 were discharged from TESS and 1 transferred to Community Mental Health Team.

Most EDIT patients received input from multiple domains of the MDT. Given baseline low admission rates and complexity of patient presentation, we were unable to determine how many hospital admissions were prevented, but consensus was that overall, a higher level of care was provided. It was not felt that different levels of intervention could have prevented any of the 5 admissions. Staff feedback was positive: EDIT improved communication, provided job role diversification, contained and shared risk, improved awareness of care plans and resulted in better-considered onward referrals.

Areas for improvement included a lack of Occupational Therapy and nursing, and concern about EDIT patients skipping waiting lists.

The EDIT subteam provides an avenue for high risk patients to be regularly discussed in an MDT setting – although impossible to empirically quantify if admissions were reduced, consensus within TESS was that the introduction of EDIT has improved community treatment for this group of patients.

To reach the target of 100% for VTE (venous thromboembolism) prophylaxis data submitted for all St Charles Older Adult inpatients.

It was found at the start of the QI project, the service was at 63% (August 2023). I reviewed this data and discussed it with the ward managers of the older adult inpatient wards and implemented two PDSA cycles. I went through the ward list of service users and noted on the database who had an outstanding VTE prophylaxis check. From this, I then created a section for the nursing handovers to include whether each service user had their VTE prophylaxis forms filled in and whether VTE prophylaxis was appropriately prescribed. The wards have a weekly MDT meeting where this could be discussed and all staff could be reminded to document the VTE data on the trust data system. I rechecked the data two months later to see if the data had improved. Following this, I created a VTE poster to be distributed via email to ward staff and hung up in the ward doctors' offices to help educate staff on the importance of VTE prophylaxis. The statistics were rechecked two months later for further improvement.

At the start of the QI, it was found that the service was underperforming in reaching its target of 100% of the VTE prophylaxis data entry for all service users in older adult inpatient wards. After implementing the first PDSA cycle, the data increased to 84% compliance (October 2023 data). After implementing the second PDSA cycle, the data increased to 100% compliance (December 2023 data). The data showed both implementations had a significant impact on the data input and the target being reached. The new strategy has now been firmly placed into the team working pattern as a routine measurement and continues to be actively utilised.

In an older adult inpatient ward setting with service users who have co-morbidities, reduced mobility and risk of dehydration from self neglect, it is vital they are assessed appropriately for VTE risk factors and prescribed the appropriate prophylaxis. Once this was highlighted to the ward staff and an easy system of the PDSAs were implemented, the team are now able to actively input the data and provide optimal care for the service users.

Women with severe mental illness are at higher risk of sexually transmitted infections (STIs), unplanned pregnancies and poor engagement with cervical and breast screening. Despite current national guidance, these issues are poorly addressed during psychiatric admissions.

We aimed to improve the provision of women's sexual and reproductive healthcare on psychiatric wards using a quality improvement framework.

Female psychiatric inpatients aged over 18 were included. A baseline audit was performed in October 2022 on a female psychiatric ward, followed by six PDSA cycles from August 2022–January 2024 (n = 108).

We introduced women's health assessments (WHAs), offering counselling on: (1) contraception, (2) cervical and breast screening, and (3) STI screening. We arranged treatment and follow-up.

Changes were made at each PDSA cycle: ensuring provision of emergency contraception and STI swabs; establishing a protocol for referring to the sexual health clinic; creating dedicated clinic time to offer counselling; developing a poster and educational leaflet; and creating a proforma to record outcomes. The interventions were then extended to a neighbouring ward.

We reviewed electronic notes and recorded the percentage of patients offered counselling at baseline and after each cycle, later also recording the percentage of patients accepting interventions.

At baseline, 12.5% of inpatients had been offered at least one of: contraceptive counselling, cervical and breast screening or STI screening. This improved to 87.7% offered a leaflet and 63.1% offered counselling by the final cycle. Of these patients, 48.8% accepted at least one intervention. On the neighbouring ward, offers of counselling increased from 28.6% to 63.6%.

Introduction of dedicated clinic time increased offers of interventions the most, to 94.1% (cycle 3). Compliance was lowest in cycle 4 (54.2% offered any intervention) which coincided with junior doctor changeover. Provision of an educational leaflet did not increase acceptance of interventions (cycle 5).

Introduction of WHAs led to detection and treatment of STIs in seven patients. Absent contraception was identified and started for a patient taking sodium valproate. Five patients were administered emergency contraception and two commenced long-term contraceptives. A case of female genital mutilation was identified, and a case of cervical neoplasia (CIN 3) was detected.

Provision of WHAs improved women's healthcare in inpatient psychiatric settings, with clinician contact being the most valuable resource in achieving this. There were several barriers, importantly clinician availability and awareness during junior doctor changeover. We will establish our interventions trust-wide, protocolising WHAs in the junior doctors’ handbook, and collect patient feedback.

Additional authors: Dr Terteel Elawad, Dr Judith Stellman.

Several sites across the North London Mental Health Partnership (NLMHP) do not have a liaison-specific rolling teaching programme. Best practice standards set by the RCPsych Psychiatric Liaison Accreditation Network (PLAN) are therefore not being met.

The aims of this quality improvement project (QIP) were to: (1) ascertain the perceived need for liaison-specific teaching across NLMHP sites; (2) develop and deliver a teaching programme; and (3) assess attendance, clinician satisfaction and confidence before and after teaching sessions.

A pre-programme questionnaire on Microsoft Forms was sent to team members across NLMHP sites to assess whether respondents were receiving liaison-specific teaching, the perceived utility of the programme, and suggestions for development.

A cross-site monthly teaching programme was developed. Sessions were presented by liaison clinicians from a list of liaison-specific topics via Microsoft Teams.

A post-session questionnaire was sent to establish session satisfaction, confidence pre- and post-session, and further comments. Mean satisfaction scores were calculated. Percentage change in confidence score was calculated for each session and overall.

Themes were identified from the qualitative data and suggestions implemented.

Of the 11 professionals who responded to the pre-programme questionnaire, 50% were not receiving any liaison-specific teaching. Respondents agreed the programme would be helpful in improving their knowledge and clinical practice (mean score = 4.9/5).

Attendance for the sessions ranged from 15–27 professionals (mean = 22). A range of 2–10 professionals completed each post-programme questionnaire (mean = 6.3; total responses = 25). Mean satisfaction for each session ranged from 4.3–5/5 (overall mean = 4.7/5). Percentage increase in confidence scores ranged from 4.6–48% (mean = 24%).

Feedback-driven changes made to improve the programme included: making session recordings available; sending reminder emails; creating an online platform and making session feedback available to presenters.

Respondents considered the sessions interesting and informative, that topics provoked good discussion, and that the 'bite-sized' training allowed attendance without interfering with clinical work.

This QIP highlighted the need for a liaison-specific teaching programme across NLMHP. Participants agreed that this would improve their knowledge and practice. The programme was reasonably well-attended across sites. Respondents reported improved confidence and felt the sessions were relevant to their clinical practice.

Limitations included the low and variable questionnaire response rate and limited data on the new programme's utility.

The next stages of the project include wider delivery, involvement of patients and carers, and of specialists in related psychiatric and medical fields.

Aims – An Audit in the Older Adult Community Mental Health Team identified that there were inaccuracies in the Addenbrooke's Cognitive Examination-III (ACE-III) scoring used to help diagnose dementia. The aim of this Quality Improvement Project was to determine if ACE-III training delivered by a neuropsychologist would improve the accuracy and reliability of ACE-III scores used by the team to help diagnose dementia.

ACE-III surveys completed over a 6 month period were analysed to determine if they followed the ACE-III scoring guidelines provided by the ACE-III Administration and Scoring Guide (2012). ACE-III surveys were completed by different members of the multidisciplinary team. Following identification of inaccuracies and inconsistencies in scoring we delivered ACE-III training via a neuropsychologist to determine if this would improve ACE-III scoring (as per the ACE-III Administration and Scoring Guide) in the following 6 month period after the training was received.

Following ACE-III training delivered by a neuropsychologist in how to complete the ACE-III survey, surveys were analysed using the Administration and Scoring Guide (2012). ACE-III scores were more accurate in the 6 months following the ACE-III training delivered by a neuropsychologist to the team.

ACE-III training improved the accuracy of ACE-III scores in the multidisciplinary CMHT. This finding would advocate for ACE-III training to become part of our roles within Older Adult Psychiatry in order to improve service delivery to the patient.

Clear, accurate and efficient clinical communication between wards and on-call doctors is vital for good patient care. Issues were raised locally regarding the quality and content of these calls, and a QI project devised to assess the issue and implement meaningful change.

An initial QI Audit was undertaken, using Likert scale questionnaires to rank areas of concern. These were sent to all the doctors currently manning the on-call rota, and doctors who had previously covered these on-calls. Responses were used to gauge the key concerns, and a blank space and multiple choice question on possible contributors to the issues were included.

A communication prompt was designed that tackled the key issues highlighted by the audit. A clear flow-chart ensured that safe and sensible steps were taken to maximise the efficiency of a necessary call. A summary of the SBAR communication tool was also included to encourage structured handover. These prompts were cheap and easily affixed to ward telephones and were laminated and wipe-clean. Implementation was agreed with and supported by the senior nursing team.

A post-QI questionnaire was then sent out one month after the intervention, getting feedback from the junior doctors covering on-call shifts in that time.

Questionnaire Likert scales measured either Frequency (1-Very Rarely – 5-Very Frequently) or Quality (1-Poor – 5-Excellent), and a mean of the scores was taken for each question.

The initial audit (n = 14) included all the doctors currently on the on-call rota (n = 7). Key issues raised were Average Call Quality (2.2/5), how frequently recent NEWS scores were available (2.3/5), and how frequently key clinical information was on hand during the call (1.9/5). Many trainees were made to feel uncomfortable or like they were being difficult for requesting more information (3.2/5). And calls were often noted to not be relevant (3.9/5) or were confusing/unclear (3.9/5).

A second questionnaire was completed 1 month post-intervention by the doctors working the on-call rota in that time (n = 6). 100% reported some improvement, 33.3% reported significant improvement. Improvements included average call quality (4/5), frequency of recent NEWS (3.7/5), and availability of Key clinical information (3.5/5).

Blank space feedback highlighted the tool's clarity and simplicity.

This QI project was able to highlight and address a key issue in clinical care in a simple, and very low cost manner. Improvements were demonstrated after one month of intervention, and a more in-depth trust-wide rollout of the project is being discussed.

The Care Quality Commission report (Smiling matters: oral health care in care homes) showed that too many people living in care homes were not being supported to maintain and improve their oral health. Lime Tree Garden is a purpose-built care home for up to 24 adults with mental health needs supporting people with enduring mental health illness to develop basic life skills so they can live supported in the community.

This is a quality improvement project aiming to improve oral health and to reduce the burden of oral diseases in people with mental disorders and ensure timely access to dental treatment in Lime Tree Gardens through meeting the NICE quality standards of care.

Auditing current implementing status of oral health procedures in place and comparing with NICE guidelines and quality standards: 1) Adults who move into a care home have their mouth care needs assessed on admission; 2) Adults living in care homes have their mouth care needs recorded in their personal care plan; 3) Adults living in care homes are supported to clean their teeth twice a day and to carry out daily care for their dentures. For each patient, their dental care plan is recorded and compared with NICE guideline.

There are challenges and space for improvement while implementing Oral health toolkit for adults in care homes at Lime Tree Gardens. A significant amount of patients (>90%) have unmet needs in terms having oral health.

There is a need to address the dental health challenges in this vulnerable population with recurrent and enduring mental illness. It is important to integrate and highlight dental health, as an important part of physical heath into the overall medical management of patients with severe mental illness in residential rehabilitation psychiatry.

Menopausal symptoms often go unrecognised in individuals with intellectual disability (ID). There is growing societal awareness of the impact of menopause on mental health, yet this has not been replicated in the ID population. In light of this, we wanted to establish the current levels of knowledge, confidence and skills of staff working in a specialist community intellectual disability service (CIDS). The findings from the survey may help identify ways of improving awareness of menopausal symptoms with individuals with ID.

We performed a cross sectional survey of staff views and practice in relation to considering and discussing menopausal symptoms with individuals with ID. The survey was anonymous, and conducted on Microsoft Forms. A mixture of quantitative and qualitative data was captured. A QR code linking to the survey was disseminated to the whole team (60 staff) via email and in-person staff meetings.

There was 50% (30/60) responses to the staff survey. The majority of respondents worked in either health (16/30) or social care (12/30). Two thirds of respondents either agreed or strongly agreed (20/30) that discussing menopausal symptoms was part of their role. 57% of respondents (17/30) felt confident discussing menopausal symptoms with service users, while 20% (6/30) felt neutral and 23% did not feel confident. 90% (27/30) of respondents either agreed or strongly agreed that they would benefit from teaching and training in the effects of menopause in our service users. Thematic analysis of the free text responses revealed that staff wanted to understand treatments available for menopause as well as improved easy read material explaining menopausal symptoms to individuals with ID.

Our survey revealed a spectrum of confidence levels in discussing menopausal symptoms with service users, and a large appetite for further training and resources to aid these conversations. In light of the results from this survey, a Quality Improvement (QI) project has been initiated. Once QI change ideas have been tested, a repeat survey will be completed to compare staff views and confidence in this area and in this way measure the effectiveness of those changes.

To create an information poster for the doctors’ on-call room and doctors’ office at Fieldhead Hospital (a Psychiatric Inpatient Hospital in Wakefield) to improve readily available practical information to doctors whilst on-call.

Background – Psychiatry on-call shifts can feel daunting, especially if this is the clinician's first (and perhaps only) exposure working as a doctor within this specialty. Psychiatric hospitals are not equipped to deal with physically unwell patients which can be challenging especially as the only junior doctor on-call out of hours. Although there is a comprehensive induction programme, doctors in training raised concerns that there is insufficient, readily available practical information whilst on-call.

Surveys were sent out to doctors in training to ascertain their initial viewpoints about producing a poster and which information they feel should be included. Doctors included were foundation years, GP and core trainees on their psychiatry placement in the South West Yorkshire Partnership NHS Foundation Trust. Both qualitative (free text responses) and quantitative information (yes/no responses) were obtained via SurveyMonkey. An initial draft poster was produced and sent out to all doctors in training as well as the project lead and clinical lead. The poster was amended accordingly. The posters were printed and displayed in the on-call rooms and doctors’ office.

Four respondents responded to our initial pre-poster survey. They were highly receptive to the suggestion that this information would be in poster format to provide easily accessible information to help whilst on-call. Key topics identified for the poster included navigating logistical issues and information on-site, clerking new admissions and the relevant investigations required, important telephone numbers, personal safety and where and how to access relevant information and guidelines.

Feedback regarding the initial draft poster survey and the included information was also positive. Seven respondents replied and overall, they felt that the poster provided the relevant information. The project supervisor and clinical lead also provided constructive feedback and identified that locating risk assessments and discussing with a consultant when a patient is recalled to hospital on a CTO should also be included. The initial draft poster was amended following this feedback.

In conclusion, we found that there was an unmet need for easy to access logistical information regarding on-call work. The on-call poster provided the necessary information in a succinct and clear manner which the trainees benefited from.

We sought to determine to what extent guidelines regarding 72 hour follow-up and 6 week medical review were being followed in a Community Mental Health Team in Brixton. Further, we aimed to find out what was happening in situations where these guidelines were not met, then implement interventions to ameliorate some of the identified barriers.

First, we conducted a retrospective review of all patients discharged from any hospital or home treatment team, over a time period from 01/07/2023 to 01/11/2023. Patients with discharge dates not in this timeframe, or those still admitted to hospital, were deemed ineligible and excluded. We extracted the dates of discharge, 72 hour follow-up, and medical review, and calculated percentages of patients who received follow-up in the required time who should have received it. Supplementary data on care-coordinator contact within a month, and primary support contact were gathered as well.

Our primary intervention was direct engagement with the involved community mental health team, delivering the findings of our retrospective review in an oral presentation on 01/11/2023. We also designed an informational poster to be disseminated among the team as well as a discharge template proforma for care coordinators to bring to patient discharges to help them acquire vital contact information details. Following the intervention, we gathered the second round of data in the same way as described earlier, from 01/11/2023 to 19/01/2024.

A considerable improvement was noted in the rate of 6 week medical review, with 69% of patients successfully achieving this target in the post-intervention population (n = 18), as compared with 56% in the pre-intervention population (n = 18). However, no significant change was observed in rates of successful 72 hour follow-up between the populations (63% to 58%). This was attributed to deep-rooted barriers such as lack of robust communication services between the wards and community mental health teams, which potentially shows a need for development of underlying system integration. Qualitatively, positive feedback was given by members of the team who described dedicating more time than previously on checking if patients have been followed up on time.

Overall, we demonstrate moderate success for a low-intensity quality improvement intervention bringing about significant improvements in 6 week medical review compliance. Interestingly, our results indicate that the longer-term 6 week medical review may be more amenable to our awareness-based intervention than 72 hour follow-up, suggesting a different array of logistical barriers between the targets.

Induction training is a crucial part of starting work in a new organization as it orientates new staff to their work role and environment, which ensures that they can work safely and competently. Given the wide geographical area of North Wales, there is logistic difficulty to continue with face-to-face induction sessions for new junior doctors. A digital format for regional induction for new doctors from all sites was introduced in 2021. This virtual induction has dealt with the accessibility problem effectively. Nevertheless, there seemed to be some ongoing issues regarding organising the session with speakers due to overlapping clinical duties. Therefore, a quality improvement project has been initiated to improve the delivery of the sessions with minimal disruption to clinical duties. This paper is aimed to share the preliminary experience of the process of digitalisation of the induction programme.

The pilot regional induction with the above changes was carried out on August 4, 2023 via Microsoft Team Meetings and was accessible to new starters from all three sites in North Wales. The sessions consisted of talks from consultants, the lead clinical pharmacist, the ST in psychiatry and clinical services/Rota coordinator. The induction was divided into morning and afternoon sessions. The participants consisted CTs in psychiatry, GPSTs, and FY trainees. The session was recorded and a pre-recorded session on history taking was introduced. Any queries about pre-recorded session were answered by the chair of session.

It was found that an estimated time saved per induction was 285 minutes with an overall saving for 3 inductions per year of 14.25 hours. The estimated cost saved (based on the lowest pay scale in NHS, £) was £151.13 with an overall saving for 3 inductions per year of £453.39. There were two Assessments of Teaching (AoT) and two Direct Observations of Non-Clinical Skills (DONCS) signed.

Digitalising the regional induction helps to save both time and cost for the health board. It also reduces the risk of speakers in availability. Furthermore, the recording can be sent out early to all the JDs before they join MHLD, which can facilitate a quicker orientation into the new role. It is also a good opportunity for core and specialty trainees to achieve competencies for leadership and teaching.