Aims: By March 2025, 90% of referrals to the Ritson Outreach Service in the Royal Edinburgh Hospital will be appropriate and contain relevant details.

Methods: Members of the Ritson Outreach team agreed the following referral criteria for inpatients on general psychiatric wards:

Prescribing for alcohol withdrawal and relapse prevention.

Prescribing in opioid dependence.

Prescribing in benzodiazepine dependence.

Advice on linking to community services.

Standards for referral details were also agreed: ward, referrer, contact number, reason for admission, specific request, community addictions input, patient’s awareness and views on referral, drug screen results, estimated discharge date, appropriateness according to referral criteria.

A baseline audit of referrals to the Ritson Outreach inbox from 19 March–28 August 2024 was conducted. Surveys about barriers to making appropriate referrals were gathered from the ward with the highest referral rate. A referral form including criteria and prompts for relevant details was devised. This was made available via an automatic reply from the referral email address. Referrals made following implementation of the form were re-audited for a four-week period from 8 January 2025.

Results: 20 referrals were included in the baseline audit.Adherence to standards: Ward 100%; Referrer 100%; Contact number 55%; Reason for admission 60%; Specific request 55%; Community addictions input 30%; Patient aware of referral 20%; Patient’s views 40%; Drug screen results 5%; Estimated discharge date 5%; Appropriate 55%.

10 surveys from the ward with the highest referral rate revealed only 10% of staff felt confident about the referral criteria and relevant details to include prior to implementation of the referral form.

In the four-week period following implementation of the referral form, 5 referrals were received via the referral mailbox. Adherence to standards: Ward 100%; Referrer 100%; Contact number 100%; Reason for admission 80%; Specific request 100%; Community addictions input 80%; Patient aware of referral 60%; Patient’s views 60%; Drug screen results 20%; Estimated discharge date 40%; Appropriate 80%.

Conclusion: Implementation of a referral form has begun to improve quality and appropriateness of referrals to the Ritson Outreach Service, although not yet reaching the target of 90% appropriate referrals. Further data collection is ongoing, along with measures to increase staff awareness of the referral criteria and process, such as posters in handover rooms and inclusion in resident doctor inductions.

Aims: A large proportion of patients referred to the Shepway Old Age Psychiatry service are multimorbid (3+ health conditions) and have polypharmacy (5+ medications), which can cause a wide range of medication side effects. These side effects, ranging from mild to severe, can compromise patient safety and often result in unnecessary re-entry into the service. This Quality Improvement Project (QIP) aims to improve the management of these patients by implementing a structured triage poster to assist on-call clinicians in deciding whether a patient needs to be readmitted to the old age psychiatric clinic or be referred elsewhere (A&E or GP). The aim of this QIP is to reduce unnecessary referrals, ensure timely intervention for high-risk cases, and optimise appointment allocation within the old age psychiatry service to optimise efficiency in the clinic.

Methods: A triage poster was designed and introduced at the old age psychiatry community unit, as a Plan-Do-Study-Act cycle, to standardise management of medication side effects in patients with multimorbidity and polypharmacy. Data on the number of patients readmitted to the service was collected over three weeks prior and three weeks after the implementation of the triage poster. The effectiveness of the poster was assessed by comparing the number of re-admissions and referrals pre- and post-implementation. The mean readmission rates pre- and post-intervention were compared and statistically analysed using a two-sample t-test to assess the impact of the intervention.

Results: The mean number of weekly readmissions pre-intervention was 2.33 (SD=1.53). The mean number of weekly readmissions post-intervention was 5.00 (SD=0.00). A two-sample t-test was conducted to compare the means, which showed a statistically significant increase in re-admissions post-intervention (t(4)=−2.92, p=0.043). This demonstrated that the triage poster did not reduce re-admissions and may have caused the opposite intended effect.

Conclusion: The implementation of the triage poster was associated with a statistically significant increase in re-admissions to the old age psychiatric community unit. External factors including seasonal patient changes, variations in referral practices, or limited staff training regarding the triage poster may have acted as confounding variables. The short data collection period (three weeks pre- and post-intervention) may not account for realistic variability, which potentially contributed to the observed increase in re-admissions. Further understanding the impact of confounding factors is needed to improve the intervention’s ability to satisfy the QIP’s aim, which is to reduce patient re-admissions related to polypharmacy and multimorbidity.

Aims: In 2022, the Royal College of Emergency Medicine (RCEM) published an updated toolkit for Mental Health in Emergency Departments (EDs), outlining clinical standards to improve care for mental health patients. These standards, based on guidance from the National Institute for Health and Care Excellence (NICE) and the Royal College of Psychiatrists, focus on (1) the ED mental health triage process, (2) observation of patients at risk of self-harm or absconding, and (3) the quality of ED clinicians’ assessments. The toolkit also emphasises collaboration with mental health teams to facilitate parallel assessments. This quality improvement project evaluated Darent Valley Hospital’s ED performance against these standards and tracked service improvements over two years.

Methods: Data was collected retrospectively from October 2022–March 2023 and October 2023–August 2024. A total of 298 cases were analysed (102 in the first year, 196 in the second). Patients aged 18 years and above who presented with intentional self-harm and were referred for an emergency mental health assessment were included. Under 18s, inpatients in mental health units and those not requiring ED care were excluded. Process measures assessed included time to triage, observation of at-risk patients, time to ED clinician review, and risk assessment quality. Outcome measures included indicators of compassionate and practical care, such as provision of food, drink, pain relief and discussions regarding treatment.

Results: Monthly meetings with the Psychiatry Liaison Team increased parallel assessments (from 39% to 56%). The appointment of an ED safeguarding lead contributed to reduced times for triage (45 to 40 minutes), and time to physical health assessment (170 to 125 minutes), with dedicated mental health triage compliance increasing (64% to 98%). The proportion of patients receiving well-documented physical health assessments improved from 86% to 92%. While risk assessment quality improved (11% to 17%), particularly regarding drug and alcohol concerns and safeguarding, further work is needed. The presence of alcohol liaison nurses twice weekly supported these improvements. Challenges remain, including a decline in documented observations of at-risk patients (30% to 20%) and only modest improvement in compassionate care provision (13% to 21%).

Conclusion: This audit demonstrates progress in assessing and managing patients presenting with self-harm. Planned improvements include a standardised mental health proforma to enhance triage and risk assessment. Further multidisciplinary team discussions will focus on optimising compassionate care, safeguarding, and substance misuse pathways, with ongoing ED staff education. The audit will continue into 2025 to assess the impact of these interventions.

Aims: Patients prescribed medication for ADHD require an annual review, generally conducted by specialist services, which accounts for a significant proportion of the workload. Delays in annual reviews can lead to GPs withdrawing Shared Care and discontinuing medication. Optimising this process could release much-needed resources for already struggling ADHD services.

This project evaluated the impact of replacing routine face-to-face annual reviews (ARs) with a streamlined, form-based system, with key objectives of assessing improvements in service efficiency, patient outcomes, and resource allocation while maintaining adherence to NICE guidelines.

Methods: A single-page Adult ADHD-friendly form consistent with NICE Guidelines on annual reviews was developed to assess medication adherence, symptom stability, and the appropriateness of continued ADHD medication. Created with a service user panel, the form was designed to allow patients to complete it by phone or email in less than 3 minutes.

Following a review of the responses on the AR form, patients requiring a further review or intervention were offered clinic appointments. Data from January to June 2023 were analysed to determine the proportion of patients requiring follow-up, and care records for this group were reviewed.

Results: Of 288 patients contacted, 262 responded, with only 60 (20%) requiring a follow-up review, mainly for medication effectiveness issues (37.1%), dose adjustments (22.6%), or side effects (17.7%), indicating that 80% of cases were manageable via the form alone.

Only 2 forms were redone due to incompletion. 25 patients (8.7%) did not respond, and were discharged after further attempts, including GP contact.

Extrapolated data: Approximately 700 patients were on the AR list. Replacing routine 1-hour face-to-face reviews with 5-minute paper reviews for 80% of patients saved an estimated 560 patient hours annually. This enabled an additional 112 assessments for new or complex cases (assuming each assessment takes 5 hours).

Consultant workload analysis:

Each Programmed Activity (PA) equates to 4 hours. 560 hours = 140 PAs saved annually, or 23 weeks of full-time consultant time (based on 6 clinical PAs per week). At an average consultant salary of £118,000/year, this system achieved a cost saving of approximately £60,000 annually.

Conclusion: This innovative approach demonstrates that replacing routine face-to-face ADHD reviews with a form-based system significantly enhances service efficiency, reduces waiting times, and optimises resources. Positive feedback from patients suggests high acceptability, with many valuing the convenience of avoiding unnecessary clinic visits. This system aligns with NICE guidelines by ensuring timely reviews while preventing service bottlenecks.

Aims: Datix is a web-based incident reporting and risk management system used across hospitals in United Kingdom to report incidents. DATIX is used primarily for risk management. Therefore the purpose of reporting an incident is to alert the healthcare system to risks and to provide guidance on preventing potential incidents that may lead to avoidable harm or death. Datix can be used to report patient safety incidents or adverse incidents of varying categories such as unexpected effects, medication errors, etc. and these help to provide learning both at individual and organisational level.

The aim is to gather staff perspectives on the current Datix system for deaths secondary to physical health in patients known to mental health settings.

Methods: Online Microsoft Form qualitative questionnaire was created to gather staff perspectives on recording of Datix incidents involving deaths due to physical health causes but outside mental health settings. The preliminary questionnaire was shared with Corporate Risk and Compliance Manager, Interim Deputy Director of Nursing in Trust and as advised one of the clinicians attended the Clinical Risk Management Group prior to rolling out to the local Older People’s Community Mental Health Team and Humber Academic programme attendants list. Data was extracted onto Excel for the time March–May 2023 from Microsoft forms. Thematic Data analysis and summary was done collectively by three clinicians in Older Adult.

Results: Total: 28 respondents.

Respondent Demographics: approximately 57% nurses; 22% doctors, 7% social workers, 14% team leaders/managers; age 64% below 50 (29% 35–40); 29% 55–65.

7% of respondents have never filled in Datix for death, 36% filled within the last three months.

Source of information: Electronic notes 36%, discussion with colleagues 28%, during review 11%, relatives 14%, never found out 11%.

48% respondents needed to spend a week before finding the cause of death.

Thematic analysis Scale (1 least intensity, 10 highest intensity): Ease of access 14%, In emotionality 43%; Exhausting 61%.

61% respondents did not feel that Datix of deaths caused by physical health needs to be completed by mental health staff. 89% think the process could be made easier.

Conclusion: The study shows clearly that most of the respondents did not feel that Datix forms needed to be filled in for older adult psychiatric patients in the community, whose death occurred due to physical health causes but outside mental health setting.

Aims: Split-post placements are part of Psychiatry training, being a combination of inpatient and outpatient settings. The outpatient post could be set within the community mental health teams outpatient clinics, Crisis teams, Gender Identity and CAMHS clinics.

Trainees in such split-posts typically spend 2–3 days per week doing outpatient work, with the remainder in inpatient settings. The allocation is primarily a factor of training needs, to ensure safe delivery of clinical services, patient safety and provision of appropriate experience. Post allocation ensures trainees have the opportunity to achieve training competencies. This means that while individual preferences cannot always be met, the posts allocated will meet the trainee’s needs.

Our survey consisted of measuring the level of satisfaction with clinical experiences and supervision whilst working in split-posts, and factors pertaining to Trainees’ perception of patient safety, continuity of care and workloads.

Methods: Taking into consideration HEE guidelines regarding training placements, we collaborated with trainee programme director and created a qualitative survey including East Midlands Psychiatric Core trainees at Northamptonshire Healthcare Foundation NHS Trust working in split-posts. Of 15 trainees, 9 responded and completed the survey.

Results: While our survey respondents were able to identify that split-posts allow for more variety in clinical experience, they also noted several difficulties in transitioning between outpatient and inpatient settings, including:

Inability to keep up with pending work.

Difficulty establishing strong professional relationships with both staff and patients in both settings, as they are only present for 1–2 days.

Interruption in continuity of care, with work from both posts frequently overlapping.

Compromise in the level of supervision available to them, as they were only assigned a clinical supervisor in one setting.

62.5% of trainees found the workload across both placements manageable. However, half of the trainees faced challenges transitioning between clinic and inpatient roles. 37.5% of trainees did not feel adequately supervised in split-posts.

Conclusion: Our survey shows room for improvement within split-post placements. Based on our findings, we can advise the following measures to mitigate some of the difficulties for trainees in such posts:

We have created a standardised handover sheet which is advised to be used and updated routinely, so that patient safety and continuity of care is maintained.

We suggest to assign a clinical supervisor to each post within a split-post placement, to ensure a trainee has ease of access to their weekly supervision in either setting, outside of the usual daily clinical discussions.

Aims: The effects on professionals following the death of a patient by suicide can be phenomenal and life changing. The Royal College of Psychiatrists has developed guidelines to promote operational strategies and adequate pastoral care for professionals affected by patient suicides. Recognizing the profound impact on mental health, burnout, retention and career progression, these guidelines aim to foster a supportive culture. Enhanced support could facilitate genuine reflection and learning from such incidents, ultimately leading to improved patient care.

The aim was to discuss the impact of suicides and homicides on clinicians while exploring available support structures and understanding relevant psychological processes.

Methods: On October 25, 2024, a one-hour medical webinar hosted 87 participants, including doctors, medical students, and nursing staff. Led by Dr Rachel Gibbons, an experienced consultant psychiatrist, the session focused on clinician vulnerabilities and defensive mechanisms. Pre- and post-workshop surveys evaluated areas of interest and effectiveness for future planning.

Results: The pre-survey results revealed that 34% of respondents were primarily interested in the potential blame associated with incidents, while 16% sought guidance on supporting colleagues. Notably, 65% had experienced a Serious Untoward Incident (SUI), predominantly suicides and homicides (92%), with many professionals expressing self-blame and feelings of failure. They struggled to support affected families and felt the review process often emphasized blame rather than learning.

In the post-survey, 77% of responders reported involvement in an SUI, with 88% linked to suicides or homicides. Support perceptions varied: 36% felt supported by fellow doctors, and 20% by their trust, while colleagues (52%) and family and friends (56%) were highlighted as key sources of support. Most learned about incidents through emails, phone calls, or word of mouth (64%), and only 40% were satisfied with how they were informed. Respondents emphasized the importance of sensitive communication and individualized support plans in enhancing their experiences.

Conclusion: Overall feedback was overwhelmingly positive, with 93% of attendees expressing interest in future events. An impressive 97% found the seminar very or extremely helpful, while 93% wanted webinars on supporting clinicians, bereaved families, and attending coroner’s court. Many reported significant emotional impacts from suicides, affecting performance in 41% and prompting 27% to consider leaving psychiatry. Attendees emphasized the need for better support systems, compassionate communication, and debriefs to alleviate blame culture and improve coping with immediate effects.

Upcoming webinars will utilise feedback, ensure wider participation, engage senior management, and raise awareness of pastoral support strategies.

Aims: The mental wellbeing of medical students has remained a pressing issue. A recent longitudinal study named ‘less supportive’ educational environments as a contributing factor to this ill-health. Anecdotally, authors of this study have found topics taught within psychiatry can be emotionally affronting for students. During their psychiatry placement, 4th-year medical students at the University of Birmingham and Aston University were offered voluntary interventions with the aim to foster an environment of wellbeing. These included 1) an Open-Door Policy with Clinical Teaching Fellows (CTFs), 2) a formal Drop-in Session, 3) a Psychiatry Film Club Evening, and 4) a Creativity Prize, for students to submit reflective pieces in any artistic medium. A mandatory final wellbeing lecture included personal testimony from two CTFs on their own mental health journeys.

Methods: All students were asked to complete pre- and post-placement questionnaires accessed online on their first and last day, no matter their participation with interventions. During the placement, interventions were promoted after plenary lectures and on an ad-hoc basis. The post-placement questionnaire ascertained student participation in interventions. Questionnaires used a forced Likert scale to measure agreement with various statements. Statements were developed by adapting validated tools (such as ATP-30 and MICA-4) to cover three domains: perceptions of psychiatry’s culture of wellbeing; stigma toward others’ mental health; stigma toward one’s own mental health. 117 responses were gathered. All responses were anonymous and could not be linked to individual students.

Results: Of the 177 respondents: 99% attended the mandatory wellbeing lecture, 11% attended the formal CTF drop-in, 9% participated in the creativity prize, 7% joined the film club, and 3% used the informal open-door policy. Across all domains, there was a general shift toward more favourable perceptions. Notably, responses to the statement “Psychiatry prioritises the wellbeing of its clinicians” improved from a median of “agree” to “strongly agree”. This was a statistically significant change. Stigma toward personal and colleagues’ mental health remained more resistant to change.

Conclusion: Results suggest that these interventions had a meaningful impact on students’ perceptions of psychiatry as a supportive specialty. Aside from obvious personal benefit, integrating wellbeing initiatives into clinical placements may be key in promoting psychiatry as a speciality to medical students. Larger sample sizes and additional data collection may be needed to detect more nuanced effects of these interventions: particularly in areas concerning self-stigma. Incorporating free-text responses in future evaluations could provide valuable qualitative insights into students’ experiences.

Aims:

Main outcome: To reduce the total time taken for Initial Assessments (IAs) in CAMHS by 10% by January 2025.

Process measure: To reduce time taken to complete the Initial Assessment Form and Care Plan letter.

Balance measures: To improve service user experience of the assessment process; to improve clinician experience of completing Initial Assessments (IAs).

Methods: PDSA 1: Developmental and medical history form collected ahead of Initial Assessment.

PDSA 2: Happy Doc Initial Assessment Proforma and automated Care Plan Letter.

PDSA 3: Dictation software.

PDSA 4: Locally developed wild card PDSA – parents offered a “Pre-assessment” session, initially trialled as a phone session (PDSA 4 i) and subsequently in person (PDSA 4 ii).

A parent QI Team member offered Expert by Experience advice on design and implementation. Parent views on the Care Plan Letter and Pre-assessment session are being collected by questionnaire. Qualitative and quantitative data has been collected from clinicians on each PDSA cycle.

Results: PDSA 1: Medical & Developmental History forms were not returned to the clinic ahead of assessment. To implement differently within PDSA 4.

PDSA 2: Process measure indicated 35% reduction in Time to complete IA Form and Care Plan Letter.

PDSA 3 and 4: No change to Total Initial Assessment Time yet. Possible early suggestion of reduced variation between assessments.

Parent feedback: Face to face Pre-assessment Clinic rated as positive and useful experience. Parents appreciate a space to share information without their children present.

Clinician feedback: “The assessment has felt so much quicker with the Pre-assessment session. Usually it feels unfinished after 2 appointments but I feel that I have enough information to conclude the assessment.”

Conclusion: The significant reduction of time from PDSA 2 (35%) reflected by the Process Measure has not yet impacted significantly on the Total IA Time.

Subsequent introduction of dictation software (DragonMedical1) was difficult for clinicians, with low satisfaction and negative impact on time. With further use and individual adaptation, feedback improved. Implementation of a technology to aid workflow may require more time for learning before benefits become evident.

Parent engagement in telephone Pre-assessment Clinic (PDSA 4i) was poor. Following further iteration to in-person format (PDSA 4ii), engagement and feedback have improved.

The Pre-assessment Clinic has reduced assessment related tasks for clinicians who report this as a positive experience.

Positive staff stories about the Happy Doc Initial Assessment Proforma and Care Plan Letter led to the whole service deciding to adopt it.

Aims: Doctors in training report high rates of burnout. The Balint group lends itself to addressing emotional stress and hence the associated risk of burnout. However, Balint group attendance among GP trainees and foundation doctors locally has been poor compared with psychiatric trainees. A Quality Improvement project was undertaken to explore and address barriers to attendance with the aim of improving GP trainees’ and foundation doctors’ engagement with the Balint group.

Methods: QI methodology was used throughout 2024. We implemented a quantitative, cross-sectional design using anonymous online surveys. We used purposive sampling by sending the surveys to GP trainees and foundation doctors on psychiatric placements within Kent and Medway NHS and Social Care Partnership Trust (KMPT). The survey was semi-structured, with closed and open-ended responses. The survey explored their understanding of the Balint group, how important they perceived it to be, and the barriers they experienced to attending.

Data gathered informed several ‘change ideas’ which were implemented through consecutive plan-do-study-act (PDSA) cycles. The timing of Balint groups was changed to ensure that less-than-full-time doctors had options to attend and that groups were less likely to conflict with clinical commitments. Improvements were made to the induction process to better socialise non-psychiatric trainees with the Balint group. A face-to-face format was trialled, replacing the previous virtual format.

Post-intervention surveys were administered, which included validated measures of burnout (Abbreviated Copenhagen Burnout Inventory).

Results: Resident doctors’ understanding of the Balint group’s function and process has improved. In parallel, attendance has increased in some Balint groups; for example, 75% attendance in June 2024 compared with 25% in March 2024. However, with frequent rotations of GP trainees and foundation doctors, each cohort having its own needs and preferences, we have found that improvements are not consistently sustained. Barriers still exist, such as conflicts with clinical commitments and the format feeling ‘alien’ and unhelpful to others. Changes to the degree of burnout through attending the Balint group are inconclusive and will be clarified with the results of a follow-up survey in March 2025.

Conclusion: GP trainees and foundation doctors are better able to engage with the Balint group when barriers to attendance are actively addressed. However, not all resident doctors feel comfortable with the Balint group format, and hence it may not reduce the risk of burnout for these individuals; in such cases, attendance should not be mandated.

Aims: Our aim was to review if procyclidine is being prescribed as per BNF guidelines at DGS CMHT. As per BNF guidelines, procyclidine is recommended to be initiated at 2.5 mg of procyclidine three times per day increasing by 2.5 mg daily until symptoms are relieved. The effective maintenance dose is usually 10–30 mg procyclidine per day. After a period of 3–4 months of therapy, procyclidine should be withdrawn and the patient should be observed to see whether the neuroleptic-induced extrapyramidal symptoms recur.

Methods: A retrospective clinical audit was conducted on 36 patients receiving long-acting injectable antipsychotics at the Dartford, Gravesham, and Swanley Community Mental Health Team (DGS CMHT) between September 15, 2023, and January 7, 2024. Data was collected on patient demographics, diagnosis, antipsychotic medication, procyclidine use, Glasgow Antipsychotic Side-effect Scale (GASS) scores, and procyclidine review.

Results: The majority of patients were male (27 out of 36 [75%]) and in the 55–64 age range (16 out of 36 [44%]). The primary diagnoses were schizophrenia (25 out of 36 [69%]) and bipolar disorder (9 out of 36 [25%]). 14 out of 36 patients (39%) were currently taking regular procyclidine, with doses ranging from 5 mg once daily to 10 mg three times daily, while 6 were taking procyclidine as PRN. Regular procyclidine reviews were undertaken in 13 patients (92.9%), with review intervals ranging from monthly to 6-monthly. The common outcomes of reviews included dose adjustments, side effect monitoring, and discontinued use due to adverse effects or lack of efficacy. Out of those on regular procyclidine, 9 patients (64%) showed an improvement in their GASS scores. Among those on regular procyclidine, the starting dose was not available for 6 patients because the starting time pre-dates electronic records. From those included in our electronic records, the data indicates that the starting dose of procyclidine varied, with some patients being started on 5 mg as per need and later changed to regular, while others being started on 5 mg once a day, but none was started as per the trust recommended dosage of 2.5 mg three times a day. While there is no specific mention of a plan to review within 3–4 months for response to start of, or change in dosage of procyclidine, the data suggests, however, that regular reviews were being conducted to monitor the effectiveness and side effects of procyclidine. However, 4 patients, when they were first started on procyclidine, were asked to be reviewed by the GP.

Conclusion: The clinical audit demonstrates that procyclidine was being used to manage extrapyramidal side effects in patients receiving long-acting injectable antipsychotics at the DGS CMHT. The starting doses and review intervals for procyclidine varied, but regular monitoring of GASS scores and patient outcomes was occurring. The data suggests that procyclidine was generally effective in improving GASS scores and managing extrapyramidal symptoms, with 64% of patients showing improvement. It was worth noting that none of the patients in the record were started on the recommended starting dose of 2.5 mg TDS. Increasing awareness of trust protocol regarding prescribing of procyclidine is recommended to ensure evidence-based practice. This was presented in the local audit conference with team of doctors and pharmacists and changes implemented.

Aims: To reduce medication errors on West Ward, a busy adult mental health ward, by addressing multiple domains of medication safety identified in a baseline audit. The project aimed to improve prescribing practices, medication administration, and related processes through targeted interventions and continuous monitoring.

Methods: A baseline audit of medication practices on West Ward revealed significant errors across various domains, including temperature recording, medication stock management, MHRA actions and alerts, record keeping, incomplete processes, prescribing technicalities, clinical issues, administration errors, controlled drug management, emergency drug and equipment availability, medicine ordering, and medicine information.

A quality improvement (QI) project was implemented over six months, incorporating three Plan-Do-Study-Act (PDSA) cycles. Interventions included:

Training: Targeted training for doctors and nurses on best practices in medication safety, focusing on identified error hotspots.

Documentation Improvement: Introduction of standardised templates and improved documentation processes to enhance clarity and completeness.

Induction Changes: Revision of the induction process for new staff to emphasise medication safety protocols and ward-specific procedures.

Controlled Drug Review: A comprehensive review and strengthening of controlled drug management procedures, including prescribing, storage, and administration.

MHRA Record Keeping Review: Implementation of a robust system for recording and acting upon MHRA alerts and drug safety information.

Data was collected throughout the project using regular audits of medication practices, mirroring the baseline audit. Error rates were tracked across all targeted domains for each PDSA cycle to assess the impact of the interventions. Sustained improvement was evaluated through follow-up audits after the project’s completion.

Results: The QI project demonstrated a significant reduction in medication errors on West Ward. Overall, a 51% reduction in the total number of medication errors was achieved over the six-month period. Each PDSA cycle contributed to this improvement, with error rates progressively decreasing. Specific areas showing marked improvement included prescribing technicalities, administration errors, and controlled drug management. Follow-up audits conducted after the project’s conclusion indicated that the reduced error rates were sustained over time, demonstrating the effectiveness of the interventions.

Conclusion: This QI project successfully reduced medication errors on West Ward through a multifaceted approach targeting multiple domains of medication safety. The combination of training, documentation improvements, process changes, and focused reviews. This project demonstrates that targeted QI initiatives can lead to significant and lasting improvements in medication safety within a busy mental health setting, ultimately benefiting patient care and safety. Further work will focus on exploring the factors contributing to sustained improvement and disseminating these findings to other wards and healthcare settings across the organisation.

Aims: This Quality Improvement (QI) Project aimed to enhance the overall level of care received/experienced by patients within the Havering Older Adult Mental Health Team (HOAMHT) through combining the clinical expertise of a Consultant Psychiatrist with the pharmacological acumen of a Specialist Mental Health Pharmacist, within a joint mental health outpatient clinic. Key areas tackled included: medication adherence, faster optimization of psychotropic medications, management of polypharmacy, de-prescription of drugs of dependence, physical health monitoring, and expediting patient discharge from HOAMHT back to the GP.

Methods: Our QI project utilised Plan/Do/Study/Act (PDSA) cycles. The first PDSA cycle took place in 2023/2024 over 6 months. The second PDSA cycle took place in 2024/2025 over 6 months. The 1st PDSA Cycle used patient satisfaction outcome scoring, which was randomly collected from 15 patients that had been reviewed within the joint clinics. The results from the 1st PDSA cycle led to a second PDSA Cycle being undertaken, in which the establishment of a ten minute pharmacist’s corner feature was implemented within the joint clinic, and further patient satisfaction data was collected. Based on this data, in 2025/26 a third PDSA cycle will take place over 6 months, where there will be joint clinics consisting of junior doctors and pharmacists. This will serve to develop and refine teaching opportunities for the specialist clinical pharmacists. Then, the 4th PDSA cycle will look to expand and include other community mental health teams within our Trust, in order to see if improvements are possible to be achieved at scale.

Results: PDSA Cycle 1: There was a 38% improvement in patient satisfaction scoring for joint clinics vs stand-alone consultant/junior doctor clinics.

PDSA Cycle 2: Patient satisfaction scores increased further with the introduction of stratification, where the pharmacist was given protected time within the clinic to tackle medication-related queries, which patients found invaluable.

Conclusion: In England, there is just one Consultant Psychiatrist for every 12,600 people. Hence, the demands on clinical services for treatment have become unsustainable. Consequently, a novel and agile approach is required when organising community mental health services, so that all available clinical knowledge and expertise is exploited and geared towards maintaining a high quality of clinical care for patients, despite the resource limitations that are present. This QI project serves to demonstrate the value of effective collaboration between professionals in the pursuit of clinical excellence.

Aims: Effective handovers are essential for patient safety and continuity of care. Poor communication during shift transitions is a major contributor to medical errors and adverse events. Guidelines from the Royal College of Psychiatrists (RCPsych), British Medical Association (BMA), and National Institute for Health and Care Excellence (NICE) emphasise the need for structured, distraction-free handovers with clear documentation of key clinical information.

A review of handover practices at Hallam Street Hospital, Sandwell revealed reliance on informal unregulated communication channels, primarily WhatsApp, raising concerns about confidentiality, documentation consistency, and patient safety.

This Quality Improvement Project (QIP) aimed to evaluate existing handover practices to implement a more secure and structured system.

Methods: A baseline survey was completed by 21 out of 35 Resident doctors (Core Trainee Year 3 and below) participating in on-call and daily handover processes. The survey assessed satisfaction, confidentiality concerns, and patient safety risks associated with the existing WhatsApp-based handover system. Findings concluded:

62% were dissatisfied with the current WhatsApp-based handover process.

66.67% felt patient safety was compromised.

61.91% lacked confidence in receiving and reading handovers by the intended recipient.

Using the Plan-Do-Study-Act (PDSA) model, the intervention involved transitioning to a structured Microsoft Teams (MS Teams) handover platform, which was already successfully implemented at Bushey Fields Hospital, Dudley.

A standardised template was produced, including key information such as patient demographics, clinical status, outstanding tasks, and risk factors. Training sessions, user guides, and drop-in support were provided to facilitate the transition.

Results: Post-intervention data was collected via a follow-up survey after the implementation of MS Teams Handover channel. The results demonstrated a significant improvement in handover quality:

100% of respondents were either satisfied or very satisfied with the new system.

Confidence in patient confidentiality increased, with 100% of respondents being either very or extremely confident.

Concerns regarding patient safety decreased from 66.67% to 20%.

Confidence in handovers being received and read improved significantly.

100% of doctors felt the new process met medico-legal requirements.

Conclusion: Transitioning from an informal Handover system to a structured MS Teams platform led to substantial improvements in documentation quality, patient confidentiality, and Resident Doctor satisfaction. The standardised approach reduced the risk of errors, improved information transfer, and aligned with national best practice guidelines. Further refinements, including optimising accessibility and ensuring sustained engagement, will be explored in future cycles of this project.

Aims: Following a pre-clinical survey of psychiatric female inpatients, it was highlighted that they found it challenging to access obstetric, gynaecological and sexual health investigations and management. It was also found that mental healthcare professionals in the same psychiatric unit had limited knowledge and awareness of women’s physical health issues. The aim of this QI project were to develop and establish a monthly women’s physical health clinic (WPHC) on an inpatient psychiatric hospital site, offering assessment, investigation and treatment by obstetricians and gynaecologists.

Methods: We have established a monthly WPHC occurring, since January 2024, on every 3rd Thursday of the month 1–5 pm at a psychiatric hospital in North London. It was run voluntarily by two local obstetrics and gynaecology (OBGYN) specialist registrars with a special interest in mental health. Specialised clinical equipment was sourced through central procurement. We developed a detailed referral pathway. This involved creating a referral form which would be emailed to all female wards and later screened. Patients accepted into the clinic were booked for roughly 45-minute slots based on priority. The OBGYN involvement included specialist investigations, treatments and liaison with patients’ GPs. In order to raise awareness of the WPHC with psychiatric inpatient staff and patients, we designed posters and information leaflets, sent weekly email reminders to the clinical team about the clinic referral procedures and raising awareness through trust induction, academic teaching, and the Resident doctors’ WhatsApp group.

Results: Referrals increased from 8 before May 2024 to 28 after implementing targeted interventions totalling 36 overall. While numbers increase initially, fluctuations occurred in subsequent months due to leave, strikes and staff shortages. Patient qualitative feedback obtained via surveys included requests for more frequent clinics (unmet need was even greater than anticipated), positive experience of a smooth service and complaints related to clinic delays linked to multiple factors. Staff feedback included satisfaction with the simplicity of the referral form, swift replies. Virtual clinics were suggested as a way of improving the access further, especially for advice regarding acutely unwell patients.

Conclusion: Our QI project data has demonstrated the importance of providing women with physical health care in a female psychiatric inpatient setting. The large increase in referrals following introduction of the WPHC highlights the unmet medical need for female psychiatric inpatients accessing obstetric, gynaecological and sexual health services. Our next steps will include securing funding for more regular, biweekly clinics, as the unmet need identified is greater than expected.

Aims: Capacity is a decision and time dependent construct and assessing capacity regularly is a core tenet of ethical practice, particularly in a psychiatric setting. However, on our ward we found that these assessments were not formally recorded for all patients. We felt it was pertinent to assess the proportion of patients for whom capacity assessments for consent to treatment and to admission were documented, and to trial interventions to improve these rates.

Methods: We collected retrospective data from electronic medical records of 40 patients admitted on an acute men’s psychiatric ward between 1/10/2023 and 2/2/2024. For each patient we identified whether their capacity to consent to admission or treatment was recorded on their clerking, or on any subsequent ward-round documentation. Further to this we recorded whether each patient had a capacity assessment recorded on the dedicated Rio capacity form. We then implemented changes including the circulation of a standardised proforma for ward-rounds and clerkings, which included a capacity assessment. After 6 months we re-recorded these metrics for 29 patients admitted between 15/8/2024 and 24/10/2024 and compared the results of each metric using a chi-square test.

Results: We found that there was an increase in the proportion of patients receiving an assessment of their capacity to consent to treatment between cycle 1 and 2. However, this did not reach statistical significance (p=0.66). Similarly, in comparing rates of assessment for capacity to consent to admission on initial clerkings, there was an increase which was not statistically significant (p=0.94). For ward-round documentation, we found an improvement in rates of capacity assessment for treatment which was not statistically significant (p=0.68), and a decrease in rates of capacity assessment for admission which was not significant (0.94). However, there was a statistically significant increase in the proportion of patients who had a formal capacity assessment documented using Rio forms (p<0.05).

Conclusion: We did not find any statistically significant increase in the recording of capacity assessment on doctor’s notes, either on initial clerkings or in ward-round documentation following our intervention. However, we did see a significant improvement in the use of Rio capacity forms. Notably, 24% of patients admitted during the second cycle were transfers who did not have initial clerkings on our ward, which may have confounded our results. Further interventions are therefore required in order to improve rates and specificity of capacity assessments on our ward in the future.

Aims: Feedback was collected from students at Black Country Healthcare Foundation Trust to survey their satisfaction with their psychiatry placement which has been changed from nine weeks to five and had moved away from a carousel system to allow independent learning for students. Primary aim was to assess student satisfaction with secondary aims to improve access to a broader knowledge of sub-specialities.

Methods: Resident doctors collaborated with the medical student tutor and an initial feedback from students was gained. A plan was formulated to deliver a trust-specific 3-week teaching programme. We created a new improved handbook with opportunities for students to attend sub-specialities.

Suggestions for improvement were collated from each set of new medical students and some from previous years with this updated at the end of each rotation. We also had regular meetings with stakeholders to monitor progress and appointed medical student champions as a way of linking up with each new cohort more easily.

Feedback was collated at the end of each placement and was acted on in real time prior to the next cohort of students starting. There were 5 cohorts of students that were asked to provide feedback across 10 qualitative and quantitative questions within Microsoft Forms.

Results: Initial results showed 64% of students were dissatisfied with the induction process in the first rotation. 45% of people were unhappy with the bedside teaching. Organisation of the sub-specialities was not consistent across the trust. Both positives and negatives were highlighted and tracked. Trends of responses were monitored compared against both time and site (as students were placed across three sites) and acted upon to create an atmosphere of constant improvement and was correlated against informal conversations. After changes were made students were 50% more satisfied with the placement and standard of bedside teaching.

Conclusion: We acted on general themes from the feedback. We concluded that introducing an induction programme to explain placements and reiterate safety would improve the programme. There was increased time on the wards, direct patient contact and sub-speciality experiences. Feedback following changes showed improvement. Improvements in student-focused teaching were seen with better knowledge gained from small group teaching and 3 structured sessions included throughout. Core trainees will continue to reassess on a 5 weekly basis and make changes to the programme accordingly.

Aims: Ward reviews are a pivotal component of patient care in psychiatric inpatient settings, offering a structured opportunity for patients to engage with their treatment team and contribute to their treatment plan. Ward reviews are essential for discussing treatment progress, making necessary adjustments to care plans, and addressing patient concerns. The aim of this quality improvement project was to assess and improve the experience of ward reviews for inpatients on the Trust’s general adult inpatient wards by ensuring inpatients are well-informed about the timing of and attendees for their ward reviews and help them prepare effectively for their ward review.

Methods: Inpatients on one of the Trust’s general adult inpatient wards were asked to complete a survey to determine their level of awareness of when their weekly ward review with the Consultant or Higher Trainee was due to happen and of what would be discussed in the ward review. The survey also captured whether the patient was aware of who would be present for their ward review and how prepared they felt. Finally, they were asked how comfortable they would feel with writing down their thoughts and feelings about their ward review before it happened and whether they thought this would be useful.

Results: 17 of the 20 patients on the general adult inpatient ward completed the survey. Half of the patients indicated that they knew when their next ward review was. Approximately 25% of patients knew which members of staff would be present in their ward review. 40% of the patients said they felt prepared for their ward review. Overall satisfaction with the ward review was low at only 40%. 60% of the patients stated they would feel comfortable with writing down their thoughts and feelings ahead of their ward review about what to discuss in the review.

Conclusion: The authors identified that, given that patient awareness of when their ward review was due to take place and patient satisfaction with the ward review was low, this needed to be addressed and improved. A “ward review sign” stating the day and time of the next ward review was designed and put up in each patient’s bedroom. A ward review template was designed to capture what things the patient wished to discuss in their ward review and the nursing team were asked to support patients with completing this in preparation for their next ward review. The impact of these interventions should then be evaluated.

Aims: Ward reviews are a pivotal component of patient care in psychiatric inpatient settings, offering a structured opportunity for patients to engage with their treatment team and contribute to their treatment plan. Ward reviews are essential for discussing treatment progress, making necessary adjustments to care plans, and addressing patient concerns. The aim of this quality improvement project was to assess and improve the experience of ward reviews for inpatients on the Trust’s general adult inpatient wards by ensuring inpatients are well-informed about the timing of and attendees for their ward reviews and help them prepare effectively for their ward review.

Methods: Following the implementation of a “ward review sign” and ward review template on one of the Trusts’ general adult inpatient wards, the patients on the ward were surveyed to review whether the implementation of both interventions had improved patient awareness of when their next ward review was and patient satisfaction with their ward review.

Results: All 20 of the patients on the general adult inpatient ward completed the survey. Patient awareness of when their next ward review was increased from 50% pre-intervention to 70% post-intervention. Patient awareness of which staff would be present for the ward review increased from 25% pre-intervention to 65% post-intervention. Patient preparedness for the ward review increased from 40% pre-intervention to almost 50% post-intervention. Overall patient satisfaction with the ward review increased from 40% pre-intervention to 75% post-intervention.

Conclusion: Whilst it was clear that implementation of the two interventions had resulted in improvement in patient experience of the ward review, it was noted that the ward review sign was not updated on a weekly basis by the nursing team for every patient on the ward and that there was low utilisation of the ward review template for patients on the ward. This highlighted the challenge of implementing change and embedding this into the ward culture, particularly with nursing staff on the ward facing competing clinical tasks to be completed. The authors recommended a need for better communication between the medical and nursing staff on the ward. It was felt that proactive distribution of the ward proforma to the patient at the end of each patient’s ward review would help improve its utilisation. The nursing team was asked to allocate a dedicated member of staff to update the ward review sign in each patient’s bedroom on a once weekly basis. A need for re-evaluation of performance would then be required.

Aims: Sleep is an essential component of mental well-being. Many patients presenting in the ADHD clinic report sleep issues, which stem from underlying physical or mental health conditions, or as side effects of prescribed medications. These sleep disturbances, if unaddressed may exacerbate existing mental health issues. It can often be challenging to complete a thorough assessment of sleep disturbance in an ADHD clinic in a limited time. Essential components of documentation of sleep assessment were identified from National Institute for Health and Care Excellence (NICE) guidance. Our aim was to achieve 100% documentations containing all essential components of sleep assessment in the ADHD clinic by August 2024.

Methods: Measurement: Number of documentations containing all the essential components of sleep assessments were measured.

Initial audit: Initial audit showed only 20% (n=4) records containing all essential components of sleep assessment. Thereafter, three PDSA (plan, do, act, study) cycles were completed as follows:

PDSA Cycle 1: Initial sleep assessment questionnaire was designed and handed over to carer and patient to fill out and uploaded on electronic record system. 50% (n=6) of the documentations contained all the components of sleep assessment.

PDSA Cycle 2: Sleep assessment questionnaire was modified and new questions were added. 70% (n=7) of the documents were found to have all the essential components.

PDSA Cycle 3: Sleep hygiene leaflet introduced. 100% (n=20) of the documentations contained all the essential components.

Results: 100% documentations of sleep assessment contained all the essential components. A modified version of the structured sleep assessment questionnaire was designed. A leaflet on sleep hygiene was constructed to improve patient and carer education.

Conclusion: Inadequate documentation of sleep disturbance assessment can lead to improper diagnosis, unjudicial prescription of medications, inability to monitor progress or treatment efficacy. Consistent documentation helps in understanding individual sleep patterns in patients with ADHD and helps to enable the clinicians to identify mode of sleep issues which in turn aids in offering adequate management. The use of questionnaire filled out by the carers and patients before the consultation ensured effective assessment and record keeping in a timely fashion and helped as a reference for future comparison to monitor progression and treatment response.