To develop and evaluate a tailored teaching session for local non-medical primary care staff on common CAMHS (Child and Adolescent Mental Health) conditions. It was hypothesised that quizzes administered before and after the educational session would evidence an improvement in clinician's knowledge of these clinical presentations.

Invitations were extended to all local PCNs to attend educational sessions held on four separate occasions in December 2022 and January 2023. Multiple choice quizzes were administered before and after a presentation on four common CAMHS conditions. The presentation and quizzes covered the presentation, diagnosis, and management of autism, eating disorders, depression and emotional dysregulation. Quizzes were scored out of a maximum 16 points with four questions per clinical condition. A paired T-test (following tests for normal variance) was performed using JASP software to compare the before and after scores.

A total of 22 non-medical clinical staff attended the sessions. This included physician associates (n = 1), allied health professionals (n = 5), practice nurse (n = 3), care coordinator (n = 3), health care assistant (n = 4), social prescriber (n = 1), mental health practitioner (n = 3), advanced clinical practitioner (n = 1) and advanced nurse practitioner (n = 1). For the 22 pairs of quizzes, mean differences and 95% confidence intervals (CIs) were calculated between before-and-after scores. The mean difference between total score was 6.9 CI [6.1, 7.7] which was statistically significant (p < 0.001).

More than 31,000 additional staff have been recruited into healthcare roles at general practices across the country since 2019 to meet soaring demand for primary care services. Since the pandemic record numbers of children and adolescents are presenting with mental health difficulties, therefore, it is likely that primary care clinicians will encounter these presentations in their practice. Our results suggest that such a tailored approach can offer effective means in improving knowledge in this growing group of professionals. Such sessions may also provide informal spaces in which to network with secondary mental health professionals, improving links between services.

Neuropsychiatry is a new and burgeoning field of medicine that combines neuroscientific principles with neurology and psychiatric medicine. Currently, there is little to none medical school literature and/or teaching in the subject. Re-integration of Neurology and Psychiatry disciplines has been recommended, especially in undergraduate and graduate medical training as well as in research. Neuropsychiatry disorders are considered one of the most important causes of disability by the World Health Organization. As a concept, Neuropsychiatry is still not clear on a global scale, from neurological examination to medical school teaching. There have already been active efforts to design and implement Neuropsychiatry training to post-graduate trainees worldwide, particularly in USA, Australia and UK. However, there seems to be no such endeavours towards teaching medical students the role of the brain in the manifestation of neurological as well as psychiatry symptoms. We set out to complete a targeted literature review looking for Neuropsychiatry teaching, if any, in medical schools worldwide.

A systematic literature search of relevant key phrases was carried out in PubMed and Google Scholar databases. These phrases were searched between 29–31 January 2024 aimed to encompass the full scope of available teaching resources and materials across psychiatry and neurosciences worldwide. These searches included:

1. (((Neuropsychiatry) AND (Medical students)) AND (Medical school)) AND (Medical education)

2. (((Neuropsychiatry education) AND (training)) AND (medical students)) AND (Medical education)

3. (Neuroscience-in-psychiatry) AND (medical school)

4. ((Neuropsychiatry) AND (Medical education)) AND (Medical students)

5. Further reading was completed from the selected articles (six in total).

A total of 324 results were found from systematic literature search after leaving out the duplicates, of which only 6 articles were included as relevant to aim of our study. None of the articles described clear Neuropsychiatry teaching to the medical students.

Our review highlighted a distinct lack of Neuropsychiatry learning outcomes within medical school curriculum. Neuroscientific principles and methodologies are incorporated in treatment of patients, rationalising clear differentiation between neurology or psychiatry, but the overall picture from both disciplines and utilisation towards diagnosing and managing the cluster of symptoms manifesting from aberrant brain processes is still unclear. In line with previous research around education measurement, we propose that fundamentals from both Neurology and Psychiatry need to be introduced as clinical neuroscience early in medical school and this can be further continued.

The importance of the humanities has been highlighted in developing a holistic person-centred model of psychiatry. The use of film to explore topics related to psychiatry, known as ‘cinemeducation’, has been shown to encourage reflection. Wellbeing has been identified as a key area in the quality of psychiatry training, however there is currently no evidence exploring the wellbeing and educational benefits of ‘cinemeducation’ within psychaitry training programmes

Our primary aim was to measure the impact of ‘cinemeducation’ events on attendees’ wellbeing and professional development, with a secondary aim to explore attendees experience of ‘cinemeduation’.

The hypothesis is that attendees will experience a wellbeing and educational benefit from the initiative.

6 events were assessed between January and August 2023. Each event involved the showing of a feature length film, followed by a 30-minute discussion. 4 out of 6 events were facilitated by guest speakers, usually a consultant psychiatrist. Following events, questionnaires were distributed which included a series of statements with Likert scales and open ended questions. Mean Likert scale scores were calculated with qualitative data interpreted by the authors using thematic analysis.

A total of 108 trainees attended events, predominantly core trainees (64.52%). All events scored consistently high for self-reported wellbeing, however facilitated events demonstrated higher scores for self-reported reflective and educational benefits. The themes derived from qualitative data were of ‘cinemeducation’ being a novel educational opportunity where attendees were able to use film to work through challenges associated with psychiatry, as well as being an opportunity for connecting with other trainees, where attendees could share experiences and foster a sense of community.

Core psychiatry trainees in particular, appear to value ‘cinemeducation’ as a tool to connect with their peers and develop their understanding of psychiatry in a relaxed, but stimulating environment, which is best achieved under the guidance of a senior colleague. The study suggests that the introduction of ‘cinemeducation’ across psychiatry training programmes would benefit trainees’ wellbeing and development. Further research is required to assess the impact of such initiatives across a broader cohort of trainees, using more robust methods of data collection, as well as formal measures of skills such as reflective functioning.

In recent years, there has been an increasing recognition of the importance of leadership skills to doctors. However, these skills are not usually formally taught or assessed. This study aims to evaluate the impact of using coaching as a novel technique to support Psychiatry trainees in developing leadership skills.

This poster summarises a primary research study which evaluated an educational intervention using a mixed-method approach.

All Higher Psychiatry Trainees at the Tavistock and Portman NHS Foundation Trusts were given an opportunity to enrol on the Coaching for Consultant Psychiatrist Leadership Pilot Programme. Those who enrolled (coachees) were offered five 90-minute one-to-one sessions with Psychiatry consultants (coaches) who received training in Coaching for Leadership. Coachees completed a self-assessment questionnaire examining their views on their own leadership skills before and after completing the programme. Questions used were adopted from the High-Performance People Skills questionnaire (HPPS) – a tool used to collect 360° feedback as part of leadership training. Coachees and coaches also attended separate focus groups to discuss their subjective experiences of receiving and providing coaching. Thematic analysis was carried out.

Eight coaches and seven coachees participated in the study. Most HPPS self-assessment scores post-intervention have increased after completion of the course. Overall coachees' satisfaction with their leadership skills increased from 3.4/5.0 to 4.0/5.0 after completing the programme.

Focus groups yielded rich qualitative data. The themes identified were: a broad range of reasons for Trainees and Consultants to join the programme, positive impact on coaches’ coaching skills, positive impact on coachees’ leadership skills and ideas on how to improve the programme to inform future curriculum design or improve implementation of any educational interventions.

Psychiatry Trainees’ self-perception of leadership skills can improve after receiving coaching. They find coaching helpful due to its individualised nature and the fact that it promotes the application of skills in real-life settings. Coaches also benefit by gaining new skills in coaching and leadership. Coachees and coaches share similar motivations for joining, including the desire to learn new skills, support others and be supported. More research is needed to evaluate the practical aspects of delivering coaching for leadership programmes as part of speciality training, but its potential is promising.

Our mental health placement has a longitudinal design and students spend one day per week in psychiatry throughout their academic year, attending clinical placement and academic days on alternate weeks. Academic days include a small group tutorial, Balint group and self-directed learning, during which students are expected to complete a ‘virtual patient’ (VP) e-learning module. VPs align with the topic of their small group tutorial and are intended to facilitate their learning. Despite this, only a minority of students complete them. Our aim is to investigate and iteratively design interventions to improve uptake of learning.

Using an iterative process, we explored potential reasons for low student uptake by reviewing routine feedback from faculty and students; most tutors and students were unaware of the e-learning. We hypothesised that increased faculty awareness and promotion of VP could lead to an increase in student access numbers. The intervention was therefore of improved communication amongst faculty by fortnightly newsletter emails which include the topic of the academic day, explanation around what is expected of students with the website link to the VP, and other useful resources tutors may wish to use. Emails are sent by medical education administrators in the week before the academic day to all tutors. Access logs for the previous (2022–2023) and current (2023–2024) academic year were obtained so comparison could be made pre- and post-intervention.

Results are available for 4 modules; thus far we are yet to see significant differences in engagement. There was a technical glitch for one module and for the other modules the difference in student access has been minimal (<5%). We also have qualitative feedback from 5/28 tutors. One was confused and thought they were being asked to do additional work, one requested for information about the VP without realising it was included in the newsletter email, and three said they found it helpful.

Fortnightly email newsletters is a simple and cost-effective way to possibly improve communication within faculty. It is likely difficult to promote student engagement with activities that their tutor is unaware of or perceives as invaluable. However there remain real challenges of using email as a communication tool for busy clinicians and is unlikely to make a difference as a stand-alone intervention. For future development we plan to include medical students and clinical supervisors as recipients in the mailing-list and spend time on a faculty development day to further explore this issue.

The 2024 National Student Psychiatry Conference, hosted at the University of Sheffield with the theme 'Me, Myself and I,' explored the intersection of the ‘self' and the ‘other.' It delved into the dynamics of individuals in the context of their lived experiences, environment, and emerging paradigms within psychiatry and beyond. Talks and workshops aimed to heighten attendees’ interest in psychiatry by challenging societal stigma and traditional norms and expanding their perspectives of psychiatry.

The pre-conference questionnaire included attendees’ year of study, university/NHS trust affiliation, current likelihood of pursuing psychiatry and career aspirations, knowledge of conference themes, and ten subspecialties represented at the conference via a faculty carousel. The post-conference questionnaire enquired about changes to the above aforementioned factors, to explore changes in career aspirations. Standardized dropdown options were used in both forms to facilitate data evaluation.

71 attendees were included in the final evaluation; 17 were excluded due to duplication or not completing both forms. Of the attendees, 31% were in their pre-clinical years, 56% were in their clinical years, and 4% were doctors. 9% of the participants were non-medical attendees.

Demographics of attendees included a majority from Yorkshire and Humber (52%), Midlands (11%), South England (6%), North England (10%), North East (8%) and Others (13%).

21% of attendees had been to a prior psychiatry-related conference and 34% were currently taking part in or had completed a psychiatry-related project in the past.

The level of interest in attendees aspiring to pursue psychiatry increased from 62% to 72%. An increased interest in medical psychotherapy (82%), forensic psychiatry (68%), and perinatal psychiatry (67%) after the faculty carousel was observed.

Following the conference, 97% reported increased knowledge of each theme. Findings from the faculty carousel revealed that, on average, over 90% of attendees reported an increased understanding of each speciality represented.

The National Student Psychiatry Conference plays a significant role in increasing exposure of psychiatry to medical students and increasing their understanding of the diverse career paths within the speciality. The conference fosters networking opportunities and facilitates meaningful connections within the field, positively influencing attendees' considerations and perceptions.

RAMPPS (Recognising and assessing medical problems in Psychiatric settings) training was set up over a decade ago by the then Health Education Yorkshire and Humber Task Group of Clinical skills project workers. Main aim was to address the Physical health agenda in mental health. It was felt that the clinical and support staff in psychiatric settings lacked confidence in recognising and managing physical health issues early on, possibly due to inadequate training in this area. RAMPPS course was designed to address this gap. The course is set up as a face to face multidisciplinary, interprofessional simulation based training with simulated actors, mannequins and other hybrid teaching models .Like any such training, there is a constant need for resources, mannequins, simulated actors, space and funding which could limit the extensive use of this training. We adapted this face to face teaching model for virtual audience to deliver an interprofessional interactive adaptable teaching module using realistic scenarios.

We adapted some of the scenarios from the RAMPPS module which suited the virtual audience and incorporated into Power point presentation and using an interactive teaching software called Slido we developed Virtual RAAMPPS.

Conducted a few trial sessions within the team and later produced a sample scenario and presented to the medical education team at the trust. The main teaching is the interactive discussion whilst going through the scenarios allowing an impact as close to a face to face teaching as possible.

Next is to do a PILOT Virtual RAMPPS morning session delivered to a group of trainees (psychiatry and foundation trainees) and gather detailed feedback and continue to deliver the pilot teaching a few more times at other avenues and continuously modify the teaching based on the feedback.

Collecting Qualitative feedback from PILOT conducted.

The aim is not to replace simulation based face to face training, but to provide a near enough realistic virtual experience of real life scenarios and to think through them in a systematic and structured way thus enabling better management of some of the physical health dilemmas faced in our psychiatric settings.

It provides the multidisciplinary staff a functional working knowledge of common physical health conditions and its complications encountered in psychiatric setting. The teaching can be modified based on the audience by changing the scenarios relevant to that area of clinical practise or of the patient group.

Allowing anonymity in responses provides a non-judgemental and safe place to make mistakes and eventually improving patient safety and staff experience within Psychiatry.

Competence in delivering psychotherapy is a mandatory part of the core trainee (CT) curriculum, as mandated by the Royal College of Psychiatrists. CTs who are confident in delivering psychotherapy may provide more meaningful benefit for patients receiving therapy. Simulation is a well-established educational modality but is not widely utilised to teach psychotherapeutic competencies. We aimed to ascertain the views of current CT doctors regarding the use of simulation in psychotherapy training. A greater insight into learning needs would guide development of novel simulated psychotherapy educational resources. This was deemed a priority area for Simulation Based Education in the North West School of Psychiatry.

Primary data were collected from a virtual focus group of CTs (n = 3) from the North West School of Psychiatry, UK. All CTs in the region were invited to take part, participation was voluntary and informed consent was obtained prior to participation. The focus group was transcribed, analysed and data anonymised to ensure confidentiality.

Participants expressed concerns about embarking on their first psychotherapy case with subthemes relating to: insufficient experience and training in psychotherapy prior to starting a case, the ability to provide an effective intervention for patients and progression through core training. Ideas for how simulated learning may help trainees develop skill in psychotherapy centred around: introductory teaching (with opportunities to watch recordings of simulated patient encounters, examples of psychotherapeutic techniques used as well as using simulation to experience psychotherapeutic supervision) and having opportunities to actively participate in, and observe, individual or group role plays. Engagement with professional actors and psychotherapy faculty during role plays was identified as a priority. Finally, the notion of an introductory Psychotherapy Simulation “one day workshop” was proposed.

There are many ways in which psychiatry CTs' anxieties regarding psychotherapy may be addressed. They may feel better prepared to embark on undertaking therapy clients by engaging in simulated learning opportunities: whether this be actively taking part in role plays and simulations or accessing pre-recorded content of pedagogical simulations outlining underpinning psychotherapeutic theory. The findings from the focus group will be used to inform development of a novel Psychotherapy simulation resource. This will aim to improve the quality of Psychotherapy training in the North West and foster trainees’ confidence in conducting therapy sessions. Psychotherapy faculty will also be interviewed in a subsequent Focus group. Co-production of resources with stakeholders could maximize acceptability and help to maintain ongoing engagement with the project.

To make a case for E-prescribing within the Paediatric Neurodevelopmental Team in Wrexham Maelor Hospital.

To trial a different way of approaching 6 monthly reviews within the ADHD clinic (option for remote reviews).

To show how we could reduce the carbon footprint of the ADHD clinic.

Process mapping was completed to consider areas in the ADHD prescribing process that could be made more sustainable.

For each patient appointment in the ADHD clinic a questionnaire was completed. The data collection period was over 3 weeks during August and September 2023. Data was collected and interpreted.

99 appointments were offered, 82 appointments attended. 77 appointments were face-to-face and 22 were via telephone. Of the face-to-face appointments, 54 families travelled in by car and 4 used public transport (2 taxis). Of those who commented 31 people found it hard to find parking by the clinic, 13 people did not.

Of the appointments attended face to face via car/taxi (57):

• • Average of 4.4 miles travel to the clinic (8.8 miles total journey)

• • Shortest journey 1.1 miles (2.2 miles total journey)

• • Longest journey 16 miles (32 miles total journey)

• • Total patient mileage for these appointments (assuming travel to and from clinic) 855.8 miles

• • Average journey 0.005t CO2

• • Total journeys 0.472t CO2

• • Assuming average sized petrol car used

• • Extrapolating this data for a whole year approximately: 8.024t CO2 from patient journeys to and from the ADHD clinic

We have made a case for e-prescribing within the ADHD clinic in Wrexham Maelor Hospital.

The current system impacts on:

• • Patient and carer's travel time and convenience.

• • Clinician's travel time.

• • Carbon emissions.

To replace pre-existing paper-based and informal handover systems with a confidential electronic handover system for on-call doctors across a large South London mental health trust, thereby improving the safety and quality of handovers.

A quality improvement project was registered within our trust. At baseline, we surveyed core trainees, GP trainees, and locum doctors about their experiences using a paper handover system for on-calls at the Bethlem Royal Hospital and Lambeth Hospital, South London and the Maudsley NHS Foundation Trust (SLaM). Their feedback guided the implantation of a confidential and secure electronic handover system integrated into the trust's Microsoft SharePoint, using the Microsoft To Do app and then Microsoft Teams. We alerted doctors to these changes via formal and informal means, such as trust inductions, emails and through communication with trust junior doctor representatives. After a period of 8 and 24 weeks, we assessed the initiative's success by collecting both qualitative and quantitative data from on-call doctors about their experience with the handover system. Based on feedback, we made multiple adjustments to improve the system, which was later adopted at Lambeth Hospital. The Microsoft To Do app was then replaced by a channel on Microsoft Teams to ensure wider access.

15 doctors responded to the baseline survey. Handover practices were varied and included paper-based handovers, phone calls, and emails. Mean doctors’ ratings for the pre-existing handover systems were 3.2/5 for overall quality (1: very poor; 5: very good) and 2.7/5 for safety (1: very unsafe; 5: very safe). 60% (n = 9) of doctors said tasks would sometimes be missed in the pre-existing handover system. 21 doctors responded to 2 post-change surveys. Mean doctors’ ratings of overall quality were 4.6/5 and safety were 4.5/5. Qualitative feedback highlighted that a verbal handover was still necessary to complement the electronic system, and that locum doctors would need to have access to the system as well as consultants and registrars during periods of industrial action.

An electronic handover system was successfully implemented to replace a predominantly paper-based handover system at two large mental health hospitals in South London, and on-call doctors reported improvements in handover safety and handover quality. Future work aims to implement a consistent electronic handover system across other hospitals in SLaM and other trusts and transition fully to Microsoft Teams for broader accessibility.

Stopping Overmedication of People with a Learning Disability, Autism or Both (STOMP) is an initiative of NHS England. This was in response to concerns raised as a result of the Winterbourne View scandal related to the inappropriate use and insufficient arrangements for the review of the prescription of psychotropic medication.

33,000–35,000 individuals with an intellectual disability (ID) are prescribed psychotropic medication daily. 20–45% are on antipsychotic medication, of which 14–30% take these to control behaviour problems rather than for specified psychiatric conditions. Psychotropic medications can have side effects with the potential to significantly impair an individual's quality of life.

This audit is to observe current practice of the prescription of psychotropic medication, with a view to identifying changes to the compliance with recommendations and outlining areas for further improvement in line with the Stopping Overmedication of People with a Learning Disability, Autism or Both (STOMP) initiative.

Data was collected from electronic records for randomly selected patients, 20 from each of the 4 Community Learning Disabilities Locality Teams within the Trust. The patients who were not currently prescribed psychotropic medication were excluded from the randomly selected samples.

There was good evidence that capacity, consent and best interests were considered, as well as multidisciplinary input. There was also good evidence of regular review of medication, side effects and treatment response. The results suggests that psychotropic medication continues to play a significant role in the management of patients presenting with behavioural problems, and more needs to be done to identify approaches that will help to reduce their use.

In this patient group it is sometimes the case that medication is prescribed legitimately for indications other than their British National Formulary (BNF) recommended use. However, the findings suggest that the rationale could be more clearly recorded. Close collaboration with primary care to provide a comprehensive medication history, the involvement of carers and family members in the active preparation for effective medication reviews and the involvement of the multidisciplinary team should continue to be encouraged and clearly recorded.

The aims of this project were to improve patient education and overall information distribution within the Memory Clinic within the Old Age Psychiatry department, based at Kingsway Care Centre, Dundee.

This project originated, after there were concerns raised from relatives of a patient who had recently been assessed in the Memory Clinic. A suggested area for improvement included distributing information to patients, highlighting any potential tests or topics of conversation that may be explored during a Memory Clinic appointment. In response, our team engaged in a thorough collaboration with our colleagues in Psychiatry and the Post-Diagnostic Services (PDS). As a result of this partnership, a summary sheet was compiled, highlighting the spectrum of cognitive testing and assessments that may be conducted, potential medicinal treatments and other significant considerations, including driving and Power of Attorney statuses. To ensure these resources were both accessible and informative, they were systemically distributed to patients. The materials were paired with feedback forms to capture patient experiences and insights, to be later collected by the PDS.

Whilst this project remains in the data gathering stages, provisional data has been very promising in showing improvement in clarity of information delivered to patients (both in current and future assessments), explanation to patients regarding medication and treatment options, and overall patient satisfaction.

Optimising educational resources for both patients and families attending the Memory Clinic through summary documentation can be utilised to improve overall patient satisfaction. Aiding patients’ understanding of their diagnosis and further management of this, allows them and their families to feel more included in their care and optimises the delivery of holistic care within Psychiatry of Old Age.

Promoting the well-being of staff is paramount within mental health services. However, a common issue arises where administrative personnel, often serving as the primary point of contact for service users, engage in mental health-related interactions without formal training. This deficiency can adversely affect their well-being, leading to diminished team morale and increased staff turnover, consequently impacting the quality of care provided by the Neighborhood Mental Health Team (NMHT). Moreover, it can contribute to dissatisfaction among service users, jeopardizing their rapport with the service. We aim to improve the wellbeing of staff and service users and to optimize service delivery at the local NMHT.

Data were gathered from a local NMHT catering to 1200 service users in the borough of Tower Hamlets in London. A pre- and post-implementation questionnaire was administered to both service users and six administrative staff members. The questionnaire highlighted several areas for improvement, including a lack of mental health understanding among administrative staff, reported low confidence when handling certain phone inquiries, and service user complaints. Change initiatives were then devised to address these concerns and evaluate their impact on enhancing the experience for both service users and administrative staff.

Administrative staff uniformly expressed the need for increased mental health training prior to commencing their roles. Implementation of targeted change initiatives led to noticeable improvements in service user satisfaction and staff confidence in managing phone interactions. These enhancements culminated in an overall advancement in service delivery.

Through the strategic implementation of change initiatives informed by our initial findings, we not only augmented mental health literacy among administrative staff and service users but also bolstered their well-being. Consequently, this directly translated into an amelioration of local service offerings. Further research is warranted to ascertain the long-term efficacy of these innovative interventions.

Following discharge from inpatient to community psychiatric services, the first 7 days is the most vulnerable and associated with an increased risk of suicide. According to the NICE Guideline 53, it is recommended that patients discharged from inpatient psychiatric services should be reviewed within 7 days by the relevant community services. Our aim was to determine how well we are adhering to this recommendation, appropriately documenting the appointment in the patients' discharge documents as well as the number of patients that attended the appointment.

We collected data on an excel spreadsheet of patients discharged from Huntly ward (a General Adult Psychiatry ward) in the Royal Cornhill Hospital from 01/09/2022 and 14/10/2022 (a period of 6 weeks).

The data collected included name, CHI, date of admission and discharge, community mental health team, follow-up appointment offered, appropriate documentation on Core discharge document and whether the patient attended the appointment.

After the first audit cycle, we had a discussion with the junior doctors on the ward highlighting the importance of 7 day follow up and the need for arranging with the Community mental health team prior to the discharge, documenting a date, time and name of the clinician for the 7 day follow up in the Core discharge document. We also encouraged the use of reminders like using the doctors' diary book on the ward to document anticipated discharges and adequate hand over of patients to the community mental health team at the start of each week's Multidisciplinary Teams meeting.

We subsequently did a re-audit on patients discharged from Huntly ward between 04/04/2023 and 12/05/2023 (6 weeks). We compared the results from the first cycle and the second cycle to identify a change.

First Audit cycle.

Over the 6-week period, 27 patients were admitted into the Huntly ward and 23 patients were discharged.

48% (n = 11/23) of discharged patients were offered a follow up appointment.

91% (n = 10/11) had this appointment documented in the Core discharge document.

100% (n = 7/7) attended the 7 day follow up appointment.

Re-Audit.

Over the 6 week period, 16 patients were admitted and discharged from Huntly ward.

81% (n = 13/16) were offered a 7 day follow up appointment and this was documented in the Core discharge document.

100% (n = 13/13) of the patients attended their 7 day follow up appointment.

The result showed good improvement from 48% to 81%.

Using reminders, properly liaising with the community mental health team, appropriately documenting a named clinician, date and time for the 7 day follow-up ensures that the patient attends.

The importance of offering support during the first week after discharge from psychiatric hospital should continue to be emphasized to prevent adverse outcome during this vulnerable period.

To ensure smooth running of Multidisciplinary team (MDT) in Community mental health team (CMHT) and reviewing MDT structure for better functioning at Parkview Mental health Resource centre.

On a Friday two Multidisciplinary teams (MDTs) were running online on Microsoft teams simultaneously. The same staff was running the two MDTs, so staff input could be limited at times and staff would dip in and out of MDTs. Discussion around ways of improving this so that both MDTs run smoothly. Also, there was no formal structure to MDT meetings. It was decided that improvement in Quality of MDT needs to be addressed.

Initially numerous discussions held online with Parkview team, nursing colleagues.

CMHT Quality improvement group was set up and a meeting was arranged where everyone's ideas were considered.

A pilot project was first introduced in March 2022 and audited in July 2022. Plan, do, study, act (PDSA) cycle was carried out.

Plan

Two nursing teams to be setup which will feed back into the two MDTs on alternate weeks. This will reduce nursing teams having to come in and out of one MDT to join other MDT, hence increasing the efficacy of the MDT.

Devise a new template to provide formal structure for the MDT presentation.

Do

Trial the new setup of two nursing teams.

Study

Ask all MDT staff members for feedback on the working of MDT.

Act

Reformat the Structured template and distribute to all staff members.

100% staff felt that new structure of MDT was useful.

84% staff satisfied with the new way of running of MDT.

84% staff satisfied with having designated teams for MDT.

Having Designated MDT teams and a structured format helped in robust functioning of the MDT in the CMHT.

Psychiatric inpatient hospital, although part of secondary care, is separate from a physical health hospital and therefore does not have access to electronic referral systems, which increases efficiency of referral processes. As part of an admission clerking for all inpatients in psychiatric hospitals, the admitting doctor takes a history of past medical issues, a physical examination, electrocardiogram and bloods. Depending on findings, further radiological and cardiac investigations may be warranted. Not having access to electronic referral systems can cause delay in delivering treatment for psychiatric inpatients, especially when referral pathways is unclear. The aim of this quality improvement project is to increase the knowledge of referrers in order to improve efficiency completing referrals and reduce incorrect referrals. With clinicians able to refer for routine imaging correctly and in an efficient manner, it is hoped that this will correlate with an improved quality of care received by patients.

Firstly we assessed the knowledge of currently employed trainee doctors, via a web-based survey, on how to refer for routine and commonly ordered radiological and cardiac investigations. Employed referrers included core trainee, GP and foundation year trainee doctors. We then created an electronic referral pack which includes a guidance and referral forms provided to clinicians when they start employment at Lambeth hospital and accessible to current trainees. A follow up survey then reassessed the knowledge of these referrers.

There was a total of 11 responses received from survey prior to sending out the electronic referral guidance pack, of which 100% believed that it would be helpful to have a referral guidance pack. A total of 4 responses were received after sending out the guidance. The surveys showed that there is improved knowledge of how to refer for routine radiological and cardiac investigations after guidance was sent. Prior to sending the guidance, 9.1% referrers were made aware of the referral process, and this increased to 50% after the referral guidance pack was sent out.

Trainee doctors in psychiatric hospitals require more support with physical health management in psychiatric hospitals, including referring for physical health investigations, as referrers cannot access electronic referral systems used in physical health hospitals. Results need to be correlated with clinical outcomes in future. A longer term project could include linking the electronic referral systems between psychiatric and physical health hospitals.

Clozapine, a second-generation antipsychotic licensed for treatment-resistant schizophrenia, has a well-documented side effect profile, the most common of which is decreased gastrointestinal motility. Clozapine-induced constipation occurs more frequently than blood dyscrasias and can lead to severe complications such as paralytic ileus and intestinal blockage; in extreme cases, it can be fatal, with a fatality rate of 20–30%. The risk of gastrointestinal hypomotility is most pronounced during the initial four months of treatment; hence, weekly assessments are imperative during this period. According to Lanarkshire's local guidelines, bowel habits should be assessed at baseline, during routine blood sampling, and ideally at every clinical interaction. Our audit aims to determine the frequency of bowel habit monitoring in inpatient settings and to ascertain the prevalence of laxative prescriptions among these patients.

Data were collected retrospectively from psychiatric inpatient wards in Lanarkshire for patients on Clozapine therapy. The review focused on electronic medical records to evaluate the regularity of bowel habit screening. Additionally, we examined the Hospital Electronic Prescribing and Medicines Administration (HEPMA) system to gather information on laxative prescriptions.

The audit revealed that bowel habit monitoring, which should be a standard practice at each clinical encounter, was found to be inconsistent. Regular assessments were documented for only 40% of patients. Monitoring was most thorough in rehabilitation wards, where patients on Clozapine had their gastrointestinal function assessed routinely through screening questionnaires. Furthermore, 80% of the surveyed patient population was documented as having been prescribed laxatives.

The documentation of bowel movements for inpatients on Clozapine was suboptimal, leading to the potential oversight of critical side effects. The audit highlights a discrepancy in adherence to national and Lanarkshire's local guidelines for the monitoring of inpatients treated with Clozapine. To rectify this, we recommend the implementation of a standardized screening protocol to assess constipation risk systematically. Proactive monitoring should be incorporated into regular clinical evaluations for patients on Clozapine, ensuring that this assessment occurs at every clinical interaction. This approach is crucial not only for patient safety but also for enhancing treatment efficacy and patient quality of life. Moreover, these measures will likely lead to improved documentation and compliance with established guidelines, thereby reducing the incidence of preventable complications associated with Clozapine-induced constipation.

The aim of our quality improvement project was to explore and improve care for patients who use sensory aids, with or without dementia, on an old age ward at King's College Hospital. We sought to do this by increasing the staff awareness of each patient's sensory needs and dementia status.

Guidelines state that sensory aids (glasses and hearing aids) are important in orientating patients with delirium and dementia, yet these devices frequently go missing during admission or are not being used appropriately. This could affect communication and therefore overall care, both physical and mental. It is widely understood that delirium and dementia are associated with increased morbidity and mortality. In this project we aimed to explore issues around sensory aid use and to identify and implement impactful changes.

2 Plan, Do, Study, Act cycles were conducted between October 2022 to February 2023. A driver diagram was created following staff interviews on the ward. The first cycle focused on increasing awareness of a form in electronic patient records (EPR) and the need for documenting each patient's sensory aid possessions and dementia status. This was done through bite-size teaching sessions to the team and monitoring of completion of this form. The second cycle included utilising a new laminated bedside checklist that is manually filled in and was aimed to serve as a visual cue of the patient's sensory impairment/dementia status. A survey was used at baseline and then repeated over the course of both cycles to evaluate awareness of staff (named nurse) of each patient's sensory impairment/dementia status on the ward.

Baseline survey showed that staff were unsure of the sensory aid needs (glasses, hearing aids, dentures) of 25% of patients and 46.7% when it came to dementia status. EPR form completion increased by 14% between 14/12/22 and 25/01/23, however this was not statistically significant. 18% of bedside checklists were filled after 4 weeks. Overall, there was a statistically significant decrease in staff not knowing the sensory impairment status (by 32%) as well as dementia status (by 40%).

Whilst uptake of the forms and bedside checklist was slow, the project did show an improvement in awareness of staff and our hypothesis is that this leads to better use of sensory aids. The next step would be to assess whether this leads to better care through further PDSA cycles.

This quality improvement project was conducted in an Early Intervention in Psychosis CMHT (Community Mental Health Team). We aimed to compare prescribing practices to the RCPsych gold standard for treatment of first episode psychosis. Following an initial audit, intervention was completed aiming to improve adherence to these guidelines and thereby the proportion of patients achieving remission.

An initial audit of the whole CMHT caseload (with exclusions for patients currently admitted to hospital, under the care of a home treatment team or awaiting assessment) was conducted in June 2021. This was completed from information contained in the electronic patient care record. This recorded for each patient details of whether an antipsychotic was recommended, if one was being taken, the dose, if remission was achieved and the number of previously trialled medications. Following this initial audit interventions were completed through designing a one-page flowchart to empower members of the wider multi-disciplinary team (in particular care coordinators) around prompting appropriate medication changes, with an accompanying education session. Following these interventions, a re-audit was completed in March 2023 and the two samples compared through descriptive statistics. In the first audit 269 patients were included (27 exclusions), and in the second 255 (49 exclusions).

The initial pre-intervention audit found that of patients taking medications, 33% (N = 172) hadn't achieved remission. In the follow up audit the proportion of patients taking medication without having achieved remission remained similar at 37% (N = 147). However, the proportion in this group receiving treatment on doses below the licenced maximum improved from 85% (N = 68) to 76% (N = 55). Those on treatment but not in remission who had sufficiently trialled 2 or more antipsychotics (and therefore would meet the criteria for treatment resistance) increased from 50% (N = 52) to 56% (N = 55). The proportion of this treatment-resistant group receiving clozapine remained low, but increased from 3.8% (N = 26) to 9.7% (N = 31).

This project demonstrated modest improvements in prescribing practice, with a small increase in symptomatic patients receiving gold-standard treatment both in terms of numbers of medication trialled and reaching maximum doses. However there remains a significant gap, with a large proportion of symptomatic cases still showing room for medication optimisation. In particular clozapine remains underutilised in this cohort, with only a small minority of patients who would meet the criteria for treatment-resistant psychosis being prescribed it. This leaves room for further interventions to improve prescribing practice.

• • The audit aims to improve the quality of physical health monitoring and physical health interventions that the EIP service provides to people with psychosis.

• • To ensure adherence to RCPsych standards for physical health monitoring in patients with First Episode Psychosis.

• • To ensure adherence to RCPsych standards for provision of required physical health interventions and health promotion in patients with First Episode Psychosis.

• • A retrospective case note audit and re-audit was conducted for 13 patients on the caseload of the North Wales EIP service from December 2022 to December 2023.

• • The case notes were audited against RCPsych standards for physical health monitoring and physical health interventions using an adapted version of the National Clinical Audit of Psychosis (NCAP) audit tool.

• • Alcohol and substance misuse screening status improved to 100% in re-audit.

• • There was significant improvement noted in Hypertension, Body Mass Index and Cholesterol screening.

• • Mental health medication review, advice or referral for diet and exercise with regards to weight gain/obesity and hypertension improved to 100%.

• • No specialist interventions were offered around health promotion and illness prevention as most of the patients were either not in the abnormal range, identified as high risk for developing the above mentioned physical health conditions or refused to have interventions for these conditions.

• • A definite increase was observed in frequency of interventions being reviewed and reoffered for those accepting and declining interventions at baseline.

• • Training for staff to complete bloods and physical health screening.

• • Increase availability of equipment to carry out physical health screening.

• • Monthly, three and six monthly prompts in the case notes for staff to discuss physical health interventions with patients.

• • Staff to use headings for physical health screening and interventions to improve documentation in case notes.