Aims: Resident doctors in inpatient psychiatric settings manage urgent or emergency physical healthcare out of hours with limited, remote guidance and support, creating a potentially stressful and isolative work environment. The primary outcome of this Quality Improvement (QI) project is to address this problem by enhancing the confidence of resident doctors working out of hours in psychiatric inpatient units. Secondary goals include improving morale, fostering connections with acute medical teams, and delivering more timely and targeted physical health care for psychiatric inpatients with urgent physical health needs.

Methods: The team used a structured QI approach, including constructing a survey-informed driver diagram and PDSA cycles. Data collection involved surveys of resident doctors at the beginning and end of a 6-month rotation across two inpatient psychiatric units within East London NHS Foundation Trust. Surveys aimed to identify confidence gaps, barriers, and existing challenges in managing physical health emergencies out of hours. Interventions implemented were designed to address these gaps and included:

Awareness and education: Promoting resources such as the BMJ Best Practice app for quick guidance. Emergency grab bag familiarisation sessions.

Integration of physical health updates: Including relevant physical health specialty sessions in the academic programme for resident doctors. Also enhancing connection with locality acute medical teams.

Working with locality physical health lead nurse: To involve resident doctors with ward-based simulation sessions already operating.

Results: Quantitative and qualitative results highlight changes in confidence levels, resource utilisation, and satisfaction among junior doctors, with 19 respondents in the initial survey and 13 in the final survey.

The post-survey showed improved confidence in managing physical health on call.

Post-intervention, respondents found the most value in the updated academic programme (76.9%), and strengthened links with acute teams (76.9%), followed by emergency grab bag familiarisation sessions (61.5%), the BMJ app (61.5%), and ward-based simulation sessions (46.2%).

Conclusion: Improved awareness of resources, physical health updates, and closer working relationships with acute medics and nurses can improve resident doctors’ confidence in managing physical health emergencies in inpatient settings.

This initiative has the potential to improve provider satisfaction and patient outcomes. The next steps include expanding interventions to the final part of the borough in the next trainee changeover and establishing a new 6-month Physical Health Representative resident doctor role to sustain momentum through continuous improvement and support the development of trainee leadership skills in this vital improvement area.

Aims: The inpatient wards at St George’s Hospital, Stafford, have a system of sending clozapine monitoring bloods (full blood count) to the local general hospital for processing.

This system is inefficient and has a significant time cost to staff. It leads to delays in getting results, both from the lab and from the clozapine monitoring service (CPMS), which can impact patient care in a number of ways.

The aim of this QI was to find out whether use of the on-site Pochi machine reduced the time it takes to get results from CPMS and simplifies the process for the wards. This machine is specifically designed for these samples and is already used by other teams.

Methods: QI methodology was used which highlighted a number of non value-added activities, waste and poor sustainability from the usual process.

The need for access to the Pochi machine from inpatient wards was clearly established and agreements made with the local service to use machine.

The two processes were compared by process maps and monitoring the time between blood being taken to a result from CPMS being inputted into the patient notes.

Results: Over a 4-week period the acute inpatient wards sent 24 blood samples to the local general hospital.

2 of these results were graded 'amber’ by CPMS meaning increased frequency of blood monitoring is needed. 1 of the 24 bloods sent in this period led to a delay in a patient’s discharge while awaiting results and 1 was sent off by a taxi to avoid delay.

Through the observation forms, the time from blood being taken to a result entered on the patient’s notes went from an average of 27 hours to 39 minutes.

The process was significantly simplified with substantial reductions in waste.

Conclusion: This QI has evidenced that widening access of the existing Pochi machine to all acute wards has led to a significant improvement in the time taken to obtain results from CPMS, which will benefit patients and staff.

It allows abnormal results to be acted on much quicker, improving patient safety.

It has also evidenced a reduction in non value-added activities and waste with improved environmental and financial sustainability.

Aims: Workplace stress and burnout are common within healthcare. The NHS Staff Survey 2023 found that approximately one third of respondents were experiencing burnout and were considering leaving the organisation. Studies suggest this is significantly higher in Child and Adolescent Mental Health Services (CAMHS). The negative impact of burnout on staff wellbeing, retainment, and patient care is well-recognised. Arts-based interventions have been shown to improve work-related stress and promote empathy and resilience. We set up a regular reflective art group for staff at an adolescent mental health team to see if this would reduce stress and improve wellbeing and job satisfaction.

Methods: We set up a monthly recurrent one-hour group, attended by the whole multidisciplinary team at the Service for Adolescents and their Families in Enfield (SAFE) and facilitated by team members with experience of art therapy. Group attendees were encouraged to express themselves in visual artwork freely, without specific instructions.

We anonymously surveyed attendees at baseline and at two- and four-months following implementation of the group to measure general and workplace-specific wellbeing, stress and burnout, job satisfaction, and staff attitudes to the intervention. We collected both quantitative and qualitative data.

Results: Out of a team of 19 members, 10 on average attended each session over 5 months. All disciplines and seniority levels were represented.

We collected 12 responses in March 2024 before implementing the group, 7 responses in May 2024 and 6 responses in July 2024 (2 and 4 months after implementation respectively).

The group was rated 5 out of 5 stars unanimously and described as a “space to connect with colleagues, reflect, and calm stress and emotional impact of work”.

Overall, there was an improvement in team wellbeing, job satisfaction and confidence from March to July, despite an increase in perceived stress and a decrease in general mental wellbeing. The findings can be better understood within the wider context of the service at the time, namely worsening staff shortages and extreme workload pressures.

Conclusion: The art group was very well received by colleagues and appeared to boost morale during a particularly difficult period for the team. However, this alone was not sufficient to reduce the stress derived from trying to meet clinical demands with inadequate staffing levels.

Interventions improving job satisfaction, like this project, could play an important role in fighting workforce erosion if combined with long-term commitment to a sustainable workforce on an institutional level.

Aims: The aim of this quality improvement project was to assess, and improve the confidence in antidepressant prescribing and management of common side effects amongst the Foundation Year (FY) trainees.

Methods: PDSA cycles involving a questionnaire sent out to 25 FY doctors in psychiatric jobs.

Results: A survey was sent out to the FY cohort currently doing a psychiatry job placement to assess their baseline confidence in antidepressant prescribing, which highlighted a lack of confidence. With regards to management of depression and anxiety, 25% felt unconfident, 50% felt neutral, and 25% felt somewhat confident. With regards to prescribing antidepressants, 75% felt neutral, and 25% felt somewhat confident. When it came to managing side effects of antidepressants, 25% felt very unconfident, 50% felt somewhat unconfident, and 25% felt somewhat confident.

A flowchart detailing indications for antidepressant prescribing and basic principles on swapping and titrating doses was distributed to help improve confidence. The group was reassessed with the same questionnaire to accurately identify any improvement.

When re-assessed, there was still a lack of confidence with regards to the management of side effects, with 63% feeling somewhat unconfident, 13% feeling neutral, and 25% feeling somewhat confident.

A presentation was prepared and delivered at the weekly teaching, which detailed the use of common antidepressants, their side effects, and the management of complications including serotonin syndrome.

The cohort was again re-assessed, showing an overall improvement in confidence in all aspects, with 80% feeling somewhat confident in management of depression and anxiety, and 100% feeling somewhat confident in prescribing antidepressants and management of side effects.

Conclusion: Positive outcomes included an overall improvement in confidence in prescribing antidepressants. Additionally, some participants found that the gaps in their knowledge were greatly reduced through these two cycles of information sharing.

Potential improvements to the study include using a larger cohort sampling outside of the FYs in psychiatry rotations to get a broader idea of the general FY cohort confidence. Furthermore, some participants still feel they have gaps in their knowledge, which could be addressed through more teaching sessions tackling individual cases in the future.

Aims: Patients are admitted to our medium secure rehabilitation ward from high secure hospitals or other medium secure wards from within and outside our trust. We have a waiting list. There is extensive documentation and updates shared prior to any transfer over months. For patients within our trust, we share the same electronic records system. The legal status of most patients requires mandatory information sharing prior to any transfer for example via Ministry of Justice applications.

We examined our process of preadmission handover meetings for all five admissions in 2023–2024. We identified a lack of structured approach to preparing for the preadmission meeting. We concluded that a structured checklist may help. At the time of the re-audit in January 2025, we had two vacant beds and therefore two planned admissions from our waiting list were imminent in the coming weeks.

Methods: We used the following broad national, forensic and trust standards. NICE NG53: “1.2.7 During admission planning, record a full history or update that covers the person’s cognitive, physical and mental health needs, includes details of their current medication, identifies the services involved in their care.” Trust Policy: “Lead professional should make contact with service that covers the area the service user is to move to/from and arrange a formal hand over.” QNFMHS: “When patients are transferred between services there is a handover which ensures that the new team have an up to date care plan and risk assessment.”

We re-audited our service using a preadmission checklist based on last year’s audit to review what information has already been handed over and what needs to be specifically requested prior to admission. We then compared the preadmission meeting minutes of the last five admissions of 2023–2024 with the first two admissions of 2025 to reflect on our learning.

Results: There was no difference in terms of overall information sought by our team both pre- and post-audit. Updates were needed regarding physical and mental health and third party safeguarding information in the meeting.

Conclusion: Going through the preadmission list in preparation for the formal transfer meeting in a structured manner ensured any information gaps were identified prior to the preadmission meeting and timely requests made. There were reflections on the relational aspect of the information sharing process.

Aims: Sialorrhoea (hypersalivation), a common side effect of clozapine can impact the quality of life of patients. At present, no drugs are licensed to manage clozapine-induced hypersalivation, but there are various practical and pharmacological management options included in literature. These include chewing sugarless gums during the day. At night, covering the pillow with a towel, elevating the head and sleeping on the side may reduce aspiration risk. With regard to pharmacological treatment, the first step should be to review the clozapine dose and reduce it if possible. The second step is to consider adding anticholinergic, antihistaminergic and adrenergic drugs and substitute benzamides such as amisulpride. There is also consideration of injecting botulism toxin to salivary glands.

Methods: We retrospectively audited the case notes of all six patients on clozapine in our male inpatient slow-stream rehabilitation service to assess if we have actively attempted to manage clozapine-induced hypersalivation side effects. We searched keywords ‘hypersalivation’, ‘drooling’, ‘pillow’, ‘saliva’ to identify case note entries and collected data on strategies used to manage hypersalivation. We reviewed past and current prescriptions and doses.

Results: Age ranges of our patients varied from 26 to 65. All six patients reported hypersalivation as a side effect. All patients had clozapine within therapeutic range with no option to reduce further. One patient preferred not to be on any medication to manage this side effect. All other patients had tried hyoscine hydrobromide tablets first. The tablet has a half-life of 4 hours. One patient was due a dose review of hyoscine due to ongoing hypersalivation. Three patients had been asked to suck or chew the tablets. Prior to this they had been swallowing the tablets. Two patients had tried the hyoscine patch (which lasts approximately 72 hours) but had found it not helpful. One patient had tried trihexyphenidyl tablets but then requested to change back to hyoscine. One patient had tried atropine drops following a trial of hyoscine tablets and patch. He then tried amisulpride with no impact and subsequently found trihexyphenidyl beneficial. All patients were monitored for worsened constipation with addition of anticholinergics.

Conclusion: The audit identified the need to proactively and systematically manage hypersalivation. It was also noted that practical interventions like raising the pillow, chewing gum during day were not routinely tried. We plan to re-audit the service in a year’s time to see if there is any improvement in use of management strategies and also measure hypersalivation using Nocturnal Hypersalivation Rating Scale and the Drooling Severity and Frequency Scale.

Aims: We aimed to reduce the use of seclusion, 1:1 and 2:1 observations in our PICU, without compromising safety, by introducing zonal observation levels which is considered less intrusive, allowing greater privacy for the patient and better engagement.

Hypothesis: We expect a reduction in number of enhanced observations with no change in levels of aggression with a further reduction in the second survey as staff become more confident in using zonal observations.

Background: PICUs often rely on enhanced observations, such as 1:1 or 2:1, to reduce violence and aggression. However, these practices have limited evidence of effectiveness and are frequently perceived negatively by staff and patients. At Willow Suite, a 12-bed male PICU, zonal observations were introduced in January 2024 as a less restrictive alternative. This approach involved designating staff to specific zones for proactive engagement with patients while maintaining safety and improving patient experience.

Methods: Data were collected from clinical records and incident reporting systems for three periods: pre-implementation (November–December 2023), immediate post-implementation (January–February 2024), and 10 months after implementation (November–December 2024). Key metrics included incidents of violence, seclusion episodes, and the duration of enhanced observations.

Results: The duration of enhanced observations reduced significantly, from a total of 51 days to 22 days in the first 2 months and maintained the same 10 months later. The average length of enhanced observations decreased by 58% immediately post-implementation, from 8.5 days per incident to 3.6, and further reduced to 3.1 days after 10 months. Seclusion episodes initially increased from 6 to 11 as staff were adapting to the new system, but the average length of seclusion dropped from 3.2 to 2.2 days with 55% of seclusions lasting a day or less. After 10 months, seclusion incidents had reduced further to 10 with average length of 2.5 days.

The length of all restrictions combined reduced from 70 days (average length 5.8 days) to 17 (average 2.7) in the first 2 months and to 11 (average 2.9) 10 months later.

There was no increase in incidents of violence and aggression in the initial 2 months and a reduction 10 months later.

Conclusion: The results suggest that zonal observations successfully maintained safety while reducing restrictive practices in our PICU over a one-year period. Other benefits observed were improvement in staffing consistency, increased staff confidence in managing clinical risks as well as patients reporting improvement in overall experience and engagement.

Aims: Technology has been rapidly expanding in the medical field, of late, AI has been adopted cautiously and is slowly being integrated to practice. Functional Neurological Disorder (FND) patients have a variety of different presentations and premorbid conditions that greatly affect their response to rehabilitation. Currently, there is no admission formula or criteria available that can assist the assessing clinician on suitability for inpatient rehabilitation regarding rehabilitation prognosis.

The aim of this study is to design an admission formula using machine learning to predict rehabilitation prognosis; whether individuals with FND would benefit from inpatient rehabilitation by generating prognostic factors based off data collected from other FND patients who have received inpatient rehabilitation.

Methods: Retrospective review of FND patients admitted for inpatient rehabilitation. Over a 4-year period (2021–2024), 55 patients were admitted for FND neurorehabilitation, of which, 48 patients were used in the dataset due to lack of necessary data. Data was extracted from medical records and department databases to create a comprehensive dataset. The model was trained and tested by logistic regression, with a data set that was split into 70% training and 30% testing.

Results: The UK Functional Assessment Measure (UKFIM+FAM) was used to measure outcomes and patients were divided into two categories: improvement in FIM+FAM outcome above 25% from baseline or below. We discovered the model was 86% accurate in predicting the FIM+FAM outcome.

Conclusion: Machine learning may act as a tool that clinicians can use when assessing suitability for inpatient rehabilitation. Although there are limitations, namely, appropriate assessment scales and data-set size, the model is able to predict rehabilitation outcomes with 86% accuracy. Since this is supervised-learning, we expect with time and a larger data set, there will be improvement in accuracy.

Aims: Suicide remains one of the leading causes of death worldwide, with rates among older adults increasing steadily. Older people face higher suicide completion rates, especially in 45–49 and 90+ age group. The impact of suicide on society is profound, underlining the need for targeted interventions for this demographic.

This project follows the Triple Aim framework to improve overall health system by:

Enhancing suicide prevention in older populations through mental well-being promotion.

Increasing awareness and improving patients’ experience by creating a supportive, responsive environment.

Developing a replicable model across healthcare settings, contributing to broader suicide prevention efforts.

Methods: Focus groups were conducted with 3 cohorts: patients, families and staff. 4–8 participants were recruited for each group using purposive sampling method. Semi-structured interview was conducted to explore their views on suicide prevention, their challenges, and expectations.

Results: Many patients identified negative emotions: stress and overthinking are contributing factors. Many find feelings of guilt/hopelessness, bereavement particularly challenging. Additionally, social isolation, physical health problems and poor sleep also lead to suicide.

According to staff, many patients lack access to service due to language barrier, immobility/disabilities, socio-economic deprivation and limited access to technologies. Cultural beliefs and stigma play a major role. Staff also highlighted that role transition to retirement results loneliness/isolation.

Preventive strategies include normalisation and promoting awareness in public. Having representation in peer support group can improve stigma in minority. Social interventions can aid role transition and provide sense of belonging. Integrated care with multiple touchpoints from emergency care to community/GP follow-ups alongside with multidisciplinary approach with occupational therapist and psychologist are crucial in providing patient-centred care.

Conclusion: These focus groups underscore the importance of suicide prevention for older people. The insight gained will inform future strategies and prioritise change ideas in our service.

Aims: Doctors in training can be at high pressure to balance the service needs with their own training needs, thus leading to a risk of burnout. Hence, supporting their wellbeing is of paramount importance to optimize their training experience. This Quality Improvement (QI) project led to an improvement in well-being support for specialty trainee psychiatrists, training in Kent, United Kingdom.

Methods: This project employed a baseline survey among the specialty trainee psychiatrists training in Kent in Jan/Feb 2024 with support from the trusts’ medical education department and the wellbeing team. The survey questionnaire was modified from the NHS staff wellbeing survey. It utilized a Likert scale (1 to 5) to explore several aspects of awareness and access to available wellbeing resources. Additionally, open questions were included to collect views of the the resident doctors regarding wellbeing support.

Following the outcome of the baseline survey, the suggestions were implemented by the medical education department over a year and a follow-up survey was conducted to assess the impact of the changes. This project was registered with the QI department of the trust.

Results: Fifteen specialty trainee doctors participated in the baseline survey. The survey identified several gaps in the participants’ awareness about wellbeing resources such as; lack of information about the resources, lack of confidence in accessing wellbeing events/activities and inadequate wellbeing check-in during supervision. Moreover, several barriers were identified including having limited access to information about wellbeing resources, lack of time and fear of stigma/discrimination to access the resources if available.

Following the baseline survey, a document with all the available resources was developed and included in the induction pack for all the resident doctors. A protected wellbeing event was organized with wellbeing activities chosen by the specialty trainee resident doctors. The findings from the survey were also shared with the consultant supervisors in the CPD session. A QI fishbone session was further organized to explore what wellbeing meant to the resident doctors.

Sixteen specialty trainee doctors participated in the follow-up survey. The findings showed improvement in awareness about the resources available to them and confidence in accessing these resources. There was a significant improvement in their perception regarding wellbeing check at workplace (baseline 53.3%, follow up 81.3%). However, there were still concerns around stigma, fear of discrimination that need further exploration and intervention.

Conclusion: This project has demonstrated improvement in the specialty trainee resident doctors’ perception about their wellbeing support. However, there are several challenges in terms of sustaining these positive changes and fostering a positive culture of help seeking by mitigating stigma and fear of discrimination.

Aims: Lithium is a widely prescribed mood stabiliser with proven efficacy in managing bipolar disorder, but its narrow therapeutic index necessitates regular physical health monitoring. Inadequate monitoring can increase risks for patients. Within the Taff Ely Community Mental Health Team (TECMHT), we identified a lack of a structured system to track and manage the necessary monitoring tests. This quality improvement project aimed to determine whether the implementation of a structured record sheet could improve adherence to the National Institute for Health and Care Excellence (NICE) physical health monitoring standards for lithium treatment in TECMHT.

Methods: A retrospective review of clinical records for 30 patients was conducted to establish baseline monitoring practices. A pre-implementation meeting with the nursing team highlighted existing challenges, including inconsistent monitoring and lack of centralised tracking. The intervention consisted of three components: (i) a standardised monitoring proforma, (ii) a formal clinic protocol, and (iii) a training session for clinic nurses. Following the implementation, prospective data for 20 patients attending the clinic during the 6-week monitoring period were analysed. Run charts were used to compare monitoring practices before and after the intervention, while Pareto charts identified areas for improvement and helped track compliance over time.

Results: Before the intervention, monitoring of BMI was not routinely performed, and calcium monitoring was suboptimal. Serum lithium level monitoring, however, showed good compliance with guidelines. After implementing the intervention, lithium level monitoring achieved 100% compliance with NICE guidelines, BMI monitoring was completed for 82% of patients, and calcium monitoring improved from 8% to 33%. A decline in compliance for urea and electrolytes and thyroid function monitoring was noted, which was attributed to initial confusion over the new system. This issue was addressed in a subsequent training session aiming to improve clarity and compliance.

Conclusion: A physical health monitoring form was successfully developed and integrated into the lithium monitoring clinic, improving access to monitoring data and ensuring better adherence to NICE guidelines. The form streamlined monitoring without requiring additional resources or labour. Following approval from senior health board management, the form is being rolled out across the health board. To assess its broader impact, further data analysis is recommended, and additional educational resources for clinic staff may be beneficial. This intervention demonstrates the value of structured systems in enhancing patient care in outpatient settings.

Aims: Main aim of this quality improvement project was to ensure that each outpatient CAMHS clinic room is equipped with the necessary, functional equipment for safe and comprehensive baseline and ongoing monitoring of patients prescribed antidepressant, antipsychotic, and ADHD medications, in line with NICE guidelines, the Maudsley Prescribing Guidelines and hospital guidelines.

Methods: The sites included in this project are Raglan house (single point of access), The Clock house (Community Service South Oxfordshire), Slade and Maple house (neurodevelopmental conditions outpatient service in Oxford).

Data collection was conducted with the help of a checklist to be used for each clinic room in outpatient CAMHS. All four sites were included in the data interpretation process each having 54 items in the checklist. It includes quantitative and qualitative data which are crucial to ensure standards and to meet requirements by the guidelines mentioned above. These items consist of three groups, physical health monitoring, infection prevention as well as privacy, confidentiality and comfort. Some of the items were window blinds and engaged/vacant for privacy and confidentiality; sanitiser and soap for infection prevention; stethoscope and height measurement tool for physical health.

Results: On average, 44% of checklist items were present on the sites, which means 56% items were not available. Of the present items, 96% were working well, whereas 4% were dysfunctional such as a clock with no battery, an unstable scale, a faulty thermometer and limited amount of sanitiser. Moreover, concerns were raised about shortage of rooms for routine and urgent appointments across multiple sites despite online and telephone appointments being offered. In addition, some of the rooms did not have appropriate lighting. The issues that pose immediate risk to patients’ safety were prioritised and reported to the estates. The rest is planned to be reported at the time this abstract was written.

Conclusion: Functional clinical equipment is essential to ensure patient safety. Efficient and active use of channels to report missing or dysfunctional items as well as regular maintenance and calibration of clinical items are key to excellent caring and safe care. All staff members are responsible to make sure that appropriate equipment is available.

Aims: There is currently no standardised triage process utilised across perinatal mental health services. Oxleas Perinatal Service (located in South East London, offering service across three boroughs) introduced 15-minute video triage calls, where the staff on duty is allocated six calls a day to screen new referrals received by the service. This was introduced to attempt to standardise the triage process, increase service numbers, and improve patient experience. This study aimed to evaluate the effectiveness of this new triage system.

Methods: We retrospectively looked at all referrals received between 15/01/2024 to 15/04/2024. 3 standardised feedback questionnaires designed for staff, admin and patients were sent out through SmartSurvey to: 14 staff members on the duty rota, 3 admin staff involved in triaging referrals and 170 patients who attended the video triage calls across the three boroughs. 7 out of 14 staff members, all 3 of the admin staff and 12 patients responded to the SmartSurvey. 105 patients were subsequently contacted by telephone to try and obtain more responses. Following this, an additional 29 patients responded with a total of 41 patient responses obtained.

Results: Feedback analysis was grouped into 3 themes: emerging themes from patient, staff and admin responses. Majority of patients reported they preferred video appointments over telephone and felt that the next steps in their care were made clear to them. Patients who were subsequently offered appointments with clinicians expressed how useful the video triage process was. Recurring challenges reported by patients included: poor connectivity, pace of the session and personal preference between video and telephone.

Staff feedback highlighted an enhanced patient experience and information gathering. In addition to this, an increase in service access numbers was also cited. Common barriers reported included: workload pressures, assessments felt repetitive and logistical issues such as wi-fi connectivity.

Overarching themes from admin responses cited a friendly approach for patients and an increase in access numbers. One major challenge highlighted was the workload.

Conclusion: Most patients found video triage useful, thereby highlighting a potential for an adapted process to be used across other perinatal services. To address workload pressures, a change has since been introduced where daily triage calls have been reduced from 6 to 4 calls a day. Anecdotal feedback received says that this is much more manageable. We are in the process of measuring the impact of this change, and findings of this will be reported in the near future.

Aims: A questionnaire distributed to psychiatry trainees at the East London NHS Foundation Trust ascertained that, as of July 2024, trainees had not received formal training on navigating the Portfolio Online system. Additionally, there was no easily accessible document outlining key information for understanding the portfolio and the Annual Review of Competency Progression (ARCP) requirements.

This project aimed to enhance trainees’ understanding of the RCPsych Portfolio, improving their ability to navigate it efficiently. By addressing common challenges and providing clear guidance, the goal was to streamline the portfolio experience, enabling trainees to document their competencies and progress confidently.

Methods: An initial survey was conducted among trainees at the East London NHS Foundation Trust to assess their current training on portfolio navigation and ARCP requirements. Key findings included:

94.1% of participants had not received formal training on the RCPsych Portfolio.

64.7% were unclear about the contents of the Portfolio, despite available resources on the RCPsych website.

70.5% were unaware of all ARCP requirements.

100% of trainees felt that formal training on RCPsych Portfolio would be beneficial.

Based on these results, the following interventions were implemented:

Trainee Portfolio Handbook: A concise, user-friendly handbook was created, offering step-by-step instructions on key portfolio components and ARCP requirements for easy reference.

Formal Training Sessions: Structured, interactive sessions were organised to introduce trainees to the Portfolio and to clarify the ARCP expectations. These sessions are now incorporated into the local induction programme to ensure standardised training for all incoming trainees.

Results: Following the introduction of formal teaching and handbook distribution, feedback included:

100% of participants found the teaching sessions “extremely useful” and reported improved navigation of the portfolio.

100% respondents found the handbook very effective in improving their understanding of the portfolio.

86% found the handbook “extremely useful” in clarifying ARCP expectations.

The explanation of Placement-Specific Personal Development Plans was rated as particularly helpful.

Regular training sessions on RCPsych Portfolio are now being provided to all new psychiatry trainees at East London NHS Foundation Trust.

Conclusion: This Quality Improvement Project successfully enhanced the accessibility of resources and improved trainee comprehension of the RCPsych Portfolio and ARCP requirements. The positive feedback highlights the effectiveness of the handbook and training sessions. Additionally, the handbook has been submitted to the Royal College for review and potential inclusion in their official resources.

Aims: The rising caseloads in Swansea Bay University Health Board (SBUHB), with some sector consultants managing over 200 patients, exceed the Royal College of Psychiatrists’ recommended caseload of 100. Patients transitioning into Intellectual Disability Services are increasingly complex and therefore need more intensive support which has compounded the issue. This Quality Improvement (QI) project aimed to:

Assess outcomes for patients on Patient Initiated Follow Up (PIFU) within Cardiff West Psychiatry sector of Swansea Bay University Health Board.

Use Patient Reported Experience Measures (PREMs) to evaluate patient and carer satisfaction with the PIFU system.

Methods: The Model for Improvement and the Plan-Do-Study-Act (PDSA) cycle were utilised. Planning phase involved stakeholder analysis and process mapping to create a driver diagram identifying problems in the current system. A survey of carers for patients placed on PIFU in 2021–2023 assessed satisfaction with communication and service delivery.

Results: In 2021–2022, 9 patients were placed on PIFU; 5 were discharged, and 4 requested a review within 12 months. In 2023, 4 patients were placed on PIFU, with 1 returning for an urgent review. Carer satisfaction was high, with 50% reporting being “very satisfied” and 50% “satisfied”. Regarding communication, 75% of carers felt they understood the PIFU process “very well” and 25% felt they understood it “well”. One carer was unaware that their relative had been placed on PIFU despite generally positive feedback about communication.

Conclusion: PIFU has shown potential in reducing caseloads while maintaining high levels of carer satisfaction. The system allowed for appropriate emergency reviews when needed. Some carers expressed a preference for face-to-face follow-up rather than complete discharge. Two barriers were identified. The first, consultant reluctance to discharge due to concerns about vulnerable patients deteriorating without reliable monitoring. The second was administrative staff challenges with IT systems used to track and manage follow-up, in the main due to a lack of awareness of training. Future PDSA cycles will focus on increasing training for both administrative staff and clinicians on the benefits and implementation of PIFU, as well as enhancing carer and patient advocacy.

Aims: People with Intellectual Disabilities (PwID) have, on average, a life expectancy 20 years less than that of the general population. The Learning Disabilities Mortality Review found that in 23% of deaths among PwID, constipation was a long-term health problem. In the past year, Swansea Bay University Health Board’s (SBUHB) Mental Health and Learning Disability Delivery Unit reported four incidents of constipation among PwID living in the community, with one fatality.

Patients prescribed clozapine are more vulnerable to constipation due to side effects. This Quality Improvement (QI) project aimed to assess the current knowledge about constipation among PwID prescribed clozapine, along with their carers, and to use a brief educational tool to address knowledge gaps.

Methods: Stakeholder analysis, fishbone diagram, and process mapping were undertaken to create a driver diagram and identify change ideas. Education was chosen as the primary driver for this project, with a focus on assessing understanding, and providing patient and carer education. The project targeted all PwID prescribed clozapine within three geographical areas: Cardiff, Swansea, and Rhondda Cynon Taf. An initial knowledge survey was administered to both patients and carers, followed by a face-to-face educational session using an Easyread leaflet. Knowledge was reassessed one week later.

Results: Seven educational sessions were held, with patients and their primary carers participating. The knowledge survey revealed that all patients understood the basic concept of constipation, but fewer understood its health risks (30%) and the recommended frequency of bowel movements (14%). Knowledge improved and was retained one week after the education session, with 60% understanding the health risks and 71% knowing the recommended frequency of bowel movements. Carers demonstrated improved knowledge, particularly in using the Bristol Stool Chart. All carers recognized the increased risk of constipation among PwID and its potential fatal consequences.

Conclusion: This project demonstrated that targeted, brief educational interventions can effectively improve the knowledge of PwID and their carers regarding the risks of constipation associated with clozapine therapy. The results emphasise the importance of accessible information and suggest that continuing education is necessary for both PwID and carers. It also highlighted the importance of a stable and educated carer workforce, with appropriate training at induction. The future aim of the project team is to develop an online educational programme for carers about constipation, and how to seek timely and effective support.

Aims: Psychiatry intensive care units (PICU) are therapeutic environments that care for people with the most severe mental health conditions often characterized by heightened agitation, aggression, or self-harm behaviours. It is also one of the most restrictive units. Royal College of Psychiatrists standards for psychiatric intensive care units has given emphasis on the provision of therapeutic activities. We identified the scope to improve the choice, availability and accessibility of activities provided in PICU.

Aim: of the quality improvement project is to improve the service user satisfaction of therapeutic activities provided in the PICU from 60% to at least 80% in a duration of 6 months.

Methods: The principles of Quality improvement were followed. Did a process mapping, change ideas was collected from the whole team including service users, a driver diagram was created, changes were introduced, and impact was measured through Plan Do Study Act (PDSA) cycles.

Data was collected from service users on a scale of 1 to 5 on a daily basis in community meetings. Balance and process measures data was extracted from the records. The data was plotted as a run chart.

Results: The primary outcome measure used was service user satisfaction. Balance measures used included risk incidents (absconsion, physical and non physical assaults, self harm and sexual offences). The process measures included occupied bed days and volume of admissions or transfers.

Service user satisfaction score improved from 3 at base line to 4.2 out of 5, soon after the launch of the project. Median of rate of risk incidents reduced from 12 to 4. There was no difference in the process measures over the project period.

Change ideas tested included improving the communication between service users and staff, improving the communication between multidisciplinary staff members, improving the interests and enthusiasm of team, maintaining the enthusiasm in the therapeutic activities for both staff and service users, improving the understanding among staff of the therapeutic activities of interest in the service users and ensuring to maintain the material resources.

Conclusion: The project fostered a multidisciplinary approach, involving collaboration among psychiatrists, nurses, social workers, occupational therapists, service users and other allied health professionals. There was an inertia to initiate therapeutic activities in the ward, the project has helped to break this and the stereotypies about who needs to take initiatives on providing therapeutic activities.

Aims: To assess and improve the consistency of family, carer and community team involvement in our MDT (multidisciplinary team) ward rounds on a PICU (Psychiatric Intensive Care Unit).

Methods: Baseline date involved retrospective analysis of EPR (electronic patient records) reviewing the documentation of 27 admissions over a six-month period (February to August 2024). We recorded details of demographics, diagnosis and length of stay. We reviewed MDT documentation for a maximum of eight weeks to ascertain invites, attendees and whether family/carers had been contacted within three days of their first MDT as this was an agreed expectation. A total of 101 MDTs were reviewed.

Following baseline data collection we made the following changes:

Circulation of expected standards regarding family involvement.

Change in format of our daily handover document to include details of important family/carer contacts and most recent recorded contact.

Use of a standardised MDT documentation proforma to improve accuracy of written records.

Results: Baseline data: The majority of our patients were male (74.1%), White British (74.1%), English speakers (88.9%), from the local area (81.5%) and had a diagnosis of a schizophrenic, schizotypal or delusional disorder (51.9%). The average age was 35 years and length of admission 35.5 days.

59.3% of admissions had documented contact with relevant family/carer within three days of their first MDT review.

On average relevant family/carers/professionals were invited to 61.4% of MDTs and attended 45.3% of the time.

On average MDT attendance reduced over time from 48.1% in week one to 33.3% in week eight.

Re-audit data: We are in the process of prospective re-audit between the period of January to March 2025. Thus far we have reviewed the records for 9 patients and analysed data entry of 18 individual MDTs.

100% of admissions had documented contact with relevant family/carer within three days of their first MDT review.

On average relevant family/carers/professionals were invited to 81.5% of MDTs and attended 59.3% of the time.

The MDT documentation proforma use was 61.5%.

We expect to have a larger data set as collection is ongoing.

Conclusion: Quality and accuracy of documentation is likely to have underestimated the frequency of contact with carers, particularly in the baseline data.

Timely, regular and meaningful liaison with family, carers and community professionals improves outcomes and quality of care for PICU patients. Simple interventions and reinforcement of expected practice can improve frequency and consistency of patient and carer involvement.

Aims: Serious mental illness is associated with higher rates of sexual assault and gynaecological cancers, alongside pre-menstrual disorders and the menopause which can be implicated in psychiatric presentation, relapse or treatment resistance. This project aimed to ensure better screening and referral for sexual and reproductive health issues in order to improve relevant health outcomes.

Methods: Two pre-existing health-recording forms were highlighted to nursing staff and encouraged using information posters placed in staff areas. Six individual referral pathways were developed for doctors’ use. Data was collected pre- and post-intervention including proportion of forms completed, abnormalities identified, appropriate follow-up initiated, and time spent carrying out these tasks. Reasons for non-completion were analysed. PDSA cycles were used to guide improvements and increase engagement.

Results: Prior to intervention, 53% of patients had the ‘women’s physical health’ (WPH) form completed, 0% the contraception form. Despite 59% of these finding abnormalities, 0% were referred for investigation or treatment (32 patients over a 2-month period August–September 2024). Post-intervention, completion of the forms remained static at 50% of WPH and 0% of contraception forms, though detected abnormalities rose to 88% and appropriate referrals to 40%. Of the remaining 60%, 7 patients identified as requiring a referral declined, most commonly refusing a smear test. 1 further patient was too unwell to engage. Overall patient group size was similar with 34 patients over a 2-month period November 2024–January 2025. Average time for form-reviewing and referring was 6.9 minutes per patient. Independently of the forms, 1 patient who remained admitted throughout both data periods was followed up for 3 separate issues, and 4 patients without completed forms were noted to have concerns, and subsequently referred appropriately.

Conclusion: Though patient referrals increased from 0 to 40% after the referrals guide was created, the proportion of concerns addressed remained low. Patient education is a key target for improvement, specifically cervical screening, and eye-catching patient education posters are to be displayed on the ward for this purpose. Form-completion rates did not improve, suggesting further engagement with nursing colleagues and specific time-allocation for completion would be of benefit. Perhaps most significantly, the increased identification of reproductive and sexual health concerns of patients without a completed form highlighted the team’s increased awareness of these issues. This suggests that clinician education can help in utilising inpatient admission as an opportunity to improve sexual and reproductive health for women with serious mental illness.

Aims: To determine whether an in-house phlebotomy clinic would reduce the length of time taken for blood tests to be completed and results reviewed within the CAMHS Eating Disorder Service in Coventry and Warwickshire Partnership NHS Trust, which would reduce patient safety incidents caused by these delays.

Methods: Collation of baseline data which includes the timeframe in days between:

Blood tests being requested and blood tests being taken.

Blood tests being taken and blood results being reviewed.

Blood tests being requested and blood results being reviewed.

This baseline data has been displayed in a statistical process chart to show the current length of time taken for each of the above. The baseline data also shows which patients had abnormal blood results that required A&E attendance for urgent repeat testing. It also reviews the near misses that occur due to the length of time taken to review blood results.

Testing change ideas using Plan-Do-Study-Act cycles for each change idea:

Created a central list of all patients who have had blood tests requested.

Introduced standardised days for checking if the blood test has been taken and reviewing the results accordingly.

Increased the number of standardised days for checking if the blood test has been taken.

Development of an in-house phlebotomy clinic.

Results: The statistical process charts show that since introducing the change ideas, the overall mean for the timeframe between blood tests being taken and blood results being reviewed has reduced from 17 days to 2 days. This shows the change in process has had a positive impact on this step. However, the same improvement has not been shown in the timeframe between blood tests being requested and blood tests being taken, nor blood tests being requested and blood results being reviewed. We hope to see an improvement in these two steps with the introduction of our in-house phlebotomy clinic.

Conclusion: Our findings show that the changes in process have had a positive impact regarding the reduction in time between blood tests being taken and the blood results being reviewed. We hope to see a continued improvement in this and all steps of the process with the introduction of our in-house phlebotomy clinic.