Aims: Sexual disinhibition, a neuropsychiatric symptom characterised by inappropriate sexual comments and/or behaviours, remains poorly understood in a general adult population. The absence of standardised assessment tools and limited measures to capture disinhibition may contribute to underestimating its prevalence and clinical significance. This study aimed to (1) determine the prevalence of sexual disinhibition on an acute all-male adult inpatient ward and (2) identify potential predictors of its occurrence.

Methods: Data from 55 patients was collected prospectively over a six-month duration to evaluate the prevalence and predictors of sexual disinhibition on an acute male inpatient ward. Included diagnoses encompassed psychosis, bipolar disorder, anxiety, depression, autism spectrum disorder, schizophrenia, schizoaffective disorder and personality disorders. Dichotomous variables included sexual disinhibition (current and past), delusions of a sexual nature, substance misuse, forensic history, history of abuse and medication use, including benzodiazepines, antipsychotics, mood stabilisers, antidepressants and depot medication. Scale variables included age. Family history of mental illness, age of onset, disease duration and unilateral parenting were excluded as a result of missing data. A binomial logistic regression was performed to examine the effects of these factors on the likelihood of sexual disinhibition.

Results: In total, 55 male patients, of whom 45.5% presented with sexual disinhibition, were included in our service evaluation (age: 44±14 years, detained under the MHA: 96.3%, previous sexual disinhibition: 61.8%, delusions of a sexual nature: 25.5%). Psychiatric diagnoses included psychosis (69.1%), bipolar disorder (16.4%), anxiety (18.2%), depression (27.3%), autism spectrum disorder (14.5%), schizophrenia (40.0%), schizoaffective disorder (21.8%) and personality disorder (25.5%). Presence of substance misuse was observed in 52.7% of patients, whilst forensic history was seen in 63.6%. Abuse was reported in nearly half of the patients (49.1%). The model was statistically significant (χ2(20)=45.329, P<0.001), explaining 75.1% (Nagelkerke R2) of the variance in sexual disinhibition and correctly classified 87.3% of cases. Only one variable was significant, delusions of a sexual nature (χ2(1) = 4.228, P=0.040).

Conclusion: Our findings highlight a positive association between sexual disinhibition and delusions of a sexual nature. Clinicians should recognise sexual disinhibition as a potential indicator of sexual delusions, aiming to assess these symptoms comprehensively and non-judgementally to better understand individual patient psychopathology. Educating patients and caregivers on this association may reduce stigma and aid understanding towards the patient. Future research should investigate the mechanisms of this relationship with larger sample sizes to minimise the risk of type II errors.

Aims: Antenatal depression significantly impacts maternal and foetal health outcomes, yet it remains underdiagnosed and undertreated. The Psychological Resilience in Antenatal Management (PRAM) programme at KK Women’s and Children’s Hospital in Singapore was established in December 2022 as a strategy to identify antenatal depression early among pregnant patients. Under the PRAM programme, universal antenatal depression screening is integrated into the routine care programme for pregnant patients, using a modified version of the Edinburgh Postnatal Depression Scale (EPDS) questionnaire during their routine obstetric check-up in the second trimester, for early intervention by the perinatal mental health team.

This qualitative study explores the lived experiences of pregnant women who have undergone screening and intervention under the PRAM programme. It seeks to understand their perceptions of the screening and intervention process, identify barriers and facilitators to help-seeking, and examine effective components of the therapeutic process.

Methods: Using an Interpretative Phenomenological Analysis (IPA) approach, semi-structured interviews were conducted with 10 women who have participated in the PRAM programme between November 2023 to January 2025. Interviews were completed either virtually over Zoom (N=8) or in person (N=2). The interviews explored participants’ experiences with antenatal depression screening, subsequent interventions, and their overall pregnancy journey while managing mental health concerns.

Results: Preliminary analysis reveals several key themes in participants’ experiences. For half of the participants (N=5), the screening process served as an opportunity for self-evaluation and mental health awareness. Obstetricians have also been identified to be crucial facilitators, serving as the initial point of psychiatric referral and influencing women’s decisions to seek support. A significant barrier identified by four participants was the stigma associated with psychiatric diagnoses and receiving psychiatric help. Additionally, participants emphasised the importance of spousal involvement in the therapeutic process, with several women expressing a desire for greater partner participation in their mental health journey.

Conclusion: Understanding women’s experiences with the PRAM programme contributes to improving screening protocols and developing more effective, patient-centred approaches to managing antenatal depression. The findings highlight the need for integrated care pathways that address stigma, enhance partner involvement, and strengthen the role of obstetricians in perinatal mental health care. These insights can inform the development of more comprehensive and accessible mental health support services within perinatal care settings.

Aims: Our aims for this project were to examine how long-acting antipsychotics are prescribed in the various teams (both inpatient, community and specialist services) across BCUHB, with a view to identify any emerging trends, and to compare this with data on efficacy and cost-effectiveness obtained via a systematic search of the available literature.

Methods: Data on depots prescribed across BCUHB was provided to us by the mental health pharmacy team for the year April 2023–March 2024. We extracted our points of interest from this data and demonstrated this graphically using Microsoft Excel.

We also completed a literature search of Ovid, Cochrane Library and Google Scholar on the topic, to identify relevant systematic reviews which included studies comparing depot antipsychotics head-to-head. This returned 1500 articles, of which 15 were shortlisted by title relevance, and 4 included following full-text analysis.

Results: According to the available research, there is no demonstrated clear superiority in efficacy of specific long-acting antipsychotics. The data on cost-effectiveness was somewhat conflicting; in that risperidone was found in a recent systematic review to be the most cost-effective in most studies apart from included UK studies; but that also paliperidone was more cost-effective than the typical antipsychotics. Our data showed that the three most commonly prescribed in BCUHB are typical antipsychotics, and interestingly, the unit price per depot for paliperidone in BCUHB was significantly higher than any other.

Conclusion: ‘Cost-effectiveness’ in the systematic review we looked at was defined by QALYS (‘one year of life in perfect health’). To look at the BCUHB ‘price per depot’, you may, incorrectly, assume that prescribing paliperidone would be a waste of money (with it being 173 times more expensive than the highest dose of the cheapest depot available). This suggests that use of paliperidone may make cost-savings in the longer-term, for example, in preventing admissions to hospital which are costly. In BCUHB, paliperidone is commonly prescribed to patients with learning disabilities, but is not a commonly prescribed depot amongst general adult groups (either inpatient or community).

There is limited guidance on choice of antipsychotic depot and given the absence of significant differences in their efficacy, it is generally down to clinician choice, taking into account patient preferences and drug tolerability profiles. As mentioned, cost does not equal cost-effectiveness and having an awareness of this may influence local guidance and decision-making.

Aims: The Mental Welfare Commission (MWC) released a report in February 2024 recommending the use of audit to ensure good clinical practice in the use of community Compulsory Treatment Orders (cCTO) as part of the Mental Health (Care and Treatment) (Scotland) Act 2003 (MHA). One particular area of concern was the use of care plans under section 76 of the Act.

An audit was performed across NHS Lanarkshire Mental Health services to determine if all patients on cCTOs had Section 76 care plans in place that were valid and compliant with the minimum standards set out by the MWC.

Methods: Medical records administration staff were contacted across all of the psychiatry specialities within the health board, to supply a list of patients on cCTOs. Their electronic medical records were reviewed and relevant data collated by the authors to determine if the appropriate paperwork was in place, was valid, and met the minimum standards, as set out by the MWC.

Results: Within NHS Lanarkshire, there were 89 patients on cCTOs. 87 of these had a Section 76 care plan in place, though one of these was considered invalid.

Only 24% of the care plans were found to meet all of the minimum standards. There was noted to be a high degree of variability in which of the minimum standards were met, how the care plans were documented and the quality of the information contained within them, across the specialties and between individual psychiatrists.

Conclusion: This was the first audit looking at cCTO Section 76 care plans carried out in NHS Lanarkshire. It demonstrated there is a need for standardisation of these care plans across mental health services, to ensure that as a minimum, all statutory information is documented.

Recommendations from the audit included the use of a proforma to capture the information required to meet the minimum standards, as well as provide prompts for additional information to improve the quality of the care plans. It has also been recommended that each psychiatry specialty sets up their own annual audit of care plans, and an audit tool for this has been provided.

Aims: To establish baseline data on melatonin use.

To compare the patterns of use with national guidelines.

To make recommendations to the teams.

Methods: A retrospective audit of patient records under the CAMHS services in Lincolnshire was undertaken to identify patients on melatonin as of June 2024. Data was collected from medical records between June and July 2024. Patients under 19 years and prescribed melatonin were included. Patients previously on melatonin but discontinued by June 2024 were excluded.

This audit was inspired by the POMH melatonin audit.

Results: 54 patients were identified, 23 males and 31 females. About half of the patients had been on melatonin for over one year (n=25).

Autism/autistic spectrum disorder was the most common diagnosis/comorbidity – 36 patients, 29 patients had an anxiety disorder, 21 patients had diagnosed/comorbid hyperkinetic disorders, 12 patients had mood disorders while 14 patients did not have a diagnosed neurodevelopmental disorder.

In 84.6% of prescriptions, evidence-based non-pharmacological measures were tried first.

The target symptom(s) for melatonin treatment was clear in 55.6% of cases. Sleep latency was the most common target, followed by reducing night-time awakening.

Licensed melatonin preparation was used in 46.3% of prescriptions. The preparation was however not clearly documented in most of the cases. (Licensed use covers insomnia with autism spectrum disorder (Slenyto), insomnia with Smith–Magenis syndrome (Slenyto), insomnia associated with behavioural disorders in children and adolescents (Adaflex)).

86.7% of prescriptions were reviewed for efficacy within 3 months while tolerability (side effects) was reviewed in 46.7%.

The need for continuing melatonin treatment was reviewed annually in 80.8% of cases while tolerability was reviewed in 30.8%.

Conclusion: The audit revealed high rates of prescription in certain areas of the county, it also showed that documentation of indication and target symptoms was not always available, similarly review of tolerability (side effects) was not always available.

The findings were presented to the CAMHS consultants. The high rates were thought to be related to shift in practice over time, perhaps due to consultants shortage.

Documentation of efficacy was more often done than review of tolerability. One reason for this could be that melatonin was being monitored by the community paediatrics team or the GP.

The need for clear documentation can therefore not be overemphasized.

The audit did not consider those who were able to stop melatonin. This could be useful to support patients.

Aims: The audit aimed to evaluate the effectiveness of transitioning from paper-based patient prescription charts (Kardex) to an electronic prescribing and medication administration system (EPMA) in improving compliance with safe deprescribing practices on inpatient psychiatric wards. Specific objectives included assessing adherence to Trust guidelines, reducing incidents of incorrect medication deprescription, and enhancing clarity regarding medication changes.

Methods: This audit was performed in May 2024 on all psychiatric inpatient wards utilising the EPMA system. This system had been in use for over a year in the Trust following a phasing out of the paper Kardex. During this period, the EPMA records of inpatients were evaluated. The findings were compared with that from a previous audit, which examined Kardex records in March 2022. The comparative analysis centred on deprescribing practices, examining whether medications were properly discontinued, entries were completely filled, and justifications for deprescribing were noted. The audit complied with Trust protocols and ethical governance requirements.

Results: The transition from the Kardex system to EPMA resulted in significant improvements in safe deprescribing practices. There was 100% compliance in details on the system corresponding to most of the standards measured in the previous audit, including name crossed, row crossed fully, ID, code (reason) and stop date. The sole exception to this was observed when utilising the 'other’ option in EPMA’s dropdown menu, where adherence to providing a stated reason was 94.5%, a metric not evaluated in the initial audit as this was not facilitated by the paper Kardex. In this audit, all the standards were met and the medications were considered safely deprescribed. This stands in contrast to the previous audit where less than 33.88% of deprescribed medications met the standards.

Conclusion: The EPMA system demonstrated substantial progress in promoting safe deprescribing practices aligned with Trust guidelines. The notable improvement in compliance clearly demonstrates the significant influence of technology on clinical practice and patient safety in relation to medication prescription and administration in this case.

Aims: To check compliance with the NICE guidance for behaviour that challenges, and to identify potential actions/change ideas for areas requiring improvement.

Methods: Data collection took place between 15 January and 15 April 2024. Data was collected by clinical staff on proformas based on the NICE guidance, which were co-designed by the Improvement Team and clinical staff. Data was collected using patients’ electronic records held on the Carenotes system and shared drives.

3 pilot proformas were initially completed across 3 different services to assess the robustness of audit proforma and to identify any changes required prior to the main audit. Following the pilot, changes were made to audit proforma after discussion in the audit meeting. Both inpatient and community teams collected data during the above-mentioned timeframe, and data was then sent to the Improvement Team for analysis. Data was input into a Microsoft Excel spreadsheet and analysed by the Improvement Team.

Results: 30 patient records assessed.

97% of patients had an initial assessment, and 95% of community patients and 100% of inpatients had a named lead practitioner.

93% of patients had a care and support plan. All inpatients (100%) had timetabled daily activities with documented evidence of participation.

90% of community patients had access to specialist behavioural support. However, only 55% of applicable community patients were supported to choose where and how they live.

100% of restrictive interventions had a documented review.

77% of patients were prescribed antipsychotics, with 100% receiving psychological support alongside medication. Among these, 65% had a multidisciplinary review (MDT) of their antipsychotic use, with 45% reviewed within 3 months of initiation and 70% having subsequent reviews every 6 months.

Conclusion: Most patients had initial assessment and a named lead practitioner with specialist beahviour support in the community. Some areas of improvement include review of PBS plans and more MDT work around antipsychotics and physical health reviews.

Aims: This audit aims to record the ethnicity of referrals to Liaison Psychiatry from January 1 to December 31, 2024, to evaluate whether the ethnic representation of these referrals aligns with the demographic composition of the local population and to identify any disproportionality in certain ethnic groups, which may require targeted intervention or further investigation.

Methods: Electronic records of all Liaison Psychiatry referrals made between January 1 and December 31, 2024, were reviewed. 539 patients were referred for self-harm and 607 patients were ward referrals. Emergency and ward referrals were grouped under ‘ward referrals’. Data from electronic records were cross-referenced with paper records to ensure accuracy. Ethnicity data, where missing, were retrieved from SCI-Docs when possible. Referral ethnicity data were compared with 2024 census data from four constituencies. All analyses adhered to strict confidentiality protocols, ensuring anonymity and privacy for all patients.

Results: Between January 1 and December 31, 2024, most of the patients in the 'self-harm’ and 'ward referrals’ groups identified as White (90.9% and 89.5%, respectively), which is consistent with 2024 census data (91.4%). ‘Mixed or multiple ethnic groups’ were absent in the self-harm group and underrepresented in ward referrals (0.7% vs. 1.3%). ‘Asian, Asian Scottish or Asian British’ individuals (1.7% and 1.5%) and African individuals (0.4% and 0.8%) were also underrepresented compared with census data. The proportion of ‘Caribbean or Black’ individuals is consistent across all groups, aligning with their low representation in the overall population (0.2%). Patients in the ‘Other ethnic groups’ category were slightly overrepresented, highlighting areas for further investigation and intervention.

Conclusion: This audit has highlighted significant findings regarding the ethnic representation of patients referred to the Liaison Psychiatry Department at Aberdeen Royal Infirmary. ‘White’ individuals dominate referrals, while ‘Mixed or multiple ethnic groups’, ‘African’, and ‘Asian, Asian Scottish or Asian British’ individuals are notably underrepresented. Conversely, individuals from ‘Other ethnic groups’ are slightly overrepresented. To address these disproportionalities, recommendations include improving ethnicity data collection, comparing the urgency of referrals, fostering community outreach to underrepresented groups, and providing cultural competency training for staff. Further research into systemic and social factors is essential, alongside ongoing monitoring and evaluation of progress. These measures aim to promote equitable, culturally informed mental health services, ensuring inclusive care for all ethnic backgrounds.

Aims: To reduce or stop inappropriate prescriptions of antipsychotic medication in Older Adults with dementia or functional illness residing in care homes in NPT, by ensuring adequate and timely reviews of antipsychotic medications.

It also compares its findings with the last audit results in October 2022.

Methods: Retrospective Audit included patients in care homes under CHIRT from NPT, a total of 164 patient were on antipsychotic medication starting this audit compared with 146 total number of patients on last audit in 2022.

Audit period: 10/5/2023 to 10/05/2024.

Data were collected from the antipsychotic register, reviewing the initiation and monitoring charts to assess patients for side effects.

Patients were classified according to Age, Gender, Diagnosis, Prescribed Antipsychotic and status of the antipsychotic reviews.

Results: A larger number of patients on antipsychotics compared with previous audit with expected demographics and side effects given the offered medication.

A total of 83 patients were continued on antipsychotics, 56 patients discontinued antipsychotics, with 25 reported deaths within the audit year. This shows a significant increase in number of patients discontinuing antipsychotic medication by 34% of total numbers in comparison to the 2022 audit.

Antipsychotic review status was up to date for 68 patients, overdue for 12 patients and not stated for 4 patients. This shows a significant decrease in number of patients with overdue reviews for antipsychotic medication currently at 19% of total reviews in comparison to last audit’s results of 61% of reviews.

Conclusion: It is good practice to review initiation of antipsychotics regularly once in 6 weeks–3 months in accordance with NICE Guidelines.

It is good practice to monitor antipsychotics in care homes once in 6 months to follow NICE Guidelines and ensure regular reviews.

It is recommended to audit prescribing of antipsychotic medication once in 6 months to maintain good medical practice.

Aims: This audit explores adherence of the Leeds Community Healthcare (LCH) Learning Disability Clinic to the STAMP/STOMP guidelines. This is to ensure that children with moderate to severe learning disability or autism are not overmedicated with psychotropic medications and are aware of their right to an annual health check.

Methods: This audit took place in 2 cycles: JA in November 2023 and EM in July 2024. On both occasions, 30 clinic patients were randomly selected. Data was collected from SystmOne and Leeds Care Record, to ascertain:

The number of children who had their Annual Health checks in the previous year.

Whether the drug names and dosages had been identified in case notes.

Whether indications for psychotropic treatment were documented.

If the drug was within British National Formulary limits.

Whether there was a discussion of side-effects at initiation and follow-up.

In cycle 2, EM set criteria for “enquiry for side-effects at follow-up”. This was interpreted as a relevant medical appointment in the past 6 months or since a change in dose. In addition, the age of the child was accounted for in the second cycle, as only children >14 years were advised to have an annual physical health review.

Results: Children receiving an annual health check: 70% (cycle 1)/80% (cycle 2).

Drug names and dosages have been documented: 100% (cycles 1 and 2).

Indication for psychotropic medications has been documented: 85% (cycle 1)/93% (cycle 2).

Discussion of side-effects at initiation has been documented: 73% (cycle 1)/38% (cycle 2).

Enquiry for side-effects at follow-up: 77% (cycle 1)/54% (cycle 2).

Conclusion: Medications and dosage were consistently documented across both Audits. In cases where only melatonin or ADHD medication is prescribed, it was more common to find that discussion of adverse effects, and specific impacts on sleep duration and latency were not documented. On an ongoing basis, team members must ensure that patients over the age of 14 (and their families) are aware of their right to an annual physical health check.

One limitation of this study is that ‘discussion of side-effects’ does not clarify the extent and frequency to which these should be discussed. This may account for the large difference between audit cycles. In addition, the spread of information between systems may have increased the possibility of information being lost or overlooked.

Aims: The aim of conducting this audit is to know whether the physical health monitoring of our clients are done appropriately in accordance with the BCUHB guidelines for physical health monitoring for adults prescribed antipsychotic therapy and also to reduce the risk of adverse side effects of antipsychotics on the physical health of our patients.

Methods: The sample in this audit consists of 18 patients (n=18) in Ty Llywelyn. To collect the data, we utilised the patients’ paper files, Paragon (computerised) clinical entries, drug charts and observation charts. The participants also had their waist circumference measured using tape measurement. Data collection was undertaken in June and July 2024 using the audit proforma. Completed GASS questionnaires were filed in the patients’ notes and the prescriptions initiated because of the questionnaires were accompanied by a Paragon entry to explain the rationale.

Results: In this re audit, it was noticed that most of the patients had their waist circumference measured. Whereas in the previous audit, waist circumference was not done on the patients. Out of the 18 people who participated in the audit only 17 people had their waist circumference measured. Out of the 17 people, 13 patients were shown to have obesity according to their waist circumference and 3 patients fall within the overweight range of waist circumference. Only one patient’s waist circumference falls within the range of normal. In addition, in this audit, we identified that 12 out of the 18 patients who participated in this audit have normal HBA1C meaning that they are not diabetic, while 6 out of the 18 patients are diabetic. Of the 18 participants in this audit, a total of 2 patients had normal weight. A total of 11 participants are obese. A total of 1 patient is overweight. A total of 4 patients are severely obese.

Conclusion: The results highlight the importance of regular monitoring and the need for targeted interventions to manage obesity, reduce and eliminate diabetes and also to reduce the risk of adverse side effects of antipsychotics on the physical health of our patients. Overall, the physical health of the patients in Ty Llywelyn medium secure unit is taken seriously, hence the higher percentage of people who have their physical health checked in this study.

Aims: Prescribing valproate to women of childbearing age in psychiatric settings requires a nuanced approach due to its teratogenicity. The Medicines and Healthcare Products Regulatory Agency (MHRA) and the National Institute for Health and Care Excellence (NICE) guidelines emphasize the importance of avoiding valproate in this population, considering alternative medications, discussing benefits, side effects, and teratogenicity, conducting pregnancy testing before initiation, and ensuring the use of highly effective contraception. This study aimed to evaluate current prescribing practices against MHRA and NICE guidelines within Hamad Medical Corporation (HMC) psychiatric inpatient units.

Methods: An initial audit was conducted between 25/10/2022 and 25/10/2023, followed by a re-audit between 10/11/2023 and 10/11/2024. The audit involved a retrospective review of electronic health records of all female patients of childbearing age (16–49) admitted to the psychiatry hospital and prescribed valproate for a psychiatric indication. Data were collected using a proforma, and the audit was approved by the HMC Audit Committee.

Results: During the first audit period, 32 patients were prescribed valproate. Of these, only 1 patient (3%) had documented discussion about teratogenicity, 7 patients (21%) about benefits, and 3 patients (9%) about side effects. 21 patients (65.6%) underwent pregnancy testing before prescription. However, none of the patients received documented education about highly effective contraception.

In response to these findings, results were widely disseminated within the department, and educational sessions were conducted for doctors and pharmacists. Additionally, the need to develop national guidelines was emphasized to ensure safer prescribing practices. Noteworthy, during the re-audit phase, there was an expansion in bed capacity for female patients.

The re-audit showed a reduction in valproate prescribing to 21 patients. Documented discussions on teratogenicity increased to 10 patients (47.6%), while 5 patients (23.8%) had discussions about benefits and 14 patients (66.7%) about side effects. Pregnancy testing before prescribing improved to 19 patients (90%). Additionally, 8 patients (38.1%) received documented education on effective contraception.

Conclusion: The re-audit demonstrated significant improvement in pregnancy testing, and noticeable progress in other aspects, though further work is required. This study underscores the importance of educational sessions and interdisciplinary collaboration among doctors and pharmacists to enhance prescribing practices. Towards sustained improvement, systematic changes are needed, including shifting clinicians’ perceptions of valproate prescribing, developing local guidelines, and introducing strict governance measures. This audit has served as a catalyst for the development and implementation of national guidelines and has led to the initiation of a quality improvement project.

Aims: This is round 2 of audit focusing on assessing the compliance of health professionals with the UK law by informing the drivers with dementia about their legal requirement to report their condition to the DVLA and their insurance companies. The aim of this audit is to ensure public safety by adhering to the General Medical Council (GMC) guidance; “Confidentiality: patients’ fitness to drive and reporting concerns to the DVLA or DVA”, as well as the Driving with Dementia or Mild Cognitive Impairment Consensus Guidelines for Clinicians; endorsed by RCPsych and Alzheimer’s Society. This will help ensure public safety and prevent potential accidents or incidents caused by impaired driving.

Methods: This is the second cycle of the audit, including patients diagnosed in 2024. First cycle was completed last year for patients diagnosed in 2022. Retrospective data was collected from SystmOne. 40 patients were selected randomly from 807 patients referred to the memory clinic of Watermill resource centre in Berrywood Hospital.

Inclusion Criteria: Patient referred to the service between 1 January–31 December 2024 who were diagnosed with Dementia.

Results: The results showed that Compliance with informing patients to report to the DVLA following their diagnosis has improved from 73% to 80%. The compliance with informing patients to report to their insurance companies fell from 45% to 0% in the second cycle. Out of the 40 patients diagnosed with dementia, 34 had a recorded risk assessment. 5 patients were driving at the time of assessment. 3 patients were referred to occupational therapy for a driving assessment. 4 out 5 driving patients were informed they must report to the DVLA (compliance 80%), and 1 out 5 driving patients were informed they must contact their insurance company (compliance 20%). No documented evidence was found about informing the patients about consequence of not reporting to the DVLA and insurance companies. There was no record of medics having to contact the DVLA.

Conclusion: Overall, the audit revealed a need for improvement in compliance and documentation. It is recommended that health professionals strictly adhere to their responsibilities in risk assessment and informing drivers with dementia about their legal requirements regarding informing DVLA and insurance companies. Clear documentation should be made using a standard template available.

Aims: To carry out a retrospective audit of medical records of people with newly diagnosed dementia in North Devon Community Older People’s Mental Health Team for any evidence of anticholinergic burden review before dementia treatment.

Methods: Data for 49 patients with dementia were identified based on evidence of clinical coding on SystmOne (the Trust’s new electronic records system) from November 2023 to August 2024. Most of the newly diagnosed patients with dementia were not captured due to missing clinical coding.

Electronic records, including GP referral letters, assessment notes, and MDT discussions, were reviewed to determine whether anticholinergic medicines were rationalised and whether ACB scores were recorded before initiating medication for dementia.

In addition, pre-referral medications were reviewed from the GP referral letters to establish pre-referral anticholinergic burden and ACB scores.

Values from the ACB calculator were used for anticholinergic burden estimation in this audit as it collates information from the German Anticholinergic Burden Scale and the Anticholinergic Cognitive Burden Scale, which have been demonstrated to have the highest validity and reliability. According to the NICE guideline [NG97], there is not sufficient evidence to recommend one validated tool over the others.

Results: Out of 49 patient records, 27 were included in this audit. Twenty-two were excluded due to not meeting the inclusion criteria.

None of the clinicians documented that anticholinergic medicines were rationalised, and only 2 (7.4%) documented that the patient’s current medications were reviewed.

There was no documentation of ACB score for any of the patients included in this audit; whereas, the vast majority (70.4%) of them were on regular medications with anticholinergic burden before presentation and such medications were prescribed for their anticholinergic effect in 1 out of 10 (11.1%) of cases.

More than half (52.6%) of the audit patients with pre-referral anticholinergic burden had ACB scores of 3 or higher (high risk).

The most commonly prescribed medications leading to raised ACB were metformin, lansoprazole and sertraline in descending order of frequency.

Those prescribed specifically for their anticholinergic effect were solifenacin and oxybutynin with ACB score of 3 each.

Conclusion: We are not documenting that we rationalised anticholinergic medicines before initiating anti-dementia treatment.

Almost 3 out of 4 of the patients referred to our team for dementia diagnosis were on medications with an anticholinergic burden. More than half of those on anticholinergic medications had ACB scores in the high-risk range.

The most commonly prescribed medication resulting in anticholinergic burden was metformin.

Aims: For the first QIP our objective was by August 2024, a completion of admission checklists jobs on clerking by out of hours Doctors in Solent and Southernhealth Foundation Trusts Psychiatric Inpatient Units by 100%.

However, if tasks were not completed, we would be expecting documentation of the reason why on SystmOne tabbed Journal and Rio progress notes (electronic records).

Methods: For the first QIP, 30 patients were randomly selected from current admissions in three facilities: The Limes (10 patients), The Orchards (Maples and Hawthorn, 5 patients each) and Elmliegh Hospital (10 patients).

For the completed audit Cycle, 35 patients were randomly selected from current admissions in four facilities: The Limes (10 patients), The Orchards (Maples and Hawthorn, 5 patients each), Elmleigh Hospital (10 patients), and Ravenswood House Forensic Hospital (5 patients).

The audit involved reviewing clerking documentation on SystmOne and Rio, measuring performance indicators for the completion of admission tasks, including DNACPR, mental capacity assessments, mental state examinations, physical examination, current medications, allergies and sensitivities, and VTE assessments.

During our first QIP, a guide was introduced in the trainee handbook to demonstrate how to complete an admission on S1 in addition to a video demonstration, link shared with all doctors working within the trust.

Results: There was excellent compliance with admission tasks across most wards, with a 100% completion rate in the Limes, The Orchards and Ravenswood House. Key achievements included successful documentation of physical examinations, current medications, allergies, and sensitivities. The audit demonstrated substantial progress in standardising admission documentation processes.

Conclusion: The audit results showed excellent overall compliance in completing admission tasks across most wards, with particular success in completing physical examinations, current medications, allergies, and sensitivities documentation. This audit reflects significant progress in standardising admission documentation across psychiatric inpatient units. This audit’s findings will support continued improvements in admission processes, enhancing both compliance and patient safety. The results have been disseminated trust wide and incorporated as part of the junior doctor induction programme.

Aims: Serious concerns have been raised by a HM Coroner in England regarding poor medical recording and communication following Mental Health Act Assessments (MHAA). We aimed to undertake a ‘deep-dive’ audit of documentation and inter-professional communication to assess compliance with GMC Good Medical Practice (GMP) and Mental Health Act Code of Practice 2015 (MHACP) following a MHAA in the Doncaster locality of Rotherham Doncaster and South Humber NHS Foundation Trust (RDASH).

Methods: Audit standards were set using the GMC GMP guidance and the MHACP. GMC GMP states ‘You must make sure that formal records of your work (including patient records) are clear, accurate, contemporaneous and legible’ and makes clear each doctor is responsible for recording their own independent medical opinion for any significant clinical intervention.

All patients detained on section 136 in September 2024 in the Doncaster locality were selected. The electronic records system (SystmOne) was scrutinised for (1) length of time taken for the assessment to be documented on SystmOne by any of the assessing team, (2) the number of doctors documenting the assessment, (3) whether any doctor communicated with the GP.

An email was sent to each patient’s GP regarding any communication they received from a doctor relating to the MHAA in case communication was not included on the internal Trust system.

Data was also collected on the outcome of the assessment, number of doctors involved, their roles and whether they were employed by the Trust.

Results: Of the 23 MHAAs, 18 took place in the Doncaster S136 suite and 5 in A&E. Nineteen assessments did not result in detention, 3 resulted in an informal admission, and 1 in detention.

Documentation on SystmOne took over 1 day for 61% (14/23) of MHAAs, all completed by an Allied Mental Health Professional (AMHP). In 26% (6/23) documentation occurred within 4 hours, all by an assessing doctor. In 4% (1/23) it was completed within 12 hours by an AMHP.

A total of 9% (2/23) had no AMHP report or documentation. In 70% (16/23) neither doctor documented, while in 30% (7/23) one doctor documented.

In only 22% (5/23) of MHAAs a letter was sent to the GP by an assessing doctor.

Conclusion: The documentation and communication following a MHAA was not in keeping with GMC GMP guidance and the MHACP in the vast majority of cases assessed. This poses a significant patient safety concern.

Aims: To audit the current practices of vitamin D screening and replacement in patients admitted to Rosewood Mother & Baby unit in Kent.

Methods: Retrospective audit was conducted to evaluate current practices in screening and treating vitamin D deficiency among patients admitted to mother and baby unit. Relevant standards were set and data collected for patients admitted Jan 2023–Dec 2023. Results presented to stakeholders and improvement plan implemented by circulating trust vitamin D guidelines and discussion with unit dietician. Re-audit was carried out reviewing details of patients admitted from Jan 2024 to Dec 2024.

Results: Audit 2023: Out of 60 patients admitted, 95% patients (57) were screened for vitamin D status. 65% of screened patients were either insufficient or deficient (12 insufficient and 27 deficient). Patients received vitamin D replacement as per KMPT guidelines. Aftercare instructions to GP communicated for 93% and 100% patients with vitamin D insufficiency and deficiency respectively. Regarding infant feeding mode 50% were breastfed, 35% on formula milk and 11.6% received mixed feeding. One patient was pregnant and data of one patient not recorded.

Re-audit 2024: Of 56 patients admitted in 2024, 2 patients were not screened. Among 54 patients, 21 and 9 were insufficient and deficient respectively. Out of these 30 patients, 24 were given appropriate supplementation in line with current KMPT clinical guidelines. Aftercare instructions to GP communicated for 17 patients. There was a drop in GP communication and this has been noted for improvement. Four infants were breastfed, 29 on formula milk and 16 received mixed feeding. Three patients were pregnant and for 2 patients the data not recorded.

It is important to highlight that lactating mothers can be deficient in vitamin D. Therefore, this was especially analysed in both audit reports. In both audits, 57 out of 116 patients either breastfed or mix fed the babies. Among these 57 patients, 8 were deficient while 28 were insufficient. This indicates significant (63%) number of patient in both were deficient/insufficient. As vitamin D is implicated in mood and immune system regulation it could play a vital role in the mental state of post-partum patients.

Conclusion: This audit/re-audit highlighted need for routine vitamin D screening in patients admitted to psychiatric units especially breastfeeding mothers. It is also important to note that vitamin D could play a vital role in mood and immune system regulation.

Aims: To evaluate and improve the adherence to NICE guidelines in recording physical health parameters during the initiation and maintenance of ADHD medications.

Methods: Retrospective data was collected from electronic medical records (RIO) of patients who were initiated and maintained on ADHD medication, referred to Islington CAMHS in 2023. Collected data was stored and analysed using Microsoft Excel. Inclusion criteria:

1. All the patients with ADHD referred to Islington CAMHS in 2023 for initiation of medication were sampled.

Exclusion criteria:

1. Patients not started on medication.

2. Patients who had previously been on medication.

3. Patients who had medication initiated by paediatrician.

4. Patients who had medication initiated by private psychiatrist.

Results: A total of 74 patients were identified, 55 males and 19 females.

Pre-medication Physical Health Assessment: The physical health parameters before initiating medication were recorded in 100% of cases, with 96% adhering to the standards outlined by NICE. This indicates a strong adherence to pre-medication assessment protocols.

Medikinet XL was the most prescribed medication for both initiation and maintenance.

Side Effects and Medication Management: Side effects were reported by 22% of patients, with reduced appetite being the most common. Medication was stopped in 4% of cases due to side effects, and 11% required a change in medication. This highlights the importance of ongoing monitoring and the need for flexibility in treatment plans to address side effects promptly.

Standard Monitoring Compliance: The monitoring of physical health parameters during medication maintenance also met the standards in 100% of cases, underscoring a consistent approach to ongoing patient care.

Comorbidities: The audit identified patients with psychiatric comorbidities, such as Autism Spectrum Condition (47%), Tourette’s (3%), Anxiety (3%), and Dyslexia (1%).

Conclusion: The audit highlighted the importance of maintaining high standards in ADHD medication management and suggested areas for further improvement, such as the documentation of rating scales to objectively monitor medication effectiveness. Based on the audit results, an ADHD clinic proforma was developed to incorporate all required data points, ensuring comprehensive documentation during clinic appointments.

Aims: To assess compliance with record keeping policies.Medical records play a vital role in supporting patient care. However, effective record keeping in clinical practice, particularly in mental health, poses significant challenges. The General Medical Council’s (GMC) good medical practice, states that doctors must ensure their records are clear, accurate, and legible. Regulation 28 of the Coroners and Justice Act 2009 empowers coroners to address concerns that could lead to future deaths. Davies Arnold Cooper (DAC) Beacroft’s 2022 report identified record keeping as a key issue in mental health.

Methods: Patients across three older adult inpatient wards were identified using convenience sampling method. Five hundred and thirty-three entries made by doctors for the audit and 424 entries made by doctors for the re-audit were identified using patient identifier. Data compilation was done using Excel spreadsheet and analysed using descriptive statistics. Outpatient entries and ECT entries made by doctors were excluded, ensuring a focused assessment of inpatient records. The results were presented using bar charts, pie charts and tables.

Results: The results were compared with the trust’s Record Management Policy and the previous audit conducted in January 2023. The re-audit found an improvement in the percentage of validated entries across all three wards compared with the previous audit. One of the wards showed the highest improvement, with a 35% increase in validated entries. However, the overall validation rate was still below the 80% requirement standard set. The timescales for validation across the three wards also showed some improvement, with the majority of validated entries meeting the 12-hour standard, although a small percentage remained unvalidated for longer periods. In addition, doctors were more likely to sign off their entries during normal work hours than out of hours

Conclusion: The findings suggest that while there has been improvement in the timeliness and completeness of clinical entries validation, more work is needed to ensure full compliance with the trust’s policies and the GMC’s good medical practice. Recommendations include regular reminders to doctors on promptly signing off clinical entries, incorporating record-keeping guidelines into local inductions, and a review of the trust’s guidelines on note validation for inpatient entries. This audit cycle led to a broader quality improvement project and trustwide policy change on validation of clinical entries. It highlights the importance of maintaining accurate and timely clinical entries.

Aims: To help specialist mental health Trusts/healthcare organisations improve their prescribing practice. To assess the Trusts’ alcohol detoxification practices, benchmark against the national average performance and to compare results to the previous audit of 2016. This was the second re-audit in the cycle.

Methods: The audit included any person (Male and Female) admitted to an acute adult or psychiatric intensive care ward, or a specialist inpatient drug or alcohol unit, who underwent alcohol detoxification (assisted alcohol withdrawal) whilst an inpatient. Patients identified via RiO, EPMA, Pharmacy Databases and Ward/Team caseloads. The final sample consisted of 80 patients, 20 patients from each of the 4 boroughs (Warrington, Halton, Knowsley, Wigan).

Data was collected in May 2021 via clinical audit days over Microsoft Teams, checked for quality twice by the audit leads and inputted by the Medicines Management Team in June 2021.

Data was analysed by the national POMH team followed by the production of a national and trust level report. The findings of the audit were then presented at various forums.

Results: Five POMH-UK Standards were chosen for the audit that were divided in 12 criteria to assess results against. In addition, three “targets” for assessing alcohol intake at admission and follow up following detoxification process were also selected for the audit.

Four of twelve standard criteria (assessment of.iver function test and glucose tests, prescription for acute alcohol withdrawal and prescribing parenteral thiamine) and all the three targets (measurement of alcohol breath test at initial assessment, relapse prevention treatment and referral to specialist alcohol services for follow up) indicated less than 60% compliance with standards and a lower compliance than the national sample.

For all targets, practices across the trust were variable.

Conclusion: There is a need for developing guidance, detailing professional responsibilities and aligning procedures and documents across Mersey Care Foundation Trust to create a single standard method for alcohol detoxification. This includes developing a standard junior doctor admission checklist for both assessment and monitoring and raising the importance of assessment for alcohol detox at Junior doctor induction programme. It highlighted the need to consider alcohol breath test as part of the initial assessment at admission and including the required blood tests in routine admission blood investigations. The financial implications of this were also considered. The process emphasised the need for dissemination of results to all staff, focussing mainly on inpatient staff.