Aims: Rosewood Mother and Baby Unit (MBU) provides inpatient psychiatric care to women with severe mental illness in Kent, Surrey & Sussex (KSS) in UK. Analysis of admission data to the MBU in 2022 highlighted inequalities in the admissions process. A quality improvement project was undertaken to improve equity of access for women irrespective of their ethnicity, location or age.

Methods: We collated data on admissions to Rosewood MBU, including demographics, origin of referrals, diagnosis, length of stay, parity, Mental Health Act status, previous MBU admissions and safeguarding concerns. In the 2024 cohort, additionally, we looked at suspected or confirmed neurodevelopmental disorders such as ASD or ADHD and deprivation decile to establish the socio-economic status of admitted patients.

The project group undertook consultations with referrers, inpatient/community teams and other stakeholders to understand barriers to referrals from various counties, for women of black and ethnic minority backgrounds and under-18s. We implemented measures such as improving ethnicity recording, building partnerships with community groups to raise awareness and build trust, offering appropriate training for staff working with young and ethnically diverse mothers, providing easy access to information about referrals pathway and role of MBU to referrers and families.

Results: In 2022, the duration of admission was less than 2 months for 64% of patients, which increased to 77% in 2023 and 70% in 2024. Psychotic illness was the most common diagnosis for patients admitted in 2022 and 2024, while anxiety-related illness was most common in 2023.

In 2022, 10% of admitted patients were of black, Asian or mixed backgrounds, which increased to 33% in 2023 and 36% in 2024. In 2023 and 2024, there were 2 referrals and 1 admission of women under the age of 18, compared with no referrals in 2022.

In 2024, mean age of mothers admitted was 30.6 years with a range between 19 and 40 years. 18% of patients had suspected or confirmed diagnosis of Autism Spectrum Disorder or Attention Deficit Hyperactivity Disorder. In the same year, 39% of admissions had lower socio-economic status with deprivation decile between 1–4.

Conclusion: Overall, this project demonstrates a positive trend with improved access for under-18s and women of black, ethnic minority and mixed ethnic population groups across the 3-year span. Further work is needed to improve access for women living in more deprived areas and to recognise and support women with neurodevelopmental disorders in the perinatal period.

Aims: Raising concerns is a vital component of optimising patient safety and improving training experiences. However, resident doctors within an acute mental health trust have expressed difficulties in raising such concerns. A quality improvement (QI) project was initiated to improve the self-reported likelihood of resident doctors raising patient safety and training concerns. We developed a pulse survey to capture this data and identify barriers to raising concerns, to thus inform and evaluate change ideas.

Methods: Over 17 months, a monthly pulse survey was distributed to all resident doctors within Birmingham and Solihull Mental Health Foundation Trust to ascertain their likelihood of raising both training and patient safety concerns using a Likert scale. Respondents were also asked to indicate the effectiveness of existing support systems for raising concerns. A free text box was available for respondents to detail other barriers or concerns. Demographic information was also collected and analysed. Data on the self-reported likelihood of raising concerns were plotted on run charts, with analysis in relation to the implementation of change ideas, to identify their effectiveness. Data on perceived barriers was utilised to inform change ideas.

Results: The mean survey response rate was 6.9 (range 1–21.4). Neither the likelihood of resident doctors raising concerns about patient.safety or training showed significant improvement, as evidenced by run charts. Barriers to raising concerns included the exception reporting system and feeling that no effective action would be taken. Residents were less likely to raise a concern if the severity was perceived as low. Over time the perception of the trust intranet as a supportive tool in raising concerns increased.

Conclusion: Although no significant changes were identified in resident doctors’ likelihood of raising concerns, the pulse survey provided valuable insight into what barriers still exist in our Trust for residents wanting to raise concerns. The feedback provided informed multiple change ideas that were implemented including modifications to the representative structure, improvements to the resident doctor meeting intranet page, and adaptations to the incident reporting system. Recommendations have also been made for future QI projects. The frequently changing workforce and low response rates meant quantitative data on the self-reported likelihood of raising concerns was limited. However, evaluation of specific change ideas showed a positive impact. Increased motivation of resident doctors to engage in QI projects was another noticeable achievement.

Aims: To improve the assessment and management of physical health comorbidities for patients admitted to Crocus Ward, Springfield University Hospital.

Methods: The Old Age PHA template was devised using the guidance from the RCPsych report 'Caring for the whole person and incorporated elements of the 'Comprehensive Geriatric Assessment Tool’ used in primary care and the Old Persons Adult Liaison (OPAL) team at St George’s Hospital, London.

In performing the assessment, clinicians gather information from multiple sources: patient interviews, collateral histories, and reviews of GP and hospital records, and recent investigations.

The following information was obtained: Past Medical History, smoking, alcohol, substance use, vision, hearing, oral health, bladder and bowel function, pain and falls assessment, physical examination, investigation results, risk calculator scores, Baseline 4AT score, Medication/Polypharmacy Review, STOPP/START tool, Anticholinergic burden (ACB) calculator result.

Using the collected information, clinicians develop tailored care plans and recommendations to address identified physical health concerns.

Results: From May 2024, all new admissions underwent a Comprehensive Physical Assessment, with the report, including care plans and recommendations, uploaded to their electronic records.

Conclusion: The comprehensive physical assessment has significantly improved patient care by enabling early identification of physical health issues and potential risks. It facilitates personalised care plans and serves as a valuable reference for the multidisciplinary team. This approach addresses immediate health concerns and contributes to better long-term outcomes. The project underscores the importance of integrating physical and mental health care in older adult psychiatric settings.

Aims: Mental health patients are often severely unwell presenting with significant risks to their health and multi-morbidity/complex health needs. Currently, at KMPT there is a lack of access to the right care at the right time with a lot of silo mentality and fragmented services. Feedback from junior doctors includes:

1. Lack of clarity or easy accessibility of relevant physical health-related trust policies.

2. Unclear referral pathways between KMPT and acute trust relevant physical health specialties.

A survey was conducted amongst resident doctors in KMPT to identify the scale of the problem. We aim to improve:

Knowledge and awareness of access to physical health interventions on KMPT inpatient wards.

Systems and protocols for liaison and consultation with physical health care teams/specialists.

Patient safety and patient experience.

Methods: Based on feedback, we felt that the best solution to increase staff confidence in managing physical health problems and increase their awareness of what is available, would be to create an online easy to access page where everything is centralized in one place. In turn this would allow for a better patient experience and improved patient safety on our wards.

The creation of a staffroom page for all physical health resources for KMPT staff. As part of our staffroom page, there will be live links to relevant policies, IT applications, IT systems and relevant referral pathways contact information

Results: Liaise with the Trust digital team to create a folder on the intranet for resident doctors containing all the collated resources. This includes:

Collated contacts for referral pathways for the 5 Acute trusts in Kent.

Collected relevant pathology and imaging request forms and made an electronic copy for easy access.

Collated all the trust policy guidelines relating to physical health and put in a folder for easy access for resident doctors.

Liaised with the Trust physical health and infection control team for one click easy access on the Trust.

We have presented to the Trust Clinical director and Head of Psychiatry, as well as Urgent care Community of practice for necessary support for the project.

Conclusion: We would go live on the trust intranet next month and then roll out the second PDSA to resident doctors.

Aims: Electroconvulsive Therapy (ECT) remains a misunderstood and underutilized treatment option in psychiatric care, often due to misconceptions and biases among healthcare professionals. This Quality project aimed to identify the perceptions, attitudes, and biases toward ECT among ward staff at Coventry and Warwickshire Partnership Trust (CWPT) and to improve their knowledge and attitudes through targeted educational interventions. The project sought to address the lack of access to accurate information about ECT, which has led to its perception as an inhumane treatment, overshadowing its therapeutic benefits.

Methods: The project involved a pre-intervention survey to assess baseline knowledge, perceptions, and attitudes toward ECT among 32 CWPT ward staff. Following this, a teaching session was organized to disseminate accurate information about ECT, its applications, and its benefits. Post-teaching questionnaires were administered to evaluate the impact of the intervention. The Plan-Do-Study-Act (PDSA) cycle was used to guide the intervention and measure outcomes.

Results: The intervention led to significant improvements in staff knowledge, perceptions, and attitudes toward ECT. Key findings included a 42.6% increase in positive attitudes toward ECT, a 22.6% improvement in knowledge, and a 12.9% increase in confidence levels when discussing ECT with patients. Staff reported higher awareness of ECTs applications and effectiveness. Willingness to recommend ECT as a treatment option also increased by 6.5%. These results highlight the importance of targeted education in addressing misconceptions and biases among healthcare professionals.

Conclusion: This project successfully improved the knowledge, perceptions, and attitudes of CWPT ward staff toward ECT. The findings underscore the need for ongoing education and access to accurate information about ECT within psychiatric services. Recommendations include incorporating ECT teaching into e-learning resources for staff and continuing to provide opportunities for staff to observe ECT procedures. These efforts can help ensure that ECT is recognized as a valuable and humane treatment option in psychiatric care.

Aims: The aim of this Quality Improvement (QI) project was to enhance the induction programme for junior doctors at an NHS Trust, ensuring it is more meaningful and better prepares trainees for their psychiatry rotation.

Methods: Surveys were conducted with junior doctors during their rotations to identify areas of dissatisfaction and potential improvements within the induction process. The feedback was subsequently analysed to develop and implement targeted interventions. These interventions included the modification of a local induction programme schedule led by junior doctor representatives and other key leaders within the Trust, revision of the Trust junior doctor handbook to incorporate up-to-date practical and rotation-specific guidance, and creation of an induction pack hosted on Microsoft Teams available to all junior doctors joining the Trust. Key quality improvement tools, including driver diagrams, questionnaires, measures checklist and Plan-Do-Study-Act (PDSA) cycles, were employed to evaluate and refine the implemented changes.

Results: Survey responses demonstrated significant improvements in preparedness for psychiatry rotations and comprehension of roles and responsibilities post-intervention. Specifically, there was a two-fold increase in the proportion of trainees reporting preparedness for their rotation, from 33% pre-change to 66% post-change. Similarly, those who reported understanding their roles and responsibilities increased from 35% to 65%. Notwithstanding these improvements, persistent challenges include the inability to fundamentally alter the overarching three-day trust-wide induction and difficulties in assessing the sustained impact of changes due to high turnover among trainees.

Conclusion: This project addressed key deficiencies in the induction programme for junior doctors in the Trust, demonstrating that targeted, trainee-led changes can significantly improve preparedness for their psychiatry rotation. Future efforts would focus on embedding sustainable improvements and exploring further restructuring of the broader trust-wide induction programme to address systemic issues.

Aims: To ensure fair workload distribution and faster patient care, SWLSTG follows a cross-cover policy, grouping wards into clusters based on proximity. Each ward has designated cross-cover doctors responsible for daytime medical advice and patient reviews in absence of the ward doctors.

A duty-doctor covers all the wards, handling emergencies, urgent reviews, and mandatory tasks if no cross-cover doctor is available. Duty-doctors carry the duty phone which is a dedicated mobile phone for urgent but non-life-threatening situations. However, in practice, ward staff often bypass the protocol and contact the duty-doctor directly, leading to:

Increased workload for a single doctor.

Delays in patient care due to unnecessary escalations.

Interruptions in emergency response.

This project aims to reinforce adherence to the cross-cover protocol, ensuring appropriate ward doctors are contacted first before escalating to the duty-doctor, reducing unnecessary workload and improving efficiency of patient care.

Methods: Pre-Intervention Data Collection: Distribute feedback forms to trainees to assess the frequency and impact of unnecessary duty-doctor calls.

New System Implementation: Set up an automatic voicemail on the duty phone using the Teams, reminding callers to contact their cross-cover doctor first (operating 9 am–5 pm on weekdays, except bank holidays). The Teams system also allows call tracking by displaying missed call numbers, unlike the previous system, which only showed “unknown number”.

Educational Intervention: Develop a leaflet and ward posters outlining the correct protocol, emphasising contacting cross-covering doctors first unless in a medical emergency.

Implementation: Circulate materials to nursing staff and ward teams, reinforcing adherence through staff meetings.

Collaboration with Ward Managers: Engage ward managers to reinforce adherence and ensure staff compliance.

Post-Intervention Evaluation: Conduct a follow-up survey to measure changes in behaviour and impact on patient care.

Results: The expected Results:

Faster response times for non-emergency reviews as cross-cover doctors are located closer to wards and responsible for fewer patients.

Improve efficiency of patient care by providing continuity.

Increase awareness among ward staff regarding the importance of cross-covering doctors.

Greater clarity and adherence to the protocol among staff.

Reduction in unnecessary escalation to duty-doctors.

Conclusion: Implementing a structured approach to protocol adherence improves workload distribution, reduces unnecessary escalations, and enhances efficiency of patient care. An automated voice message serves as a constant reminder, reinforcing the correct escalation process. However, Teams system carries potential downtime risk, so the old duty phone number will remain as a backup. Future steps include ongoing reinforcement, monitoring reliability, and periodic re-evaluation to sustain improvements.

Aims: ECGs on psychiatric wards are crucial for detecting cardiac side effects of psychotropics and identifying patients with underlying cardiac conditions. However, there can be variable patient uptake of standard 12-lead ECGs, which can lead to delays in initiating treatment and poor quality of physical health monitoring. KardiaMobile is a portable ECG device which can offer an alternative when 12-lead ECGs have been declined by patients, and was therefore explored as a way to improve ECG uptake. The aim was to reduce delays in ECG completion for patients admitted to inpatient settings and to explore the views of patients and staff around their experience of the device.

Methods: From September to October 2023, baseline data was collected retrospectively from one general adult psychiatric ward (A) and one psychiatric intensive care unit (B). This included the dates of patients’ admissions and the dates admission ECGs were completed. KardiaMobile devices were then introduced to wards as an alternative and in-person training sessions were delivered. Data was collected post-implementation of the devices from September 2024 to January 2025, recording use of KardiaMobile ECGs and dates of completion. Questionnaires were also used to collect patient and staff feedback.

Results: The metrics used were average delay to ECG completion (days) following inpatient admission and percentage of patients delayed by 3 or more days. On Ward A, baseline average delay to ECG completion was measured at 6.93 days and percentage of patients delayed by 3 or more days was 24.14%. Ward B recorded 12.77 days for average delay and 69.23% for delay by 3 or more days. Post-implementation data was collected until similar numbers of KardiaMobile ECGs were completed compared with baseline ECG data. There was insufficient uptake of KardiaMobile identified on Ward A for comparison, with patients reported to decline use. Ward B post-implementation recorded 0.5 days for average delay to KardiaMobile ECG completion and 7.14% of patients delayed by 3 or more days. Their feedback was overwhelmingly positive with respect to the use of the device and gave insight into why 12-lead ECGs had been declined.

Conclusion: There were identified reductions in delays on Ward B following introduction of KardiaMobile devices. Patients and staff expressed preference for the device due to its ease of use and convenience. Comparing data across the two separate wards has given insight into the possible challenges with use of KardiaMobile, as well as the significant benefits, suggesting potential applicability outside of inpatient settings.

Aims: This Quality Improvement Project evaluated antipsychotic prescribing for dementia patients in Wakefield (WF9), comparing local practice with NICE guidelines. NICE recommends antipsychotics for severe agitation/distress, initiated and monitored under specialist supervision for ≥12 months. NHS England data (Jan 2024) shows similar dementia diagnosis rates in Wakefield compared with the national average, but antipsychotic prescribing is ~33% higher regionally. This project investigated this.

Aims were to:

1) Compare antipsychotic prescribing in two WF9 care homes with NICE guidelines (initiation, monitoring, follow-up).

2) Compare local data with NHS England data for Wakefield.

Methods: Data from 95 care home residents (Apr 1–Jun 1, 2024) were collected with staff support. Medication charts were reviewed, and data on physical health monitoring and care plans were extracted from System 1. Of 95 residents, 65 were open to community older people’s services, and 30 were not (data from care home records/register). Data were compiled in Excel.

Results: Of 95 residents, 66.3% (n=63) had dementia. Among these, 66.4% (n=40) were open to community services. Antipsychotic prescriptions were initiated by local psychiatrists in 58% (n=14/24) of dementia patients; by out-of-area services (unknown) in 21% (n=5/24); and by GPs/hospitals in 21% (n=5/24). Blood monitoring was documented in 56% (n=13/24) and ECG monitoring in 50% (n=12/24). A clear follow-up plan existed for 81% (n=51/63) of dementia patients, but 19% (n=12/63) lacked documented follow-up >1 year. Only 8% (n=2/24) had a documented plan to reduce antipsychotics.

Comparison with NHS England Data: This audit confirmed higher antipsychotic prescribing in Wakefield than the national average. Local data suggested a 4-fold higher rate. ~60% of prescriptions were initiated >1 year prior, and 92% (n=22/24) lacked a clear reduction plan, possibly due to anxiety around reduction (especially by trainees) and limited multidisciplinary input. Regional variations (e.g., Barnsley’s lower rate) raise questions about prescribing thresholds, service differences, and MDT caseload management.

Conclusion: Of 95 residents, 66.3% (n=63) had dementia, and 38% (n=24) of those with dementia were on antipsychotics. 8% (n=5/95) were on antipsychotics without a dementia diagnosis. While 81% had follow-up plans and all were monitored for side effects, adherence to NICE guidance for blood/ECG monitoring was suboptimal (56%/50%). Documentation of follow-up and antipsychotic reduction plans requires improvement. A maintained antipsychotic register may improve documentation and ensure appropriate monitoring/review.

Aims: The King’s Fund have noted that the number of people waiting more than 12 hours after decision to admit to admission has increased significantly over the last ten years. With increasing demand for psychiatric inpatient beds, waiting times for mental health patient admissions are projected to similarly increase. This study aimed to investigate the length of stay for patients within a large inner city emergency department (ED) awaiting a mental health inpatient admission.

Methods: Time of decision to admit (DTA) and time of discharge were recorded and reviewed for all patients awaiting a psychiatric inpatient admission in August 2024.

Results: In total 101 patients were assessed for a psychiatric admission during this period. The average length of stay from arrival to discharge from the ED was 1 day and 7 hours, with the longest length of stay being 5 days and 5 hours. The average time from DTA to discharge from ED was 1 day and 16 minutes with 73.3% of all patients spending more than 12 hours waiting for their bed from DTA. It is noted, that out of the 101 patients initially assessed for admission, 14 were discharged to the community.

Conclusion: Emergency departments are less likely to be equipped with the resources, physical infrastructure and trained staff required for caring for patients with high acuity of mental illness for prolonged periods of time. This study provides information demonstrating the strain that services have in providing the right care in the right place. With the reduction in available inpatient psychiatric beds by 24% since 2010, ongoing consideration needs to be given on how appropriate care can be delivered to this cohort of vulnerable and unwell patients.

Aims: Tatchbury Mount is a large hospital site at the edge of the New Forest National Park (NFNP), home to four secure inpatient units, community teams, an 80-bed nursing home and management offices. It has an abundance of wooded areas and nature. The site is part of the NHS Forest scheme which aims to support the NHS in becoming more sustainable and to reach net zero carbon by 2040. Despite the natural attributes of the site the grounds are underused by staff and patients with the only sensory trail on the site overgrown and neglected.

The aims of our project are threefold: to firstly regenerate the sensory trail, encouraging staff to use their one-day allowance of volunteer leave alongside volunteers from the New Forest National Park Authority (hosting our fellowship). Secondly, to communicate to staff through the wellbeing team and champions network as well as engagement with clinical teams on site the benefits of spending time in nature and to increase awareness of the sensory trail. Finally, to better understand the barriers for NHS staff accessing nature at the site.

Methods: We have liaised with key stakeholders in regeneration of the sensory trail including Hampshire County Council Public health wellbeing team, estates department, NFNPA volunteers and the trust wellbeing team. Two days have been agreed to regenerate the site with advertising created as well as communications through the wellbeing champion network. We will continue to gather insights from staff and have prepared a questionnaire to be completed by NHS staff to evaluate the impact of volunteering on wellbeing.

Results: Through this project we have made links with the Wellbeing team for Hampshire and IoW trust and Hampshire County Council PH wellbeing team. We have identified that staff including the trust wellbeing team are currently not aware of the sensory trail and by using the COM-B model of behaviour change we have identified that the barriers to access nature are multifactorial and link with each other. These include time/workload, staff shortages, culture not to take a break, knowledge that the trails exist and physical health/injuries.

Conclusion: There is great opportunity for NHS sites across the country to be used by staff to connect with nature and in turn enhance wellbeing.

The involvement of the trust Wellbeing team, wellbeing champions and management is vital to ensure that the embedded culture surrounding taking breaks and focusing on wellbeing is recommended and supported.

Aims: Venous Thromboembolism (VTE) is a preventable condition that significantly contributes to morbidity and mortality in hospitalized patients. In psychiatric inpatient settings, VTE incidence ranges from 2–12%, with a rate of 1.5 per 1000 admissions within the first three months of hospitalization. The National Institute for Health and Care Excellence (NICE) guidelines recommend that all mental health inpatients, including those on psychiatric wards, should undergo a VTE risk assessment upon admission. The aim of this project was to assess compliance with these guidelines in the Older Adult Ward at East-Mid Surrey (The Meadows).

Methods: The initial phase involved auditing the records of all inpatients at The Meadows to assess the rate of completed VTE risk assessments. Feedback was then collected from junior doctors, who are primarily responsible for performing the assessments during patient clerking. The feedback indicated that the main barrier to completing the VTE assessments was difficulty accessing the risk assessment tool on the electronic medical records system, SystemOne. To address this, several interventions were introduced:

Posters with flowcharts on how to access the tool and an admission checklist were placed in the doctors’ office.

Emails were sent to all junior doctors to remind them of the importance of completing the VTE assessment.

An announcement was made at the Local Academic Programme to emphasize the need for compliance with the guidelines.

Collaboration with IT led to making the VTE tool more easily accessible on SystemOne, reducing the number of clicks required.

A re-audit of patient records was conducted after these interventions.

Results: Initial Audit: Out of 23 admitted patients, only 4 had completed their VTE risk assessments.

Feedback from junior doctors:

90% were aware of the NICE guidelines, and 70% could find them in the Induction Package.

100% found the assessment relevant to their practice, but 70% struggled to access the tool on SystemOne due to excessive clicks.

80% of doctors reported completing the assessment in under 5 minutes.

Post-Intervention Re-audit: Of the 19 admitted patients, 17 had completed their VTE assessments, indicating a marked improvement in compliance.

Conclusion: The initial audit highlighted a gap in compliance with VTE risk assessments due to accessibility issues with the electronic tool. The implemented interventions, including enhancing tool access, raising awareness, and providing reminders, resulted in a significant improvement in assessment completion. These steps should be continued to ensure better patient safety and adherence to NICE guidelines.

Aims: Research shows that mental health problems are experienced by the majority of drug (70%) and alcohol (86%) users in community substance misuse treatment.

Islington Better Lives is a busy inner London community substance misuse clinic and service users frequently present in mental health crisis. The substance misuse multidisciplinary team is primarily nonmedical, as a result substance misuse keyworkers reported feeling uncertain of how to manage and at times overwhelmed by service users in acute mental health crisis.

Methods: To improve both the confidence of the keyworkers and more effectively and safely manage service users in acute mental health crisis we put on several talks across two sites in the borough. These talks covered how to manage, risk assess and appropriate referral to the various pathways within the North London Mental Health Partnership; the roles of Mental Health Crisis Assessment Service (MHCAS), the crisis team and crisis house and when psychiatric admission may be merited.

Results: 30 keyworkers were surveyed before and after the talk on confidence in managing several domains of mental health crisis. Asked: How confident are you in managing a service user a. having a mental health crisis? b. with thoughts of self-harm? c. with suicidal thoughts? and finally d. Do you feel you know the appropriate next steps if you feel a patient is in mental health crisis?

There was an average increase amongst key workers for a. 27%, b. 26%, c. 25% and d. 30% following the talk.

Conclusion: Presentations from clinicians are an effective way of improving the confidence of nonmedical substance misuse keyworkers in managing service users in acute mental health crisis. This is likely to lead to more effective and safer management of community substance misuse service users in acute mental health crisis.

Aims: Clozapine is critical for treatment-resistant schizophrenia, yet inappropriate monitoring can have severe physical and mental health consequences. Toxicity can result in bowel obstruction, myocarditis, and life-threatening agranulocytosis, while subtherapeutic levels increase the risk of relapse. Ensuring appropriate blood monitoring is a national concern in inpatient psychiatric care.

In response to missed full blood counts (FBCs) and inappropriately ordered clozapine levels in our trust, this quality improvement project (QIP) aimed to improve adherence to Trust Guidelines. The goal was to ensure that FBCs were sent routinely while clozapine levels were only requested upon consultant guidance, reducing inappropriate tests from 53% at baseline to zero by April 2024. The intervention was targeted towards nurses responsible for ordering routine blood tests.

Methods: An initial audit of all clozapine-related blood tests was conducted between 1 November 2023 and 1 January 2024. The intervention was implemented in January 2024 which included a 20-minute training session on clozapine blood monitoring, delivered to nurses across three separate days to maximize attendance. The training covered clozapine pharmacology, monitoring requirements, appropriate indications for clozapine level testing, and practical steps for arranging blood tests. Additionally, an aide-memoire was placed at key ward locations, including near the laptop used for blood test requests and in the nursing station. The primary outcome was the number of inappropriate clozapine levels sent over a three-month period, while the secondary outcome assessed staff confidence in clozapine blood monitoring through pre- and post-training questionnaires.

Results: The project successfully achieved its primary aim. During the re-audit period, FBCs were sent routinely for all patients on clozapine. Clozapine levels were only sent upon consultant guidance for suspected toxicity, with no inappropriate requests. Regarding the secondary outcome, staff reported increased confidence and understanding of clozapine monitoring protocols based on questionnaire responses.

Conclusion: Engaging frontline staff in understanding the rationale behind clinical investigations was key to achieving sustained practice change. Providing structured, accessible training ensured that staff directly responsible for ordering routine blood tests felt confident in making appropriate testing decisions. This highlights the broader importance of equipping frontline allied healthcare workers with both the knowledge and the reasoning behind clinical guidelines to optimize patient safety and care. To maintain long-term improvements, periodic training refreshers and integrating these principles into standard staff education programmes are recommended. Future initiatives should explore similar training approaches across other clinical settings where test ordering decisions impact patient outcomes.

Aims: Sexual and reproductive health (SRH) is often overlooked in the care of individuals with severe mental illness, despite national guidance from NHS England advocating its inclusion in routine mental health care. Women with psychosis are at increased risk of relapse during key life stages such as pregnancy, childbirth, and menopause. They often face compounded vulnerabilities, including intimate partner violence, substance misuse, and barriers to accessing reliable contraception. This audit aimed to assess whether the SRH needs of premenopausal female service users are considered and addressed within South Gloucestershire’s Early Intervention in Psychosis (EI) service.

Methods: 50 females were receiving care from South Gloucestershire EI service in December 2024. Their electronic records were reviewed retrospectively. 13 individuals were excluded for the following reasons: 11 post-menopausal, 1 primary ovarian insufficiency, 1 transgender. The remaining 37 pre-menopausal females were included in the audit. Their mean age was 33, range 17–48 years. Their Personal Wellbeing Plans, clinical documents, physical health assessments, primary care contraception prescriptions, and clinical progress notes were searched for evidence of SRH discussions relating to contraception, sexually transmitted infection (STI) screening, and signposting to SRH community services.

Results: Documentation of discussions about contraception and STI screening were minimal, found in 0% of physical health assessments, 3% of Personal Wellbeing Plans, 11% of clinical letters, and 5% of electronic progress notes (all post high-risk events). Uptake of long-acting reversible contraceptives was low with only 8% accessing IUS, 0% IUD and 5% implants.

The women displayed notable vulnerabilities: 51% had experienced intimate partner violence, 62% had a history of sexual assault (27% in past year), 46% reported substance misuse, and there were child safeguarding concerns in 38%, with 16% having children no longer in their care. Two unplanned pregnancies had occurred in the past year. From a mental health perspective, 11% had previous perinatal or postnatal mental illness, and 5% had been admitted to specialist mother-and-baby units.

Conclusion: There is a critical gap in addressing the SRH needs of females accessing the EI psychosis service. Despite the high risks, SRH discussions and referrals to community services were infrequent. Care could be enhanced by staff training, introduction of routine screening for SRH needs on intake to the service, and at reviews, and inclusion into health checks, supported by clearer referral pathways to access community SRH services. These improvements are crucial to meeting national and local guidance and improving SRH and mental health outcomes for this vulnerable group.

Aims: Once referred to child and adolescent mental health services (CAMHS), children and young people often report long waiting times for assessment, diagnosis, and treatment (Young Minds, 2022). The COVID-19 pandemic also brought an unprecedented mental health crisis (UNICEF, 2021), increasing the burden on over-stretched CAMHS, thereby increasing the waiting time. Most research and quality improvement projects on ‘waiting lists’ focusses on how to avoid missed appointments or effectively manage booking/triage systems. This Multidisciplinary Prescribing Meeting Pilot project was initiated in an attempt to reduce the waiting times.

Objective: To assess the impact of introducing fortnightly Multi-Disciplinary Prescriber meeting in Dragon Square.

Methods: This Pilot programme ran from November 2022 to August 2023. Referrals to the Prescribing team came from weekly Child and Adolescent Mental Health Services (CAMHS) Multi-Disciplinary team meetings. These patients were discussed by prescribers comprising a Consultant psychiatrist, Core psychiatry trainee, Higher psychiatry trainee, a Staff grade doctor, Nurse Consultant and Non-medical prescribers. After discussion patients were allocated to prescribers based on the complexity of cases. Prior to this non-medical prescribers were mainly reviewing children with Attention Deficit Hyperactivity Disorder. Complex cases were brought back for discussion when prescribers needed support. There was also an opportunity to step cases up or down based on their complexity and the level of support required.

Results: Waiting times have significantly reduced during the Pilot period. The average wait time reduced from 59.33 days to 24.5 days.

The highest wait time before the Pilot was 86 days which reduced to 42 days. Similarly, the lowest wait time before pilot was 50 days which reduced to 11 days.

This meeting also provided peer supervision for the prescribers.

Analysis of the data showed a positive impact in multiple ways. The Strengths of the Pilot included a reduction in waiting times, complexity Based Patient Assignment, peer supervision and Learning and upskilling of Prescribers. The team did not identify any weaknesses except for the time commitment.

Conclusion: This project had a significant positive impact on the service overall.

This model can be successfully implemented in other teams with a strong cohort of prescribers.

Aims: The Scottish training survey 2024 and General Medical Council national training survey 2024 showed that the general psychiatry training post at the Stobhill Mental Health Campus (SMHC) scored lower in the induction domain compared with the national average. The aim of this quality improvement project was to identify areas of induction that required improvement, implement this improvement, and deliver a new upgraded induction.

Methods: An eleven-question survey was devised which included nine 5-point Likert scale questions and two free text questions. In November 2024 the survey was sent to current resident doctors to gather feedback about the original induction. There were eight respondents, and based on this feedback a new induction was set up. The existing presentation was replaced with seminar-style discussion and a duty doctor simulation session, led by current psychiatry trainees. This focused on site-specific scenarios designed to familiarize new trainees with common challenges.

In December 2024 five new resident doctors received this new trainee-led induction and following this they completed the survey. Again, based on this feedback the induction process was adjusted and in February 2025 five new resident doctors completed the updated induction and provided feedback via the survey.

Results: The feedback from doctors who had received the original induction was poor, and there was marked improvement in responses for both the December 2024 and February 2025 induction.

Of those who received the original induction, only 14% agreed that the induction had prepared them well for their first on-call shift at SMHC. This improved to 100% and 80% with the implementation of the new induction. There were also marked improvements in the number of respondents that agreed that induction helped them understand the post’s roles and responsibilities, as well as their understanding of the electronic handover document. Improvements were also evident in the resident doctors feeling more confident in their ability to contact senior psychiatry colleagues and other acute specialities.

Conclusion: The new induction format has significantly improved the induction experience at SMHC, and resident doctors now feel more prepared for on-call shifts. We hope that this will eventually improve trainee morale, overall satisfaction with the training post and also improve clinical care.

This new version of induction will continue to be delivered, and feedback will be collected to ensure ongoing improvement. We await the results of the Scottish training survey and GMC national training survey to see whether our data is reflected in their results.

Aims: Resuscitation events can be highly stressful, particularly for those expected to lead them. As a psychiatric doctor on-call, you are often the most senior member of the resuscitation team. However, the available equipment and expertise differ from the medical settings trainees may be accustomed to. This project aimed to create a safe and supportive environment for on-call doctors to practice leading emergency resuscitation scenarios using the available equipment in a psychiatric setting. The goal was to better equip doctors to provide optimal patient care in real emergencies.

Methods: Doctors on the on-call rota across three Oxleas sites were invited to participate in a simulated resuscitation event. Before the session, a questionnaire was distributed to assess their baseline knowledge and confidence regarding resuscitation.

The session was led by an Advanced Life Support (ALS) trainer, a resuscitation officer, and a core trainee. Trainees engaged in three on-call scenarios, including a ligature emergency. Each scenario was followed by a structured debrief, and the sessions were recorded for review.

After the event, participants completed a follow-up questionnaire to evaluate changes in their confidence and knowledge. In total, 11 doctors at various training stages attended the sessions at Green Parks House and Oxleas House.

Results: 27% of the cohort had no prior experience with Advanced Life Support (ALS). Before the session, only 9% of doctors strongly agreed with the statement: “I know what is expected of me in a cardiac arrest scenario.” After the session, this increased to 82%.

Following the training, 91% of doctors became familiar with the contents of the emergency medical bag. Before the session, only 36% of participants somewhat agreed that they felt confident leading a cardiac arrest, with none strongly agreeing. After the session, 82% of participants reported increased confidence, including 18% who strongly agreed.

Additionally, 100% of participants found the session beneficial and stated they would recommend it to a colleague.

Conclusion: Overall, the session provided a valuable introduction to resuscitation in a psychiatric setting. Nearly all participants reported improved confidence, increased knowledge of their role in a cardiac arrest scenario, and greater awareness of the contents of the red emergency bag and blue drug box.

Aims: Upon discharge from an inpatient psychiatric unit, effective communication regarding discharge medications with general practitioners (GPs) is vital for continuity of care. Delaying the transfer of this information may compromise patient safety. According to their guidance, The Royal College of Psychiatrists expect discharge summaries to be sent within 7 days.

The aim of this quality improvement project (QIP) is to improve the time taken for GPs to receive discharge medication information to 7 days, achieving a rate of 100% over 9 months.

Methods: Baseline data was collected for patients discharged in May and June 2024 from two acute psychiatric wards at Edgware Community Hospital. Outcome measures included completion of a discharge summary and the time taken for it to be sent to the GP.

For the first PDSA cycle, a discharge notification form containing only vital information for GPs, and therefore a more succinct method of communication, was created. This form consisted of patient demographics and discharge medication, and was implemented for doctors to complete within a 24-hour period. Post-intervention, in addition to previous outcome measures, completion of a discharge notification and the time taken for it to be sent to the GP was also reviewed.

The second PDSA cycle intervention involved meeting with senior administrative colleagues to address ward clerk cover, and educating new doctors on the discharge notification template.

Results: Baseline data showed that a total of 57 patients were discharged; 3 were excluded as they were transferred elsewhere. Of the 54 discharge summaries, 30% were not sent within 7 days to the GP.

After the introduction of the discharge notification, 51% of patients had discharge summaries delayed beyond 7 days and of these around 50% were due to administrative issues, 5% had a discharge notification sent within 24 hours and 13% had a notification sent within 7 days of discharge.

After the second intervention, 30% of discharge summaries were delayed beyond 7 days due to doctors completing them late. However, 100% of these had discharge notifications sent within 24 hours.

Conclusion: This QIP emphasised the importance of communication with administrative and new medical staff. It highlighted the discharge notification’s role as a safeguard when there is a delay in discharge summary completion. This simple intervention could be replicated across other inpatient units to ensure continuity of care in the community.

Aims: Psychiatry is often considered a challenging specialty by medical students, largely due to the stigma attached to it. It also demands a unique skill set and relies heavily on interpreting subjective experiences, which can be a daunting task. Many students report hesitancy when approaching psychiatric patients, which indicates a need to bridge the gap between theoretical and practical learning. We believe that simulation is an effective way to achieve this. The aim of this Quality Improvement Project (QIP) was to assess and enhance medical students’ knowledge and understanding of common psychiatric conditions and instil confidence in them regarding psychiatric evaluation.

Methods: A hands-on simulation exercise was conducted on 04/07/24. Resident doctors, currently working in psychiatry, volunteered as simulators for the sessions. The scenarios included common psychiatric conditions such as depression, bipolar disorder, psychosis, anxiety disorder, schizophrenia, post-traumatic stress disorder, etc. There were a total of 8 stations, each comprising 15 minutes of history-taking, followed by 7 minutes for feedback and discussion with the simulator. Students also completed a questionnaire before and after the simulation, which assessed their understanding and confidence in handling psychiatric scenarios with a focus on history taking and risk assessment.

Results: The simulation was successfully conducted with all students participating actively. Pre- and post-simulation questionnaires revealed significant improvement in students’ understanding and confidence in handling common psychiatric scenarios.

Before the simulation, 38% of students reported feeling confident in conducting psychiatric history-taking and risk assessments. Afterwards, this figure increased to 85%. Furthermore, the percentage of students reporting good understanding of common psychiatric conditions increased from 44% to 87% after the stimulation.

An open-ended question revealed further support for these findings, with students expressing that the simulation helped them feel more comfortable approaching psychiatric patients and conducting interviews. A particular point noted by many students was the opportunity to receive immediate feedback from the simulator, allowing a clear explanation tailored to each scenario and the student’s performance/skills.

Conclusion: The Quality Improvement Project significantly improved medical students’ understanding and confidence in assessing common psychiatric conditions. Students reported increased comfort with history-taking and risk assessments, and specifically commended the value of realistic scenarios and immediate feedback. Based on these results, we aim to continue this initiative for the next cohort of students and integrate it as a regular component of the psychiatric education programme at the Irwell Unit, Pennine Care NHS Trust.