Aims: Driving is a complex and rapidly evolving task that requires a high level of skill and the ability to simultaneously interact with both the vehicle and the external environment. Mental illness can impair these abilities, potentially compromising both the driver’s safety and the safety of others. While individuals with mental health conditions have a legal obligation to refrain from driving if their condition renders them unfit, healthcare professionals, including doctors, have a crucial role to play. They are responsible for advising patients on the potential impact of their condition on driving ability, their legal duty to inform the Driver and Vehicle Licensing Agency (DVLA), and, in certain circumstances, directly notifying the DVLA on the patient’s behalf. Unfortunately, the driving status of patients is often overlooked during both admission and inpatient stays. There is also a concerning lack of awareness among patients regarding their duty to inform the DVLA and potential driving restrictions.

To mitigate these risks, it is essential to gather relevant information about driving status on admission, during the inpatient stay, and, most importantly, to discuss this with patients and carers at the time of discharge planning. The aims and objectives of this project were to achieve a 100% rate of driving risk assessment for all patients admitted to inpatient settings and to ensure that 100% of service users receive information about DVLA guidance following a mental health illness.

Methods: This Quality Improvement (QI) project involved assessing baseline practices against the local fitness to drive policy of Leicestershire Partnership NHS Trust. Data was collected from ten inpatient wards (six general adult and four older age) for patients discharged in January 2023. Information was gathered on driving risk assessment at admission, driving status at admission, driving risk assessment during the inpatient stay, and advice on fitness to drive given at discharge. An educational training video was developed and shared with trust-wide clinicians via email in September 2024, followed by a reminder email two weeks later. Data was collected again for patients discharged in October 2024.

Results: In the first cycle (January 2023), 128 patients were included. Driving risk assessment was completed for 95% of patients at admission. Approximately 12% of patients were driving at admission. Driving risk assessment during the stay was conducted in only 11.7% of cases. Advice on fitness to drive was given in 12.5% of cases. Notably, a quarter of driving patients did not receive such advice at discharge.

In the second cycle (October 2024), 85 patients were included. Driving risk assessment remained at 94%, similar to baseline. However, the proportion of driving patients increased to 20%. Driving risk assessment during the stay improved to 19%, a 7% increase. Advice on fitness to drive at discharge increased to 21.2%, an 8% increase. Surprisingly, the percentage of driving patients receiving advice decreased from 75% to 53%.

Conclusion: While there has been some improvement in compliance with the fitness to drive policy, significant gaps remain. To address this, it is crucial to enhance awareness among healthcare professionals regarding their role in driving risk assessment and patient advice. The educational training video will be made available on the uLearn training portal. It is recommended to incorporate this training into the induction process for new employees. Regular monitoring (biannually) of practices related to the fitness to drive policy is essential to further evaluate service delivery.

Aims: Care plans are the cornerstone of Rehabilitation Psychiatry. These were not being completed collaboratively with patients during monthly ward rounds, leading to impaired communication, lack of patient involvement in risk reduction strategies, and frustration. This contributed to volatility and increased risk incidents.

This Quality Improvement Project aimed to Co-produce Care Plans with staff and patients with primary outcomes relating to reducing risk incidents and secondary outcomes aiming to improve Staff and Patient engagement with Care Plans.

Methods: Baseline questionnaires (Likert scale and open-ended questions) were conducted with clinical staff and patients to assess care plan satisfaction. Feedback revealed concerns about care plan length (average of 40–60 pages), user-friendliness, appropriateness and engagement with patient/carer views not captured conspicuously.

This feedback was discussed with the Senior Management Team and care plan survey participants. A report with graphs was sent to Maple ward staff and stakeholders and later presented at the National Steering Rehabilitation Cygnet group meeting.

A new care plan template was co-produced in two focused group meetings (8 paged). The ward round format was changed to being care plan-based, aligned with Cygnet’s rehabilitation standards. A multimedia screen was purchased to support collaborative care plan completion. The new care plan featured columns for verbatim patient views, relevant discipline feedback, goals, and evaluations. The rows included sections for Treatment (Psychology, Occupational Therapy, Nursing, Social Needs, and Medical), Safety (Risk Management Plan), Recovery (Discharge Planning), Physical Health, Well-being (Spiritual, Cultural, Protective Factors), and Monthly Patient Progress Feedback.

Results: Primary outcomes showed a substantial reduction in physical restraints (65.5%), rapid tranquillisations (90%), and physical aggression (35%). However, verbal aggression incidents increased by 311%, though they did not escalate to restraints or tranquillisations, indicating improved ward safety.

The project led to a significant positive impact: 100% of patients now read their clear, concise care plans. Secondary outcomes showed an increase in patient satisfaction with care plans (57%), staff views on care plan effectiveness (60%), and a reduction in care plan length (62%).

Conclusion: Patients, carers, families, social workers, and advocates actively collaborated with multidisciplinary staff and Community Mental Health Teams to achieve shared goals and provide real-time feedback. To support co-production initiatives, infrastructure must be in place, and processes should be streamlined to ensure efficient embedding of quality improvement learning, including policy updates.

Given the successful outcomes of the pilot, the project is being considered for national rollout across Cygnet Healthcare’s rehabilitation wards.

Aims: Medical students are known to be apprehensive about psychiatric inpatient placements. Anecdotally, they assimilate less well than other health profession students during shorter placements, and nurses and occupational therapists (OTs) may not understand their role in supervising and engaging with medical students. We applied the Model for Improvement to deliver a quality improvement (QI) project to enhance student self-rated experience on placement by exploring induction, participation in a community of practice, engagement with the broader multidisciplinary team (MDT) and consider student safety.

Methods: The project involved clinical ward staff from two inpatient wards, the Medical Education team, the QI team, medical students from GKT School of Medical Education and resident doctors. We applied the Model for Improvement using routinely collected end of placement data as a change measure for student experience, with an additional Sense of Belonging Survey. Interventions drew on the themes of improving communication, preparation, early assimilation and participation with the work of the wider team. These included early communication with the ward manager and ward administrator; provision of a guide and structured timetable; day one arrival for nursing handover at 7.30 am; week 1 prioritisation of working alongside nurses, nursing students, nursing assistants, OTs, physiotherapists and in therapeutic groups; and support from Foundation doctors.

Results: Analysis of End of Placement Survey Data showed an early sustained trend of improvement, most marked in the themes of:

The block was well organised and the team was prepared for my arrival.

Teachers were welcoming and were expecting me for timetabled sessions.

During this placement I had opportunities to learn with the multidisciplinary team.

Students participated in the OT and physio therapeutic programme in a way that had never happened before and felt positive about the experience. Nursing colleagues felt strongly medical students should understand their role in inpatient care and welcomed their involvement. Students qualitatively reported feeling more welcome by other professions, felt safer and that they got to know patients more rapidly.

Conclusion: Medical students welcome changes to placement planning to enhance their engagement and assimilation with the mental health ward MDT. Ward MDT members place importance on medical students understanding their role and contribution. With planning, student placements can enhance interprofessional learning. We suspect that better student integration enhances their safety on wards. Foundation doctors can lead placement planning and embed change sustainably. Quality Improvement methodology can be applied to enhance medical education.

Aims: Interruption of sleep-wake behavioural patterns and circadian rhythms has been associated with the development and worsening of a range of mental health disorders, including depression, bipolar disorder, and schizophrenia, and specific high-risk outcomes such as aggression and suicidality. In full knowledge of the above, we aimed to improve patients’ self-reported sleep quality in an acute male ward, by 20% by the end of January 2025.

Methods: An initial survey was conducted for patients to rate their sleep quality on a Numeric Rating Scale (1–10, where 1 = a worst night sleep and 10 = a best night sleep). This survey included close- and open-ended questions for patients to identify perceived barriers to good sleep. Responses were collected over one week from all consenting patients on the ward (10/18 patients). Insights from the survey were used to design targeted interventions addressing the key contributors to poor sleep. These interventions included: a) Offering earplugs to patients; b) Posters with QR codes for a free white noise app to mask disruptive noises; c) Sleep hygiene education through leaflets, with practical tips to improve sleep. A following survey was conducted after two weeks to measure the results of our interventions.

Results: Initial survey results included: a) 6/10 median sleep rating reported by our patients, pre-intervention; b) 5/10 of our patients reported their sleep to be disturbed by noise on the ward; c) none of our patients reported sleep to be disturbed by the temperature or lighting of the room; d) 2/10 reported psychiatric symptoms such as auditory hallucinations to disturb their sleep. Results after interventions included: a) all of our patients stated that they received the sleep hygiene booklet, were counselled about the tips, and saw the posters around the ward; b) 11/16 included in the post-intervention survey reported that they found the tips useful; c) 10/16 had used the earplugs and 7/10 of these had found them helpful; d) 1/16 downloaded and used the white noise app; e) 7/10 median sleep rating was reported post-intervention.

Conclusion: Non-pharmacological interventions such as earplugs and sleep hygiene education proved to be effective in improving patients’ quality of sleep. The development of a standardized protocol that includes these sleep-friendly practices has been implemented on the ward. Methods’ limitations such as baseline sleep medications and the complexity of contributing factors were taken into consideration.

Aims: To streamline the communication process for doctors by integrating essential contact numbers into the Accurix system, making information readily accessible and reducing time spent searching for contact details.

Methods: Pre-intervention survey among junior doctors; Integration of trust directory into Accurix; Post-intervention survey with analysis of results and feedback.

Results: Before: Ease of locating correct ward/unit numbers:

58.6% find it difficult (rating 1–2 out of 5).

34.5% neutral (rating 3 out of 5).

Only 6.9% find it easy (rating 4–5 out of 5).

Before: Current methods for finding phone numbers:

65.5% use Google.

62.1% use WhatsApp Group Chat/Word document.

51.7% use KFC Doctor Office.

After: Ease of locating correct ward/unit numbers:

Now, nearly 60% find it easy (rating 4–5 out of 5).

After: Current methods for finding phone numbers:

With 70% of people now using Accurix.

Conclusion: The implementation of our technological intervention has significantly transformed the way healthcare professionals communicate across different units, leading to improved patient care and efficiency. Prior to the introduction of the app, many clinicians faced considerable challenges when attempting to contact colleagues in other units. The reliance on outdated methods, such as word of mouth, personal contacts, or searching through Google, often resulted in delays, miscommunication, and frustration. These inefficiencies not only hindered the flow of information but also impacted patient care, as timely communication is critical.

The Accurix app, which serves as a comprehensive and up-to-date phone directory for multiple trusts, has addressed these issues head-on. Since its introduction, the majority of doctors across the trusts have adopted the app, with usage rates steadily increasing. Feedback from users has been overwhelmingly positive, with many reporting that the app has made it significantly easier to contact the right person at the right time. This streamlined communication has had a direct impact on patient care, as doctors can now quickly consult with professionals, arrange transfers, or coordinate care across units without unnecessary delays.

The reduced dependence on informal communication methods, such as word of mouth or searching for contact details online, has not only saved time but also improved the accuracy and reliability of information. This has led to a more efficient patient flow, as clinicians can now focus on delivering care rather than spending valuable time trying to track down contact information. Furthermore, the app has contributed to a more standardized approach to inter-trust communication, ensuring that all healthcare professionals have access to the same resources, regardless of their location or specialty.

Authors

Heather McAdam (presenting), Ruth Goh, Gloria Cheung, Felicity Allman, Samyak Pandey, Julia Alsop, Annabelle Hook, Jessica Randall, Benjamin Perry, Katherine Beck, David Codling, Judith R Harrison

Aims: Self-harm is increasingly prevalent among adolescents in the UK, with rising hospital admissions for those under 18. The updated National Institute for Health and Care Excellence (NICE) guidelines (NG225) for managing adolescent self-harm, published in September 2022, emphasised the need for timely, structured care, including risk assessments, psychosocial support, and family involvement. This study aimed to assess the clinical management of children and adolescents presenting to Emergency Departments (ED) for self-harm, evaluating compliance with the updated NICE guidelines across nine teaching hospitals in Scotland, England, and Wales.

Methods: This retrospective, multicentre study reviewed ED records of individuals aged 8–17 years who presented with self-harm between 7 September and 7 November 2022. Consecutive sampling was used, with data collected by medical student regional leads, who were recruited and trained through a national steering group. The leads followed a structured protocol to ensure consistency in reviewing records, focusing on risk assessments, psychosocial evaluations, consent for family involvement, and age-appropriate ward admissions. Data was centralised for analysis, where compliance with each audit criterion was assessed, and statistical analysis was conducted to identify trends and areas for improvement.

Results: A total of 328 patient records were analysed. The majority of patients were female (82.0%) and white (68.2%), with a mean age of 14.7 years (σ = 1.58). Compliance with NICE guidelines varied significantly across audit criteria. The highest compliance was for family involvement, with 73.5% of records documenting consent. However, social media interactions, a key component of risk assessment, were documented in only 21.5% of cases. Delayed psychosocial assessment was noted in 17.8% of records. Only 26.1% of 16–17-year-olds requiring inpatient care were admitted to age-appropriate wards, suggesting gaps in the provision of suitable care.

Conclusion: This audit demonstrates variability in adherence to the updated NICE guidelines across nine hospital sites. Family/carer involvement showed the highest compliance, but there were significant gaps in the use of risk assessment tools and timely psychosocial evaluations. The findings highlight the need for improvements in these areas and the importance of further training for clinical teams. The study also illustrates the value of student-led research in engaging future healthcare professionals in academic psychiatry and national data collection.

Aims: Ketamine use among young adults in England has increased significantly, with prevalence more than doubling in the past five years. Ketamine use disorder (KUD) is a disorder of regulation arising from repeated or continuous use of ketamine for at least three months. The systemic effects can include urinary, sexual, hepatic and cardiovascular dysfunction, memory impairment and mental illness. Although people who use ketamine constitute a smaller proportion of patients in addictions services compared with opioid or alcohol users, the complexity and morbidity of KUD dictates the need for interdisciplinary collaboration. In 2024, a collaborative effort between a local addiction and urology service was initiated to address KUD and ketamine uropathy (KU).

Methods: Both services presented at the local Addictions Continuing Professional Development Day to share knowledge and develop staff understanding on KUD and KU. Meetings were held to evaluate local prevalence of KUD and KU, address barriers to treatment and develop easier referral pathways into both services. Best practice guidance on KU was reviewed and a new interdisciplinary treatment model implemented. Re-strategisation required clinician time and adjustments to clinic schedules.

Results: In 2024, nine patients from Urology and 23 patients from the addiction service with ketamine use were seen. Key improvements included the establishment of a direct two-week referral pathway to Urology, development of referral and assessment proformas and initiation of monthly interdisciplinary team meetings. These changes aimed to reduce delays in initiation of treatment and improve co-ordination between services. However, the major challenge faced was a high attrition rate in the clinics.

Areas identified as requiring further attention included management of weight loss and constipation, medication for symptomatic relief of ketamine withdrawal and cravings, safe analgesic alternatives, treatment of co-occurring mental illness and trauma, safeguarding and risk considerations and psychological therapeutic options. The embarrassment of urinary incontinence was identified as a barrier to appointment attendance.

Conclusion: An interdisciplinary management approach is recommended to optimize patient care. Systemic complications of KUD and co-occurring mental illness should be treated simultaneously. Intensifying the support from Addiction Recovery Coordinators may improve attendance at appointments.

Recommendations include more health worker education and staffing, early pain team involvement and provision of harm reduction advice. Peer-informed, ketamine-focused psychosocial programmes and national psychiatry guidelines for KUD are required.

Our collaborative model demonstrates a significant step towards improving management of KU and KUD, however its impact on clinical outcomes will need further evaluation.

Aims: Psychiatric patients attending acute hospitals settings in North East London are reviewed by the Psychiatric Liaison Service (PLS). Those who PLS deem to require Older Adults Home Treatment Team (OAHTT) input on discharge are re-assessed face to face by a member of the OAHTT prior to discharge from the acute hospital. This is time consuming as it requires OAHTT staff to travel to the acute hospital and re-assess the patient. This can delay discharge and the outcome of the assessment is rarely different to the decision PLS staff would have made.

The aim of our quality improvement project is to streamline the process of referrals to OAHTT and prevent duplication of work. Referrals made to the OAHTT from PLS at Queen’s Hospital, Romford (QH) and King George Hospital, Ilford (KGH) would be discussed on the phone and accepted for OAHTT follow up or admission without the need to conduct a separate assessment.

Methods: Baseline data were collected for all patients referred to the OA HTT in January 2023–Dec 2023 from QH PLS and in July 2023–June 2024 from KGH PLS. The percentage of patients who had face to face assessments by OAHTT were recorded. The trusted assessments intervention was launched in QH in January 2024, and in KGH in July 2024. Following intervention, the percentage of patients who had face to face assessments by the OAHTT were recorded.

Results: Prior to intervention, 95% of all referrals made from QH PLS to OA HTT were assessed face to face. This reduced to 25% post-intervention (data from January 2024–November 2024). Therefore, a 75% reduction in face to face assessments was achieved.

In KGH, prior to intervention, 84% of referrals were assessed face to face. Preliminary data (July 2024–November 2024) show that post intervention in KGH, 50% of referrals were assessed face to face. This is a reduction of 40%.

Conclusion: The trusted assessment model resulted in a large reduction in face to face assessments conducted by the OAHTT following referral by the PLS teams. This model appears to have achieved its aims of streamlining referrals, preventing duplication of work and improving efficiency. The next step would be to extend this model to adult HTT services and evaluate if the same benefits can be achieved.

Aims: Clozapine is a critical treatment for patients with treatment-resistant schizophrenia, requiring close monitoring through the Clozaril Patient Monitoring Service (CPMS). Access to the electronic CPMS (eCPMS) is vital for healthcare professionals on Chebsey Ward at St George’s Hospital to ensure safe prescribing, dispensing, and monitoring of clozapine. Delays in obtaining eCPMS access can disrupt patient care and treatment continuity. This Quality Improvement Project (QIP) aimed to streamline the registration process and reduce the time taken for healthcare professionals on the ward to gain access to the platform.

The primary aim of this QIP was to reduce the time required for healthcare professionals, including nurses and doctors on Chebsey Ward, to obtain access to the eCPMS website. The project sought to identify barriers to timely registration and implement strategies to expedite the process, improving workflow efficiency and patient safety.

Methods: The project was carried out on Chebsey Ward at St George’s Hospital over a four-month period. Initial testing was conducted to assess the average time taken for healthcare professionals to gain eCPMS access. Root cause analysis identified key delays, including administrative bottlenecks, lack of awareness about the registration process, and incomplete applications. Interventions included the creation of a simplified registration guide specific to the ward and closer collaboration with the CPMS registration team to expedite approvals. A post-intervention cycle was conducted to assess the effectiveness of these measures.

Results: The baseline audit revealed that healthcare professionals on Chebsey Ward took an average of seven days to obtain eCPMS access. After implementing the targeted interventions, the post-intervention cycle showed a reduction in registration time to an average of three days, representing a 57% improvement. Staff satisfaction with the registration process increased, and feedback highlighted greater clarity and efficiency in obtaining access.

Conclusion: The QIP successfully reduced the time taken for healthcare professionals on Chebsey Ward to gain eCPMS access, improving workflow efficiency and ensuring uninterrupted patient monitoring. The structured approach of process simplification and enhanced collaboration with the CPMS team contributed significantly to the improvements. Future steps include sharing the simplified registration guide to other inpatient wards at St George’s Hospital. This project highlights the importance of targeted interventions in overcoming administrative barriers to enhance patient care and safety.

Aims: The aims of the project were (i) to enhance collaboration between the multidisciplinary team working with people living with dementia such as the carers, general practitioners, pharmacists, mental health professionals and patients` families; (ii) improve the Community Mental Health Team (CMHT) response to referrals; (iii) reduce unnecessary referrals; (iv) provide psychiatric training to primary care colleagues; (v) reduce care home visits; (vi) reduce polypharmacy, especially antipsychotics in dementia; and (vii) increase the use of memory medications for dementia patients where indicated.

Methods: A pilot project was conducted with a care home specialising in dementia with a high rate of referrals to secondary mental health services. A fortnightly MDT meeting was set up which included care home staff, CMHT staff, GP staff and family members. Data was then captured from notes for analysis, with corroboration from the electronic patient record (EPR) as necessary.

Results: The project involved 64 patients with various psychiatric and dementia-related needs. The median age of the patients was 86, with a male to female ratio of 36:64. The project addressed a range of symptoms of concern, with 95% of patients exhibiting Behavioural and Psychological Symptoms of Dementia (BPSD), and the remaining 5% presenting with other issues such as seizures, elevated prolactin levels, and memory decline. Over the course of the project, there were a total of 317 patient discussions.

There was a 25% reduction in referrals to the CMHT in the 24-month period after MDT was started. Medication management was a significant focus, with 11 patients starting melatonin, 45 patients starting other medications, 22 patients starting antipsychotics, and 12 antipsychotic reviews conducted. Additionally, 10 patients had their antipsychotics stopped, 29 memantine titrations were performed, and 5 acetylcholinesterase inhibitors (AChEi) titrations were completed. Physical health monitoring, including prolactin and ECG checks, was conducted for 28 patients.

Family involvement was a key component, with 21 out of 64 patients having family members participate in the MDT meetings. Palliative care discussions were held for 5 patients, and there were 6 referrals to the Intensive Older People’s Service (IOPS) and 2 referrals to the Memory Treatment Service.

Conclusion: This pilot study demonstrated the effectiveness of a regular MDT for a care home with a high referral rate to secondary care, by reducing the number of referrals, improving communication between services and optimising the medical treatment of BPSD. This model shows promise for broader implementation to enhance the quality of psychiatric care for older adults in care home settings.

Aims: This quality improvement project (QIP) aimed to improve nursing staff confidence and understanding of diabetes/management by 40% by the end of February 2024, taking place on a dementia intensive care ward in South East London. This project was led by a medical student and FY2 doctor who noticed significant anxiety and uncertainty amongst healthcare professionals (HCPs) managing a patient’s severe type-2 diabetes, leading to disruption in care as HCPS sought repeated consultation with medics for reassurance prior to implementation of plans, creating an environment of dependency and reduced confidence making independent decisions. Barriers to delivering high-quality care for diabetes in psychiatric services are well-documented and associated with limited understanding of the condition and low confidence in management. Suboptimal management increases risk of diabetic emergencies such as diabetic ketoacidosis/Hyperosmolar Hyperglycaemic State (DKA/HHS), and long-term complications.

Methods: Three PDSA cycles were carried out:

PDSA 1: a poster displaying an individualised care plan and insulin regime, alongside an information sheet on diabetes care.

PDSA 2: a teaching session was delivered to nursing staff regarding diabetes care and recognising/managing diabetic emergencies including DKA/HHS.

PDSA 3: further teaching session incorporating feedback from PDSA 2 e.g. using worked examples for staff to apply learning.

Confidence and understanding were assessed using self-reported scales before and after intervention, alongside feedback for potential improvements to subsequent cycles.

Results: PDSA 1: Post-intervention feedback showed 47% increase in mean staff confidence in managing diabetes, and 45% increase in understanding of insulin management, exceeding the predictions for PDSA 1.

PDSA 2: Confidence levels improved by 58% and understanding of diabetes management increased by 57%.

PDSA 3: Post-intervention feedback showed mean staff scores for understanding of diabetes increased by 63%. Understanding around blood sugar checks improved an average 38% and most notably, the average score for understanding around ketone checks improved 108% following the teaching session. Confidence levels improved by 91%, and there was an 83% increase in recognition of diabetic emergencies following this presentation.

Conclusion: This QIP exceeded its aims and supports the effectiveness of posters and educational sessions in elevating confidence and understanding of diabetes and its management, for the sake of patient care. Worked examples to apply and consolidate new knowledge were the most effective intervention, and the benefits of regular teaching through presentations alongside posters as visual aids are evident. Next steps include consideration around maintaining the change and expanding at directorate/Trust level, and potential rollout for other physical health conditions.

Aims: Qatar has struggled with substance use disorders among its population. Qatar has maintained a relative political and social stability, which has informed a dramatic restructuring of its health and social care services with emphasis on being led by international best practice and primacy of patient rights. However, the rehabilitative model for substance use, which Qatar has placed emphasis on so far, has been based upon voluntary engagement of people who use substances. This has led to lack of provision of care to a significant proportion of patients with substance use disorders in addition to system-wide disagreements around models of care.

Methods: This study employed a retrospective patient record review of 163 patients admitted to the Umm Slal Treatment and Rehabilitation Center between January 2022 and October 2023. The data were systematically analysed to evaluate the effectiveness of the innovative Recovery Journey model.

Results: The majority of patients (61.3%) were aged 20–29, with 54% unemployed or students. Methamphetamine (77.3%) and cannabis (76.1%) were the most commonly used substances. Notable comorbidities included drug-induced psychosis (29.4%) and depression (19.5%). Most patients (90%) had previous treatment encounters. The Recovery Journey model, consisting of court-mandated detoxification and stabilization, residential rehabilitation, and community based continuing care, facilitated treatment completion for 91 out of 149 patients advancing from detoxification to rehabilitation. Challenges included managing complex co-occurring disorders and aligning multidisciplinary teamworking efforts.

Conclusion: The innovative Recovery Journey model at the Umm Slal Treatment and Rehabilitation Center demonstrated promising results in treating individuals with substance use disorders. While initial outcomes are encouraging, challenges related to stakeholder engagement, treatment adherence, and post-discharge care remain. This model emphasizes the importance of balancing directed care with patient autonomy and may serve as a framework for similar initiatives in the region. Further research into and adaptation of cultural contexts are essential for optimizing treatment outcomes.

Aims: NICE guidelines (NG97) emphasize the importance of assessing the anticholinergic burden of medications in older adults. Anticholinergic side effects of medications can worsen constipation, urinary retention, sedation and confusion, exacerbating cognition, falls and BPSD risks.

Medichec, a free online tool, measures medication effects on cognition and evaluates the cumulative impact. The tool provides an Anticholinergic Effect on Cognition (AEC) score for each medication, ranging from 0–3. The greater the score, the greater the need to evaluate its benefits versus risks.

This project aimed to evaluate the effectiveness of integrating the AEC score into multidisciplinary management of dementia inpatients.

Methods: In a 10-bed specialist dementia ward, AEC score was calculated weekly over four weeks for each patient using Medichec. This included 15 inpatients over 4 weeks. Medications contributing to AEC score were recorded and reviewed during the weekly ward multidisciplinary meetings. Individual plans were then made to reduce, hold, or stop medication where appropriate.

Results: Total AEC scores were between 1–7 for each patient, scoring primarily for psychotropic medications. The weekly percentage of patients with total AEC scores over 3 on the ward ranged between 10–37.5%. The overall trend in percentage of patients with a score over 3 showed a reduction from 37.5% at baseline to 20% at week 4.

There were 10 occasions where patients had an AEC score of 3+; on 90% of these occasions there was a documented multidisciplinary care plan and these 10 occasions represented 5 individual patients. Of these 5 patients, medications were adjusted for 2 patients, continued for 2 patients and not discussed for 1 patient.

The mean AEC score varied between 1.5–2.13; there was no reduction from baseline (1.89) to week 4 (1.9) however the average in week 4 was skewed by an outlying individual result of 7.

Conclusion: The weekly data collected in this audit supports a culture of avoiding medications with high anticholinergic burden for physical health reasons e.g. antimuscarinics for incontinence. Additionally, medications for insomnia, like 'Z-drugs', are not routinely prescribed. This helps lower the risks of side effects and aligns with NICE (NG97) guidelines for managing medications which can adversely affect cognition.

Medications with an individual anticholinergic score of 2+ or patients with a total score of 3+ on Medichec should trigger a review as this can have a clinically significant impact on individual patients.

Aims: High-dose antipsychotic therapy (HDAT) carries an increased risk of adverse effects, including metabolic syndrome and extrapyramidal side effects, requiring regular monitoring. However, adherence remains inconsistent due to challenges in patient attendance, staff awareness, and varying monitoring intervals. This quality improvement project aimed to determine the prevalence of HDAT use in an assertive outreach team, assess adherence to the local trust HDAT monitoring guidelines, and implement a clinician-built HDAT Calculator and Tracker to improve monitoring efficiency.

Methods: In the absence of an electronic prescribing system, monitoring was routinely done manually. Therefore, clinicians created an HDAT Calculator and Tracker using Microsoft Excel, based on local trust HDAT monitoring guidelines and the Prescribing Observatory for Mental Health (POMH) Ready Reckoner Version 11, to automatically calculate and identify patients on HDAT, flag upcoming and overdue assessments, and facilitate monitoring. Data collected included the dates and results of the most recent electrocardiogram (ECG), blood tests, quantitative antipsychotic side effect assessments, and weight.

Results: Of 105 patients reviewed, 11 (10%) were identified as receiving HDAT at the time of data collection. 5 of the 11 patients on HDAT were in an inpatient setting. ECG and blood test compliance were both 91%, with reasons for missing parameters documented in all but one instance. 2 of 11 patients were due for their annual weight assessment. Notably, gaps were identified in the documentation of quantitative antipsychotic side effect assessments, with 3 of 11 patients lacking a recorded assessment and 4 of 8 overdue for their annual review.

Clinicians identified a significant challenge in monitoring patients after HDAT initiation due to varying intervals between required assessments (e.g. 3–4 days, 1 month and 3 months post HDAT initiation) and the complexity of ensuring timely follow-up. The HDAT Calculator and Tracker offered a systematic, sustainable solution, enabling clinicians to recognise upcoming assessments and plan timely interventions. Overall, feedback highlighted reduced administrative workload and increased confidence in ensuring continuity of care and safe prescribing.

Conclusion: This project highlights the importance of structured, ongoing monitoring in psychiatric practice and presents a model for improving safe prescribing in high-risk populations. Future steps include iterative updates to the tool as new knowledge emerges, increasing HDAT monitoring awareness within the multi-disciplinary team (particularly around the adverse effects of HDAT), joining up care with local physical health clinics, embedding the tool into routine clinical practice and integrating it with electronic patient records and prescribing systems currently under development.

Aims: Mental Health and Neurodevelopment Resource Group (MHNRG) are planned to replace Mental Health Clustering. However, they are broad diagnostic groupings which will potentially have limited benefit in relation to evaluating outcomes, health inequalities, pathways, and interventions. In addition to mandatory completion of MHNRG, local services have the option to collect additional categorical data which led to the introduction of Working Diagnoses.

This is a pilot study to trial Working Diagnoses to test its functionality and feasibility.

Methods: The aim of the Working Diagnoses is to create an accessible form on the electronic patient record allowing assessors to select a list of up to four working diagnoses via a drop-down menu. Following consultation with clinicians from differing psychiatric specialities, a list of 53 separate working diagnoses were agreed upon which were individually mapped to their respective ICD–11 diagnostic codes and Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) to make it future proof.

The pilot was conducted within the local Crisis Resolution and Home Treatment and Primary Care Mental Health teams. A live and secure Microsoft Excel document with a list of the working diagnoses through a drop-down menu was created. Assessors consisting of both doctors of various grades and psychiatric nurses within the teams were briefed on the aims and objectives of the pilot study.

At this stage, it is not intended for the diagnostic data to flow into the Mental Health Services Data Set (MHSDS).

Results: 127 patients referred to the teams between November to December 2023 were included in the pilot study and allocated their working diagnosis; 66 received one diagnosis, 52 received two and 9 received three diagnoses and none received four.

All presentations were able to be satisfactorily described by the Working Diagnoses options. The general feedback from assessors who participated in the study reported that it was simple and easy to use despite having limited formal training.

Conclusion: We believe that mental health services require granular details of a person’s presentation if we are to effectively commission, transform and manage our services. Though other options could be utilised, implementing a limited categorical diagnostic list appears to be an acceptable, effective, and efficient method of gathering the information that has been missing in mental health services locally.

The next steps will be to trial this to other services within the wider trust.

Aims: Kent and Medway NHS and Social Care Partnership Trust (KMPT) had been providing fewer Electroconvulsive Therapy (ECT) treatments per capita compared with the national average. Following a reduction in patient numbers after the COVID-19 pandemic, the KMPT ECT Suite aimed to offer both initial and maintenance therapy. This required increasing the number of sessions per day to enhance clinic capacity by 20% to accommodate the reintroduction of a maintenance slot.

The project aimed to enhance the ECT clinic’s capacity by 20%, from 6 to 7 patients per session, in order to reintroduce the maintenance slot. The goal was to provide continuity of care, especially for patients who relapse during specific periods, such as the winter or festive seasons.

Methods: A quality improvement approach was utilized, starting with a process map and Gemba walk to observe the day-to-day operations of the ECT suite. Both assessments revealed smooth clinic operations with no major issues. Data review showed that 25% of clinics ran at full capacity, suggesting there was room to trial the reintroduction of the maintenance slot with current staffing levels.

The project used the Plan-Do-Study-Act (PDSA) methodology to trial the maintenance slot. The plan involved offering 5 inpatient slots, 1 community slot, and 1 maintenance slot per month. The maintenance slot was trialled once a month, with the aim to reduce readmissions for specific patient groups. The trial ran from October 2023 to March 2024. During this time, the team was able to accommodate 7 patients per session, but increasing the number to 8 proved difficult. However, after an agreement from the Senior Leadership Team (SLT), the clinic extended its hours to accommodate up to 8 patients per session.

Results: Results showed that each ECT session, including treatment and recovery, took approximately 39 minutes. Clinics averaged 180 minutes per session, with 5 patients per session, although the clinic capacity was 6. Despite fluctuations in patient numbers, 25% of clinics reached full capacity.

Conclusion: Data analysis from the trial period demonstrated that the team could accommodate the increased workload for a short period. Given that 25% of clinics already operated at full capacity, further efforts to increase ECT uptake may require a review to assess the sustainability of the maintenance slot. Feedback from staff confirmed that 7 patients per session could be managed with current staffing, provided transportation was efficient. The team also began recording safety huddle notes, enhancing data-driven decision-making and tracking attendance strictly.

Aims: Effective monitoring of children and young people (CYP) with eating disorders (ED) is vital to prevent complications such as malnutrition, electrolyte imbalances, and refeeding syndrome. Assessments at the Northamptonshire Healthcare NHS Foundation Trust Children and Young People Community Eating Disorder Service (NHFT CYPCEDS) & Leicestershire CAMHS Eating Disorder Team (LPT CAMHS EDT) revealed poor coordination between primary care, the clinics, and paediatric hospitals, coupled with limited staff knowledge of physical complications in ED and their management. This contributed to delayed and substandard referrals, high-acuity cases, and increased paediatric admissions. Reliance on GPs, owing to capacity issues, resulted in inconsistent and subpar physical monitoring. Therefore, we aimed to improve physical health monitoring and management for CYP with known ED in Northamptonshire and Leicestershire.

Methods: CYPCEDS established a dedicated physical health department, introducing regional clinics in Northamptonshire to improve accessibility. SOPs were developed to streamline physical health management, including refeeding protocols and escalation pathways, while a MEED-based physical health template was integrated into the Trust’s software. A physical health-focused referral letter and the Early Risk Management (ERM) Guide were provided to primary care, explaining ED, its red flags, and key helplines. Staff training workshops were conducted, and innovations like point-of-care machines were implemented. Collaboration with LPT CAMHS supported shared learning. The QIP’s impact was evaluated through audits of paediatric admissions, referrals, and physical health templates, and staff and patient feedback.

Results: Electronic physical health template ensured consistent baseline assessments for all new referrals and monitoring during follow-ups. High-acuity referrals were addressed within 24 hours by the Service, while physical health nurses and structured referral pathways reduced the psychiatrists’ workload, improving waitlists and caseload management. Refeeding monitoring improved, with most blood work done in-service using point-of-care technology, reducing reliance on external providers like GPs. Patient feedback highlighted better accessibility and satisfaction, with remote clinics boosting attendance. Staff confidence in managing physical health complications increased, and primary and tertiary teams felt well-supported by joint pathways.

Conclusion: The QIP addressed gaps in physical health care for CYP with ED in the region by establishing physical health departments, improving monitoring, standardizing assessments, training staff, optimizing resources, and enabling timely escalation. These improvements led to better patient outcomes, reduced physical acuity, and fewer hospital admissions. Referrals were streamlined, and collaboration between primary, tertiary services, and LPT ensured high-quality care across the region. Future plans include monitoring patient outcomes, creating an SOP repository, and piloting a GP early warning system.

Aims: Accurate implementation and marking of the ACE-III (Addenbrooke’s Cognitive Examination) within memory assessments is vital in informing clinical diagnoses. The 100-mark cognitive test is subject to various nuances in its marking criteria that can easily be overlooked or misinterpreted.

Given noticeable discrepancy in staff completion, we aimed to review the accuracy of scoring of the ACE-IIIs completed by the team. We sought to identify the domains with the greatest variability in scoring, hypothesising that this would be the visuospatial domain, and feed this back as a teaching session with view to improving future accuracy in completion.

Methods: 50 patients were identified from the Wyre Forest Older Adult Community Mental Health Team who had recently (last six months) undergone an ACE-III examination, split equally between the geographic East and West of the region (as covered by different consultant psychiatrists).

Independent reviewers reviewed each ACE-III against the 2017 scoring guide. Any ambiguous cases were decided by consensus. Certain aspects of the ACE-III cannot be objectively verified retrospectively and require contemporaneous observation, therefore these questions were excluded from the analysis.

Results: 45 of the 50 patients had a valid ACE-III available for review. Only 44% (20/45) assessments had no identifiable marking errors.

As hypothesised, the highest failure rates occurred in the visuospatial domains, with incorrect marking in the “copying a cube” in 20% (9/45) and “clock drawing” in 18% (8/45).

Moderate failure rates were observed within the language section with “sentence writing”, being inaccurately marked in 9% (4/45) and the visuospatial task of the “infinity diagram”, with issues in 7% (3/45).

Several of the attention, memory and fluency-specific tasks saw a mistake in at least one patient.

The mistakes were generally evenly spread across patients with no single ACE-III examination accounting for a disproportionate number of errors.

Conclusion: Uniformity in application and marking of the ACE-III requires revision with the team in order to achieve consistency. Even marginal inaccuracies in scoring could result in an under- or over-estimation of cognitive ability and influence clinicians’ interpretation and subsequent diagnosis.

In the teaching session, the team reflected on the results and their experiences, and collectively decided on further improvement measures:

1) in-house simulation ACE-III completion with a volunteer administrator, the team lead as patient, and remaining team observing,

2) to include a bi-annual team re-training with the ACE-III training video as a refresher, and

3) for re-evaluation in approximately six months’ time to monitor improvement.

Aims: Individuals with severe mental illness (SMI) face a significantly reduced life expectancy, primarily due to preventable physical health conditions. This project aimed to enhance the timeliness and comprehensiveness of physical health checks for inpatients in an acute psychiatric ward. An initial audit cycle identified gaps, prompting targeted interventions, with subsequent re-audit assessing their impact.

Methods: The first audit cycle (March 2023) reviewed adherence to physical health assessments, including physical examinations, observations, height and weight measurements, ECGs, blood tests, and cardiometabolic checklist completion. Interventions implemented included daily reviews in the Multi-Disciplinary Team (MDT), integration into daily job lists, and master list documentation. These measures reduced delays in completing assessments.

The second cycle (November 2023) involved 35 inpatients over four months. Interventions included the introduction of a whiteboard for task tracking, post-MDT reviews, staff reminders, and induction sessions emphasising physical health monitoring. Colour coding was introduced to enhance task visibility and efficiency. Specific patient needs, such as those with heart failure and left bundle branch block (LBBB) or end-stage renal disease (ESRD) requiring dialysis, were incorporated into tailored care plans.

Results: The second cycle demonstrated that, overall, there were visible improvements in clinical practice. The whiteboard intervention significantly improved the timeliness and completion rates of physical health checks. Key findings included:

Physical examinations: Success rates increased from 93% to 100%.

BMI measurements: Reduced delays and increased completions.

Physical observations: Maintained at 100% completion.

Challenges included gender-based refusals for ECGs and reluctance from patients with eating disorders to undergo BMI measurements. These findings highlight the importance of personalised approaches to monitoring and addressing barriers to compliance.

Conclusion: Implementing a whiteboard for tracking physical health checks demonstrated substantial improvements in timeliness and completion rates through simple, cost-effective interventions. Despite challenges, this project underscores the potential of structured systems to enhance physical healthcare for patients with SMI. Scaling and expanding these strategies hospital-wide may contribute to addressing health disparities and improving outcomes for this vulnerable population.

Aims: This Quality Improvement Project (QIP) aimed to assess the impact of incorporating the Seizure Quality Rating (SQR) scale into ECT dose titration practices. The objective was to optimize treatment by improving seizure quality assessment and reducing cognitive side effects associated with higher electric doses, ultimately enhancing patient outcomes.

Methods: The QIP was conducted at the ECT clinic of Surrey & Borders Partnership NHS Foundation Trust. The SQR scale evaluated seizure quality using parameters such as EEG and visual seizure duration, mid-ictal amplitude, interhemispheric coherence, postictal suppression, and peak heart rate. Patients were categorized into two groups:

Pre-SQR (Standard Group): Treated between May 1, 2023, and October 30, 2023, with dose titration based on seizureduration.

SQR (Post-Intervention Group): Treated between December 1, 2023, and May 31, 2024, with dose titration guided by the SQR scale.

Inclusion criteria were depressive disorders (e.g. recurrent depression, bipolar depression), excluding primary psychotic disorders. Outcomes measured included the number and dose of treatments, Clinician’s Global Improvement (CGI) scores, and subjective memory reports (patient-rated).

Results: The SQR group (n=7) received lower mean electric doses (622 mC) compared with the pre-SQR group (n=11; 705 mC) while maintaining comparable therapeutic outcomes. Both groups required a similar number of treatments (mean: 12 sessions). CGI improvement scores (CGI-I) and subjective memory ratings post-ECT showed no significant difference between the groups. These results suggest that the SQR scale may support safer dosing without compromising clinical efficacy.

Conclusion: The integration of the SQR scale into ECT practice demonstrated a promising trend toward optimizing treatment by reducing electric doses while maintaining clinical effectiveness. This structured approach offers the potential to minimize cognitive side effects, particularly in vulnerable populations such as the elderly. These findings underline the broader implications of incorporating data-driven tools like the SQR scale into routine ECT protocols across various trusts to enhance precision, safety, and patient outcomes on a wider scale. Future recommendations include gathering patient feedback to assess the cognitive and mood benefits of lower doses, conducting further research with larger cohorts to validate the findings, and embedding the SQR scale into standard ECT guidelines to promote consistency and improve treatment outcomes.