Aims: Individuals with ADHD and autism may face increased risks of cardiovascular issues or metabolic disorders influenced by both their neurodevelopmental traits and prescribed treatments. Ensuring consistent monitoring can help manage these risks and support better long-term outcomes. This paper explores the challenges of physical health monitoring in ADHD and autism and presents a quality improvement project aimed at enhancing monitoring practices in clinical care.

Methods: Challenges in physical health monitoring for individuals with ADHD and autism include variability in practice, limited access to medical equipment, space constraints in clinical settings, and the need for clearer guidelines. To address these issues, we conducted an assessment within the ADHD and autism service in Oxfordshire to identify essential materials for comprehensive monitoring of ADHD medications, antipsychotics, and antidepressants, alongside overall physical well-being.

Results: Key materials identified included blood pressure monitors, ECG machines, height and weight measurement tools, blood glucose and cholesterol testing kits, liver and kidney function tests, electrolyte testing kits, drug screening tests, and nutritional assessment tools. The assessment identified several challenges in physical health monitoring within ADHD autism service. Out of 12 assessed items, 58.33% had the necessary materials available, though essential equipment was not always present, and time constraints made integration difficult. Among those, 85.7% had functioning equipment, while 14.3% had non-functional equipment.

Conclusion: In ADHD and autism services, where psychopharmacology plays a central role in treatment, the importance of physical health monitoring becomes even more critical due to the side effects of medications such as stimulants, antipsychotics, and antidepressants. Inconsistencies in equipment availability, maintenance, and staff training were noted, leading to potential risks to patient safety, reduced efficiency, and increased costs. Recommendations include improved maintenance, acquisition of additional equipment, and enhanced staff training to ensure effective monitoring across services.

Aims: Raising concerns is an important duty for those working in medicine, which can have a broad impact on factors including safety, training, and wellbeing. This project aims to explore resident doctors’ experiences of raising concerns in psychiatry, including establishing awareness of available processes, and identifying barriers to utilising these. This work has been conducted as part of a wider Quality Improvement Project, aiming to improve resident doctor awareness and engagement with the process of raising concerns by overcoming identified barriers.

Methods: Resident doctors of various grades working in psychiatry within a six month period were invited to attend focus groups to gather information about their perspectives of raising concerns. Thematic analysis of focus group discussion was conducted. Quantitative data was obtained from an online survey which was sent to all resident doctors working in the trust for anonymous completion.

Results: 19 resident doctors attended focus groups. Thematic analysis of this content demonstrated five key themes with additional subthemes:

Repercussions (impact on career + feedback, wellbeing, reputation).

Futility.

Uncertainty (culture, acceptability, process).

Division (hierarchy, staff groups).

Variability (receptiveness, response, supervisor relationship).

25 resident doctors responded to the survey: 52% felt unfamiliar with the process for raising concerns; 5 respondents had raised a concern within the trust; 9 had experienced concerns that they had wanted to raise but could not.

Most concerns related to training (56%), supervision from seniors (31%), patient safety (25%), bullying/harassment (19%), and resident doctor wellbeing (13%). 16% of respondents felt that a barrier to raising a concern was related to race, sexuality, gender, or any other protected characteristic. 57% felt they were not taken seriously when they had raised a concern. 71% felt they had not received adequate feedback after raising a concern.

Conclusion: Resident doctors are experiencing a range of concerns, but many find that barriers prevent them from raising these. These barriers generally relate to uncertainty regarding the process, futility of raising concerns based on previous experiences, and fear of repercussions. This data suggests that there are issues resident doctors are experiencing that are going unreported, relating to their own training experiences as well as patient safety concerns. Focus group data has allowed us to have a better understanding of the barriers resident doctors face when raising concerns. Subsequently, we are working alongside resident doctors and key stakeholders using Quality Improvement methodology to trial the implementation of several change ideas to streamline the process of raising concerns.

Aims: People with Intellectual Disability (PwID) have a reduced life expectancy in comparison to the general population, and constipation has been identified as a contributing factor to mortality by the Learning Disability Mortality Review. As part of a broader Quality Improvement project seeking out ways to reduce the rate of constipation for PwID it was recognised that robust and long-term education of carers was lacking.

An online learning resource was created ‘Constipation in PwID for Social Carers’ to support those caring for PwID to recognise and appropriately signpost constipation-related issues.

The learning resource was created by healthcare professionals, and it was therefore deemed necessary to undertake Quality Assurance of the module to ensure it was appropriate in both content and tone for support workers working in the social care sector. The final module was developed therefore with the input of those it was aiming to teach.

Methods: Focus groups and feedback forms collected information regarding carer’s role, experience working with PwID, understanding and relevance of learning outcomes, overall quality, and suggested improvements of the learning resource. This was undertaken in focus groups, or on a one-to-one basis. Feedback forms were completed by 12 individual participants. Focus groups involved 20 participants total including community nurses, supported living managers, support workers, social workers, and occupational therapists.

Results: Overall, the quality of the draft learning resource was rated ‘excellent’ and the general feedback was that it was appropriately pitched for carers. Aspects of the draft that helped with understanding content involved the use of scenario based interactive questions and visual aids. The information which was considered most useful included the Bristol Stool Chart, red light signs of constipation, and statistics on the prevalence of constipation in PwID.

Suggested improvements for language were consistent terminology for PwID, and avoiding medical jargon to keep advice applicable in different settings. Participants asked for clear communication of the responsibility of support workers to escalate information to supported living management, GP, and NHS 111.

Conclusion: Undertaking a robust Quality Assurance exercise for this online learning resource has ensured that language and terminology is appropriate for the target audience. Participants requested a clear message about how to escalate concerns. The next step will be to publish the resource online and evaluate its effectiveness in improving knowledge of constipation for carers of PwID.

Aims: There are new requirements for addictions competencies as part of the 2022 core trainee curriculum. The Silver Guide, section 5.1.2 includes a requirement for two work based placed assessments (WBPA) in addictions to be completed during core training. This has posed challenges nationally, especially in England due to the way addiction services are commissioned and tendered. Whilst most training schemes have opted for CBD groups, our region of London wanted to provide practical and experiential learning with taster days at both NHS and 3rd sector services. Trainees were an integral part of the stakeholder group to ensure co-production.

Methods: Between Nov 23 and March 24, a pilot training lecture day and 4 taster days were held. Trainees registered on a first-come-first-served basis. The taster days gave trainees an opportunity to assess at least one patient under supervision in an addictions environment and have a case-based discussion (CBD) with an addictions consultant. The teaching day included presentations across addiction topics requested by the trainees. Feedback, both quantitative and qualitative was collated after both events.

Results: 100% of trainees felt more confident in assessing patients with substance use problems and 88% felt more confident in management after attendance. 100% of trainees also felt that the programme gave them useful knowledge in their future practice beyond what could be offered by other sources. 100% of trainees also felt the topics were relevant and would recommend the course to others. Trainees described the taster days as providing “intensive, immersive and enriching experience”, and that 1 trainee each day “was the right level”. It was also described as “a really great learning opportunity” that they “would do again”.

Conclusion: Both the training day and taster days had overwhelmingly positive feedback. This has led to a permanent implementation of a rotating programme between the 3rd sector and NHS addiction services in the region. Particularly with the new curriculum requirements, these appear to fill a gap in trainee learning. This programme is the first of its kind in the country, as other trusts have opted to run CBD groups. The aim will be to expand this into an annual programme for all core trainees in the trust, continually improve on the structure and possibly expand attendance to higher grades. This year, many doctors of varying grades, including other consultants have expressed interest in attending. Widening addiction training will only improve patient care nationally.

Aims: A trial of Balint Group for eleven medical students during their psychiatry placement in Rotherham, UK, to add to the existing pool of evidence regarding the impact of Balint Group on empathy, communication skills, understanding of doctor-patient interaction and to improve the understanding of the wider socio-political context of patients, with the hope of developing agency, consultation abilities, advocacy and well-being among future doctors.

Methods: Balint Groups were facilitated by two Psychiatry Core Trainees with weekly supervision by a consultant medical psychotherapist. Five sessions were integrated into the students’ weekly timetable. The students were sent questionnaires before and after the pilot, asking for views on the role of psychological factors in the doctor-patient interaction as well as Balint Groups. There were seven closed questions in both questionnaires and an extra two open questions in the ending questionnaire.

Results: Three students attended all sessions, with others having inconsistent attendance, resulting in six to ten students in each session. With each subsequent session, the students displayed more openness and reflection during discussions. Ten students answered the initial questionnaire and nine the ending questionnaire. Therapeutic relationships were discussed in the context of wider issues, such as abortion, homophobia, migration and racism, menopause, and prejudice from healthcare professionals towards patients from lower socio-economic backgrounds. In answers to the open questions, the students highlighted the beneficial effects of the sessions on their subjective levels of empathy, better understanding of psychosocial factors involved in patients’ presentation, benefits of reflection to help resolve internal conflicts, reduce burnout and create solidarity between students. However, there was no significant change in the answers to the closed questions. This could be a result of inconsistent attendance, short duration of trial and ambiguity of questions. The students were, on average, already highly aware of the role psychological factors play in patients’ presentation and had some awareness of the role of doctors’ attitudes towards patients, which could have contributed to this also. Both trainees found their own benefits facilitating the sessions; improving their leadership, organisation and psychotherapy skills.

Conclusion: This five-week Balint Group pilot produced benefits described by the medical students as improved empathy, psychosocial awareness, reflective practice, reducing burnout and improving peer to peer bonds. The pilot also demonstrated the role of Balint Groups as an educational tool to enhance sociopolitical understanding; empowering doctors as advocates and addressing harmful biases that can otherwise persist in healthcare settings.

Aims: The unique demands of studying for a healthcare-related degree are associated with an increased risk of developing mental health problems. Stigma and fear of repercussions for their future careers may be a barrier to these students seeking professional help. Mental Health First Aid (MHFA) is a globally disseminated psycho-education course, training members of the public to recognise and respond to people experiencing mental health problems in their communities. Training healthcare professional (HCP) students in MHFA may help them support their peers and optimise their own wellbeing.

We aimed to review the literature regarding experiences of MHFA in medical, nursing and allied HCP students and its impact on mental health knowledge, confidence and skills in supporting others, stigmatising attitudes, self-care, peer support and student wellbeing.

Methods: This systematic review was conducted in accordance with PRISMA guidelines and registered on PROSPERO (ID: CRD42024589509). Electronic databases (Ovid, Medline, PsycINFO, CINAHL and ERIC) were searched on 9/10/2024 for primary studies evaluating the impact of MHFA in HCP students. Data was extracted independently by two authors. Study quality was assessed using the MMERSQI (Modified Medical Education Research Study Quality Instrument) and Cochrane Risk of Bias tool.

Results: Searches identified 1613 studies, 25 of which met inclusion criteria. Study types were heterogeneous, including four randomised controlled trials (RCTs) and four qualitative studies. Eight studies reported that MHFA significantly improved post-test knowledge and mental health literacy. Fourteen studies reported enhanced confidence in providing MHFA post-training. Three studies described outcomes based on performance on simulation assessments, and eight studies reported reduction in discriminatory attitudes following MHFA training. Data on peer support and student wellbeing was limited. Qualitative studies suggested that MHFA clarified misconceptions around mental illness, facilitated supporting friends and family, and helped with self-care and seeking professional support for their own mental health. Student pharmacists felt that skills gained from MHFA were particularly advantageous in their professional roles. Qualitative data also suggested that tailored content for HCP students and increased pace of delivery would be beneficial.

Conclusion: The evidence base on this topic is limited, with many small studies and few RCTs. However, the available literature suggests that MHFA may be a promising strategy to improve mental health literacy, confidence, skills, and reduce stigma in HCP students. Findings suggest that there is demand for bespoke MHFA courses for HCP students, which may fulfil an unmet need in facilitating them to provide support to their peers, and optimise their own wellbeing.

Aims: Risk of burnout amongst Resident Doctors is higher now than even pandemic levels with 63% of trainees at moderate-high risk in the 2024 GMC NTS. With an ever-increasing need to consider novel approaches to tackle this, Art Therapy (AT) “experiential” workshops were delivered for attendees of the weekly academic programme at SABP NHS Foundation Trust.

The primary aim was to explore whether engaging in AT could positively impact doctors in 5 wellbeing measures: relaxation, self-awareness, self-confidence, connection with others and positivity about the day ahead. The secondary aims were for doctors to gain personal experience of the psychotherapeutic nature of AT and an understanding of the role of AT in treating mental illnesses.

Methods: The workshops were delivered by Art Therapists to 3 different cohorts between October and November 2024. The workshops comprised:

A 10-minute arts-based cross bilateral stimulation exercise.

A 40-minute art making session.

Collective reflection on individual art pieces with psychotherapeutic facilitation.

The pre- and post-workshop surveys included 6 Likert scales measuring wellbeing and understanding of AT, and 2 items exploring perceived personal and professional benefit of AT to doctors. Since the surveys were not labelled for matching, independent samples t-tests (α=0.05) and descriptive statistics were used for analysis.

Results: 62 participants completed the pre-workshop survey (55 Resident Doctors and 7 others (Consultants, non-training grade doctors, PAs)); 43 participants completed the post-workshop survey (39 Resident Doctors). All 6 Likert items scores increased post-workshop, with the following being statistically significant:

Relaxation (p <0.001; MD 1.12, 95% CI 0.68 to 1.56);

Self-confidence (p<0.001; MD 0.73, 95% CI 0.31 to 1.15);

Connection with others (p<0.001; MD 0.66, 95% CI 0.30 to 1.01);

Positivity about day ahead (p=0.04; MD 0.46, 95% CI 0.02 to 0.90)

Understanding of art therapy (p<0.001; MD 1.35, CI 1.02 to 1.70).

The increase in self-awareness scores was borderline statistically significant (p=0.06; MD 0.65, 95% CI 0.19 to 1.11).

Post-workshop, there was an increase in the proportion of respondents who felt AT could be beneficial to doctors personally (74% to 98%) and professionally (61% to 93%).

Conclusion: Engaging in Art Therapy during work hours has a significantly positive impact on doctors’ wellbeing, with particularly strong evidence for increased relaxation, self-confidence and connection with others. With an overwhelming majority of respondents agreeing it could provide personal and professional benefit to doctors, Psychiatry training schemes would do well to consider arts-based psychotherapeutic approaches within their localities to enhance trainee wellbeing.

Aims: The RCPsych’s position statement recommends a spirituality/religious belief (S/R) history be routinely considered in clinical assessments, and that an understanding of S/R and their relationship to psychiatric disorders are essential components of psychiatric training. In reality, psychiatric training at local and collegiate level is likely lacking in both quality and quantity of training in S/R considerations. There are likely a myriad of factors barring trainees from broaching this topic, which this survey-based QI project sought to explore.

Aims: 1. Explore Resident Doctors’ attitudes towards the significance of spirituality/religion (S/R) in mental health. 2. Explore Resident Doctors’ experiences and satisfaction with S/R training in Psychiatry. 3. Explore current frequency with which Resident Doctors’ consider S/R in clinical assessments. 4. Establish Resident Doctors’ perceived confidence in and barriers to exploring S/R in their clinical assessments.

Methods: An online, self-completion questionnaire was constructed for a target population of 108 Resident Doctors employed with SABP trust during the survey window from 16/07/2024 to 27/08/2024. It was advertised through work email and WhatsApp groups.

The survey included 8 quantitative items and 1 free-text item, exploring various aspects of trainees’ perceptions around S/R. The quantitative items were analysed using simple descriptive statistics and the free-text item was analysed using thematic analysis via coding.

Results: The survey received a total of 39 responses (1 FY Doctor, 8 GP trainees, 19 core trainees and 11 higher specialty trainees).

Quantitative analysis: 90% felt S/R consideration was extremely or somewhat important clinically; 54% felt either neutral or not confident in exploring S/R clinically; 49% reported they rarely or never consider S/R clinically; 15% reported satisfaction with current S/R training; 90% felt there was an unmet training need on S/R considerations in Psychiatry.

Common barriers to consideration included: Lack of training (64%), concerns around triggering psychopathology (46%) and lack of time (46%).

Qualitative analysis: The free-text item explored any other perceived barriers. Responses were coded into 7 clear themes: fear of litigation, cultural barrier, lack of awareness, time pressures, lack of prompting and lack of training.

Conclusion: This project highlights a significant disconnect between the RCPsych’s position on spirituality and trainees’ current experiences. Interestingly, the common barriers that emerged are all factors that can be addressed via formal teaching/training at the local and regional level, which should seek to dispel fears and normalise conversation around and consideration of this oft neglected yet essential aspect of holistic mental health care.

Aims: The Kent and Medway Psychiatry Undergraduate Scheme (KAMPUS) aims to provide medical students with experience in psychiatry at an early stage in their training, and psychiatry trainees the opportunity to develop mentoring and leadership skills.

Early exposure to psychiatry improves student perceptions of the specialty. KAMPUS is based on a similar programme in a London medical school which has reported positive outcomes. KAMPUS was adapted for the structure and geography of the local medical school and mental health trust.

Methods: A committee of psychiatrists, trainees and student representatives co-developed KAMPUS and wrote handbooks for students, trainees and clinical supervisors. Year 1–2 students and core psychiatry trainees were invited to participate. 18 students and 15 trainees registered for KAMPUS in the 2023–2024 academic year. Lead mentors supported small groups of students virtually, and clinic-based mentors were trainees based near the school, who provided clinical shadowing opportunities. Combined educational/social events were organised in collaboration with the Psychiatry Society, and a formal day of mentoring training was provided for trainees.

Results: Trainees provided regular mentoring and shadowing opportunities. Lead mentor group discussion topics included training pathways, case presentations and practice exam questions. Two educational/social events were attended by students and trainees. Trainees gave positive feedback regarding mentoring training.

Conclusion: KAMPUS is deliverable across the wide geographical area covered by the medical school and mental health trust in Kent. It has provided early experience in psychiatry for students and a development opportunity for trainees, with positive initial feedback.

Aims: People with learning disabilities (LD) experience significant health inequalities, including higher rates of obesity and associated comorbidities. This quality improvement (QI) project within East London NHS Foundation Trust (ELFT) aimed to enhance weight management interventions for individuals with LD by improving engagement with weight monitoring and lifestyle interventions.

Methods: A multidisciplinary team (MDT) implemented the Model for Improvement framework to address low rates of BMI (Body Mass Index) and weight recording among service users. Baseline data showed that less than 30% of service users had BMI recorded, and fewer than 3% had their weight documented at appointments. Interventions included training staff in routine weight monitoring, introducing accessible health education materials, and implementing structured weight management pathways. Plan-Do-Study-Act (PDSA) cycles were used to iteratively test and refine these changes. A total of 30 service users participated in the project over 12 months.

Results: The interventions led to significant improvements in weight monitoring and engagement with weight management strategies. By the end of the project, BMI recording increased to over 80%, and weight documentation rose to over 60%, demonstrating improved adherence to monitoring practices. In terms of clinical outcomes, 40% of service users achieved a ≥5% reduction in body weight, highlighting the effectiveness of tailored interventions. Furthermore, there is increased engagement with structured dietary and physical activity programmes, with over 75% of service users consistently participating. Additionally, 85% of carers reported increased confidence in supporting service users with weight management, further enhancing sustainability.

Conclusion: This QI project successfully demonstrated that structured, MDT-led interventions can improve weight management and health monitoring in individuals with LD. Increased documentation rates and service user engagement suggest that targeted, person-centred approaches can address health inequalities effectively. Future efforts will focus on scaling up these interventions, addressing remaining barriers to participation, and evaluating long-term sustainability.

Aims: People with severe mental illness (SMI) experience greater physical health inequalities, poorer health outcomes and significantly lower life expectancy (15–20 years) than the general population. Despite National and local guidelines on routine physical monitoring to mitigate these inequalities, the practice in this clinic is inconsistent, often fraught with delays and inefficiencies. This quality improvement project (QIP) aims to achieve full compliance with monitoring guidelines to 100% over 8 weeks, enhancing patient safety and outcomes.

Methods: A baseline audit on compliance with physical health monitoring guidelines was conducted by reviewing the local and national guidelines, clinic records, the monitoring log, and Resident Doctors’ outstanding reviews list. A semi-structured staff interview and reviewing GP correspondence identified key barriers to compliance. Three changes were introduced using the PDSA framework (plan, do, study, act); first staff training on Kardia ECG interpretation; then weekly logging and mop-up of outstanding ECG (electrocardiogram) and blood test results; and third, streamlining workflow by improving cover and swap during annual leaves to ensure continuity.

Results: There was a significant improvement in compliance with physical health monitoring during the project. Outstanding blood test results decreased from 140 to 24, and pending ECG results from 16 to 1 in four weeks. By eight weeks, full compliance (100%) was achieved. The weekly mop-up proved the most effective intervention in clearing the backlog while staff reported that training in Kardia enhanced their confidence in conducting the reviews.

Conclusion: The QIP illustrates that improving physical health intervention requires targeted interventions that can result in improved physical health monitoring in community mental health centres. Sustaining this improvement requires enhancing staff skills and confidence, greater team collaboration and coordination of planned staff absences through appropriate swapping and cover arrangements. Future work will focus on developing a centre-specific guide, improved induction and shadowing for Resident Doctors and involving them in job planning.

Aims: The MBBRACE (confidential enquiry into maternal deaths in the UK) report tells us women in the perinatal period are a high-risk group and that this is not always recognized. The unique nature and complexities of perinatal illness that can present in these vulnerable groups requires thinking about both mother and baby. MBBRACE report tells us that we must recognize these risks and there must be a lowered threshold for accessing and referring to Mother and Baby Units and how to do this out-of-hours. As a gateway to mental health services, FRS, IHTT, ALPS services must have perinatal awareness and risk training as mandatory.

This quality-improvement project aims to improve clinical skills, service delivery and patient safety

Methods: We aimed to first identify the knowledge level of the FRS, IHTT and ALPS teams, if they had attended any perinatal training before (in the last 12 months, longer than 12 months or never) and asking their areas of developmental needs. This was through interactive online questionnaire tools (pre-intervention questionnaires). Then teaching sessions on perinatal mental health risks delivered to these teams. A post-intervention questionnaire to objectively measure improvements in skill and confidence.

Results: Pre-questionnaire revealed for majority of responders, the last time they attended a perinatal mental health teaching was 12 months ago – 3 years (barring ALPS, who had a teaching few months ago). Confidence level pre-intervention (teaching) – 14% (not confident), 28% (slightly confident), 51% (somewhat confident) and 7% (confident). Post-intervention – 33%(confident), 50% (very confident), 17% (extremely confident).

The outcome was that confidence levels in identifying and managing perinatal mental health risks were significantly increased.

Conclusion: Having regular inter-team teaching sessions on perinatal mental health risks (including perinatal red flags) increases the confidence levels of first line/Acute Clinical Services in identifying and promptly managing these perinatal mental health risks. This would in turn reduce perinatal mental health safety incidences or near misses.

Aims: The management of acute behavioural disturbances necessitates an appreciation for the potential methods, risks, and monitoring requirements needed following assessment and initiation of management. A previous quality improvement project highlighted variability in clinicians initiating rapid tranquillisation agents in response to the same clinical vignette. This study aimed to improve Resident doctors’ confidence in deciding to use pharmacological or non-pharmacological methods in managing acute disturbance by 25%.

Methods: Initially, a fishbone diagram was created to help visualise the possible causes contributing towards lack of confidence in managing acute behavioural disturbance via word-of-mouth conversations. Subsequently, a quantitative survey was circulated amongst 25 resident doctors in a single district general hospital. The survey consisted of questions using a 5-point Likert Scale, with scores of ‘1’ representing ‘no’ and ‘5’ representing ‘extremely’. Following this, a teaching session was organised as part of the local foundation programme teaching series to help clarify common queries. A second questionnaire was then circulated, and feedback was gained to investigate changes in confidence, as well as inform future interventions.

Results: A total of 25 people had completed the baseline questionnaire. Confidence in utilising non-pharmacological approaches improved by 21%. Confidence in prescribing in acute disturbances improved by 32%. Overall confidence in managing a delirious patient improved by 26%.

Conclusion: Post-intervention, Resident doctors’ confidence in managing acute disturbances improved by 26%. Following feedback, a poster has been developed, and Resident doctors’ confidence will be re-audited.

Aims: The term ‘Black Wednesday’ has been used to describe the August national changeover day for nearly 50,000 junior doctors in the NHS, a day when a new cohort of inexperienced doctors start work. Junior trainees have reported a 7–14% reduced satisfaction compared with higher specialist trainees.

Doctors need to be supported in the workplace to provide safe and high-quality patient care. Induction as a minimum should introduce trainees to organisational policies, procedures and arrangements for clinical governance, orientation, and support. Although there is an existing induction system, having a written structured manual will assist the trainees to get through this process more easily. This project aimed to develop an Induction handbook containing all necessary information and links for trainees in Psychiatry at SBUHB to improve trainees’ overall satisfaction of the induction programme.

Methods: Data was collected through baseline pre-QI questionnaire which was analysed by a Pareto chart. Following that the induction handbook was circulated to the trainees and a post-QI questionnaire was completed and final data was analysed and compared against the pre-QI results

The project had one PDSA cycle. During which we approached different mental health services directorates within SBUHB as well as community and inpatient consultants for their input. Policies search was carried out on the health board intranet and SharePoint drive.

Results: The post-QI questionnaire receiving 15/18 respondents showed: 60% respondents rated very satisfied, 26.7% satisfied while 13.3% rated neutral; 60% respondents strongly agreed and 26.7% agreed that the handbook will help in safe delivery of patient care while 13.3% rated neutral.

Conclusion: The Post-QI survey has successfully confirmed that the updated and improved induction handbook has helped to improve the trainee’s satisfaction and overall experience by having a more comprehensive induction; as it has all the necessary information required to guide them through different systems and processes. Ultimately, finding it very helpful to get the required training to deliver the safe and effective patient care needed at their new placements.

Aims: An effective and safe clinical handover system is at the heart of safe healthcare delivery, ensuring continuity of care between clinical teams. Handovers are completed face-to-face or verbally and recorded within the NHFT’s SharePoint handover system, the standard agreed upon within the Trust. This project aimed to improve the usability, access, and safety of a preexisting SharePoint handover system.

Methods: A pre-implementation survey with 30 responses from the Resident doctors showed that 90% of respondents were aware of the handover system. Still, only 60% carried out face-to-face handovers regularly, while 40% relied on other methods. 35% viewed the SharePoint handover system positively, but 50% found it inefficient, suggesting improvements. Model for Improvement Quality Improvement Methodology was used to design and develop this change project; working alongside key stakeholders (Resident doctors, Medical Education unit, Quality Improvement team and Information Technology (IT) professionals), changes were made using a Plan-Do-Study-Act (PDSA) framework to improve awareness, access, usability and accuracy of the SharePoint handover system. Awareness improved through sessions in the Resident doctors’ induction, emails and medical education newsletter. Working in collaboration with the IT team, the SharePoint system was securely moved to a safe server with changes made to the template and dropdown options to improve safety and accuracy. Automatic email reminders were set up to improve handover job completion and recording. A PowerBI dashboard was created to assess system use and the quality of the handover recording to ensure ongoing quality assurance and improvements.

Results: Six-week baseline data showed that the compliance rate of handovers was 80%, with 20% of handovers indicating neither face-to-face nor verbal communication. Only 20% (42 out of 209) of the jobs were marked complete, against standards of 100%.

After implementing change ideas, four-week data showed 100% compliance, indicating that all handovers were completed and recorded. Only 23.03% of the jobs were marked complete on the handover system, indicating an area for further improvement.

Conclusion: A Trustwide Standard Operating Procedure for Resident Doctor Handover is being developed, and further IT changes are planned to continuously monitor and improve the handover system. In this case, collaborative leadership, perseverance when encountering roadblocks, and a systematic data-driven improvement approach with iterative changes helped establish a safer, more usable, and accessible handover system.

Aims: Individuals with severe mental illness have been recorded to have a life expectancy 10–20 years shorter than the general population, with part of this discrepancy being attributable to an increased risk of cardiovascular disease. The QRISK3 score is a validated tool for assessing an individual’s 10-year risk of a myocardial infarction or stroke.

Our aim was to assess the practicality and impact of making calculation of the QRISK3 score routine practice for new admissions onto our general adult acute male inpatient ward, in order to improve detection of increased cardiovascular risk and offer atorvastatin as primary prevention if indicated.

Methods: Over the course of six months (August 2024–February 2025), we calculated the QRISK3 score for 50 inpatients on a general adult male acute ward. Patients who had a score of 10% or more were counselled on their increased risk of stroke or myocardial infarction, and were offered atorvastatin as primary prevention.

Results: At the start of data collection, only one of the 17 patients on the ward was on a statin and none of the patients had a documented QRISK3 score.

Of the 50 patients included, 10 of them had a QRISK3 score of 10% or more. Of those 10, two were already on a statin. Of the remaining eight, four agreed to start atorvastatin whilst the remaining four declined.

QRISK3 scores were included on the discharge summaries of all patients who they had been calculated for, with a request to the patient’s GP to revisit the topic of primary prevention in the future for those patients who had declined a statin.

The average time to acquire the information required to calculate the score for a patient was 6 minutes and 24 seconds.

Conclusion: Calculating the QRISK3 score for psychiatric inpatients is a quick process that can feasibly be a part of a checklist for new psychiatric admissions and may increase the proportion of patients on appropriate treatment with a statin.

In the future, use of a semi-structured interview that includes both statin counselling and lifestyle advice can be implemented, and we will trial this for the second cycle to see if it has an impact on uptake of a statin. Future research could involve longitudinal follow-up of cardiovascular outcomes to assess the impact of primary prevention in this patient population.

Aims: To reinforce nurses’ initial physical health management knowledge on Darwen and Calder wards at Pendleview unit (LSCFT). This quality improvement project attempted to bridge the gap (of physical health knowledge) amongst nursing staff by providing a short teaching course of 3 topics to mental health nurses on Darwen and Calder ward at Pendleview mental health unit, Royal Blackburn Hospital.

Methods: The quality improvement project was conducted using the PDSA (plan, do, study, act) cycle methodology. The sample included 20 mental health nurses across Darwen and Calder wards in Pendleview unit. Three teaching sessions were delivered to nursing staff by doctors on both Darwen and Calder wards (6 in total) covering blood sugar monitoring, EWS and escalation and pain management. Quantitative and qualitative data was collected via pre- and post-teaching feedback forms, assessing nurses’ confidence and knowledge in managing physical health conditions. Confidence and knowledge were both scored on Likert scales numbered from 1–5.

Results: 85% of nurses (17 of 20) stated they had not received training on the teaching topics before starting work Data across the three teaching sessions revealed the following;

Blood sugar monitoring (n=8): Mean confidence (1 – not at all confident, 5 – confident) increased from 2.75 95% CI [1.85, 3.65] to 4.75 95% CI [4.45, 5.05] out of 5. Mean knowledge (1 – very poor, 5 – extremely good) increased from 2.75 95% CI [2.292, 3.208] to 4.75 95% CI [4.45, 5.05] out of 5.

EWS and escalation (n=6): Mean confidence increased from 3.5 95% CI [2.493, 4.507] to 4.3 95% CI [3.704, 4.896] out of 5. Mean knowledge increased from 3.5 95% CI [3.1, 3.9] to 4.5 95% CI [4.1, 4.9] out of 5.

Pain management (n=6): Mean confidence increased from 4.33 95% CI [3.953, 4.707] to 4.83 95% CI [4.532, 5.128] out of 5. Mean knowledge increased from 3.5 95% CI [3.1, 3.9] to 4.67 95% CI [4.293, 5.047] out of 5.

Conclusion: Physical health management teaching to mental health nursing staff has shown to increase nurses’ confidence and knowledge in physical health. Providing physical health management teaching trust wide can help to eliminate knowledge gaps among the nursing staff, irrespective of their prior knowledge. Flow charts, posters, and providing regular physical health teaching and training to nurses during induction and beyond can all aid to empower nursing staff. A further QI cycle could be explored, looking into new teaching content after determining any additional gaps in physical health knowledge of the nursing staff.

Aims: Psychotic illnesses are more common in people with intellectual disabilities with rates as high as three times what is found in the general population. Making a diagnosis of psychosis in intellectual disability is complicated by various reasons such as communication difficulties, comorbidities, cultural differences, diagnostic overshadowing, and atypical presentation. The presence of comorbid Autism can further complicate the diagnostic process.

The clinical approach in diagnosing psychosis in people with intellectual disabilities must be based on a phenomenological assessment that aims to clarify in the patient, objective reality (that may include the “normal alternate” reality of neurodivergence) and the “loss of reality contact” observed in psychosis, from one another.

Our aim in this article is to illustrate phenomenologically the atypical nature of psychotic symptoms in people with neurodevelopmental disorders compared with the general population.

Methods: We analysed features of the mental state examinations of men admitted to the regional medium secure unit for men with neurodevelopmental disorders over the period of June 2021 and September 2024, identifying atypical descriptions of psychotic phenomena as indicated in the ICD–11 criteria.

Results: Over the study period, 16 men with psychosis and neurodevelopmental conditions were managed. The abnormal phenomena recorded included both classical descriptions similar to the general population and some atypical descriptions also.

In addition to bizarre, persecutory and grandiose ideas, other abnormal beliefs were reported as “bad thoughts”, and “paranoia”. Somatic, visual, and auditory hallucinations were also documented. Second- and third-person auditory hallucinations were experienced as external, located inside the head, or in some cases unclear. Abnormal thinking processes were described as “muddled thoughts” or “my head is screwed”. Clinicians also highlighted muddled conversation, disjointed thoughts, speaking in unfamiliar (non-existent) language, repetitive speech, minimal effective conversation, perplexity and loosening of associations. Negative symptoms were quite common including grossly disorganised behaviours such as agitation, combativeness, physical and sexual violence.

Conclusion: Core features of neurodevelopmental disorders may be misinterpreted as symptoms of psychosis and when psychotic phenomena are described atypically, clinicians may miss the diagnosis often with negative consequences for the patients.

Aims: The audit was conducted to evaluate the effectiveness and procedural compliance of pre- and post-Electroconvulsive Therapy (ECT) assessments in accordance with the Scottish Electroconvulsive Therapy Accreditation Network (SEAN) Standard. Specifically, it assessed whether healthcare professionals are adhering to protocols by conducting the required Montreal Cognitive Assessment (MoCA), Montgomery–Åsberg Depression Rating Scale (MADRS), and Clinical Global Impression (CGI) evaluations. The goal is to enhance patient care and ensure strict adherence to established SEAN standards.

Methods: The audit utilized a retrospective analysis of patient records who received ECT in the two years 2022 and 2023. The focus was on the completeness of the MoCA, MADRS, and CGI assessments pre-ECT, immediately post-ECT, and during follow-ups at three and six months. ECT notes and digital notes were collected, and ECT packs were scrutinized to collect the data of the patients.

Results: Out of 32 patients evaluated, 20 underwent a Montreal Cognitive Assessment (MoCA) prior to electroconvulsive therapy (ECT). It was not feasible to conduct the assessment for 6 patients, and it remains not done for another 6. Post-ECT, only 10 patients have completed MoCA, with none receiving follow-up assessments at 3 or 6 months. Regarding the MADRS (Montgomery–Åsberg Depression Rating Scale), 28 patients were assessed before ECT. Two were unable to undergo this assessment, and it was not performed for another 2 patients. Post-ECT, 11 patients have completed their MADRS, but no follow-ups have been conducted at 3 or 6 months. For the Clinical Global Impression (CGI) scale, assessments were completed pre-ECT for 26 patients, with 2 unable to participate. Post-ECT, the CGI was completed for 13 patients, but there has been no follow-up at 3 or 6 months.

Conclusion: The audit reveals that while the pre-ECT MOCA, MADRS, and CGI assessments met established standards, there were notable gaps in the completion of post-ECT evaluations. Particularly concerning was the poor completion rate of these assessments at both the 3-month and 6-month intervals. To address this, the audit recommends implementing robust processes to ensure the consistent and timely completion of these crucial assessments, which are essential for evaluating not only the therapeutic efficacy of ECT but also its cognitive side effects. Additionally, the audit suggests the establishment of specialized clinics staffed by senior-level specialist nurses to conduct these assessments. This approach would not only facilitate the collection of comprehensive data on the effectiveness of ECT but also enhance research into its cognitive aspects.

Aims: We aimed to assess adherence to the Mental Health Act Code of Practice within University Hospital Wishaw’s inpatient psychiatry setting, focusing on the documentation of consent to treatment for patients under Compulsory Treatment Orders (CTO). Compulsory Treatment Orders (CTO) authorize the treatment of mental disorders under specific legal and ethical guidelines, requiring meticulous documentation of consent. Initial reviews highlighted poor electronic documentation standards for patients under CTOs, prompting a proposed practice change to include scanning and filing consent forms electronically.

Methods: An initial review was conducted in December 2022 across three inpatient wards at Wishaw General Hospital, covering 57 patient records to establish the presence and adequacy of T2 and T3 documentation. A follow-up review in January 2025 re-examined 65 records to assess improvements in electronic record-keeping and documentation practices following the implementation of the proposed changes.

Results: The 2024 review showed that all patients under CTOs had their T2B or T3B forms properly documented in physical and electronic formats. However, only 70% had their consent status adequately recorded in the electronic clinical notes. This marked a significant improvement in electronic record-keeping from the initial 2022 review.

Conclusion: The integration of scanned consent forms into electronic records has enhanced the accessibility and quality of documentation, allowing for better coordination of care across multiple units. Despite these improvements, the consistent documentation of patients’ capacity and consent status during clinical reviews remains a challenge. Ongoing education for medical staff and further reviews are recommended to ensure continuous adherence to the Mental Health Act Code of Practice and improve documentation practices.