Aims: To evaluate current clinical practices in prescribing of antipsychotics in dementia patients for non-cognitive symptoms within our services and to assess whether antipsychotic medications are prescribed safely and reviewed appropriately.

Methods: 31 patients with a confirmed diagnosis of dementia who were prescribed antipsychotics for non-cognitive symptoms were selected. Patients with diagnosis of other co-morbid mental illnesses were excluded. Retrospective review of these 31 patients’ medical records was performed, where we looked for whether a comprehensive assessment was performed by a trained member of staff before prescribing antipsychotics, documented trial of non-pharmacological interventions before prescribing anti-psychotics, indications of anti-psychotic use, discussion about antipsychotics with the patients or caregivers before prescribing it, documentation of discussion made with patient or caregivers specifically mentioning risks and benefits including risk of stroke, TIA and mortality along with discussion regarding potential side effects including risk of falls, sedation and EPSEs, choice of antipsychotics, documentation of planned review after initiating antipsychotics, monitoring of side effects, outcome of planned review, consideration given to not use benzodiazepines for non-cognitive symptoms.

Results: All patients underwent a thorough evaluation by a trained healthcare professional before being prescribed antipsychotics. A documented trial of non-pharmacological interventions was conducted in 90.3%. Severe distress, accompanied by agitation, aggression, or psychosis, was observed in 51.6%. Additionally, 12.9% were at risk of self-harm, and 6.5% posed a risk to others. A documented discussion with the patient/or NOK regarding antipsychotics was held with 61.3%. And there was documentation of discussion with patient/or NOK regarding risks/befits specifically mentioning risk of stroke, TIA and mortality and side effects i.e. sedation, falls and EPSEs appeared in the medical record of 13 %. Regarding choice of antipsychotics risperidone was prescribed in 64.5% patients. Quetiapine was prescribed in 32.3% patients and olanzapine was prescribed in 3.2%. A review planned after initiating antipsychotics was documented in 96.8% patients, and all patients were monitored for side effects. Within three months of starting antipsychotic therapy, 61.3% patients had their dose increased, 22.6% patients continued the same dose, 12.9% patients had their dose reduced, and 3.2% patients the antipsychotic was discontinued. For 93.5% patients, benzodiazepines were intentionally avoided for managing non-cognitive symptoms.

Conclusion: The data highlights appropriate prescribing of antipsychotics medications within our services. Documentation regarding risk/benefits, specifically mentioning risk of stroke, TIA and mortality and discussion regarding the side effects of antipsychotic medication was not present in most cases, which can be a potential area for improvement.

Aims: Controlled drugs are defined as substances, products or preparations that are either known to be or have the potential to be dangerous or harmful to human health, including being liable to misuse or cause social harm. The Misuse of Drugs Regulation 2017 came into force on 4 May 2017 and all prescribers must adhere to these regulations. The objectives of this audit were to assess, intervene and improve compliance of a POLL Community Mental Health Team (CMHT) service with the gold standard prescribing guidelines illustrated in the “Safe Prescribing and Dispensing of Controlled Drugs” Joint Guidance by the Irish Medical Council and Pharmaceutical Society of Ireland in order to allow best practices to develop in the care of patients.

Methods: Prescriptions required certain details to be included e.g. strength, form and quantity of medication (words and figures) to be deemed valid and compliant. During the initial stage of the audit, every patient file was reviewed and the most recent prescription checked to assess if the patient was prescribed a controlled drug since receiving treatment from the service. A data collection tool was utilised to compare each prescription to the gold standard guidelines and all omissions were recorded. The results of the initial audit were circulated to the prescribing members of the CMHT and presented at the weekly multidisciplinary team meeting. Improving inclusion of components deemed poorly compliant on the initial stage of the audit was emphasised.

Results: Of the 158 files initially audited, 70 patients were prescribed controlled drugs (exclusively benzodiazepines and z-hypnotic medications) by the POLL CMHT. 100% compliance was observed regarding inclusion of date, name of patient, strength of medication, dosing frequency, signature, profession and registration number of prescriber. 98% compliance was observed regarding inclusion of name of prescriber and telephone number of prescribing setting. 97% and 94% compliance was observed regarding inclusion of address of prescriber and patient respectively. 61% and 47% compliance was observed regarding inclusion of form and quantity of medication respectively. Re-audit was completed 3 months later which showed 15/70 patients had been reissued prescriptions. The compliance rate improved to 100% for all components.

Conclusion: Compliance greatly improved particularly regarding components of prescriptions frequently omitted during the initial audit stage i.e. form and quantity of medication. Other components were largely compliant during both stages. As a result of this audit cycle, controlled drug prescribing patterns underwent significant quality improvement and became more aligned with the gold standard.

Aims: Infections are common amongst old age psychiatry patients in an inpatient setting, which often require treatment with antimicrobials. Antimicrobial stewardship is important in reducing side effects caused by unnecessary antimicrobial use as well as preventing antibiotic resistance.

Electronic prescribing is becoming increasingly common in clinical practice. Reasons supporting these systems include increasing efficiency of prescribing and reducing human error. The old age psychiatry ward in Rochford Hospital migrated from paper drug charts to electronic prescribing (ePMA) from the beginning of December 2024. ePMA allows prescribers to set an end date or a review date for each prescription, which may help reduce the number of unnecessary or inappropriately prolonged duration of antimicrobial prescriptions.

This study aimed to compare antimicrobial prescriptions made on paper drug charts to those on ePMA.

Methods: Two groups of patients were included in the study. One group consisted of 28 patients admitted prior to December 2024 who had their medications prescribed on paper charts, including 14 instances of antimicrobial prescriptions. The paper charts were retrieved from electronic patient records. The other group (n=38) had electronic prescribing available with 25 antimicrobial prescriptions. The parameters reviewed included the duration of antimicrobials, documentation of an end date or review date, and whether an indication was stated for the prescription.

Results: Prescriptions on paper charts included end dates in 71% of cases, whereas this fell to 48% on ePMA (p=0.03). Of those without end dates on paper, 100% had no review date, compared with 62% on ePMA. Paper prescriptions included indications for treatment in half of cases, whereas no indications were documented on ePMA (although indications were consistently documented in the medical notes).

Conclusion: Antimicrobial prescriptions on paper drug charts were more likely to have had a set duration compared with those on ePMA, with a statistically significant fall in the presence of end dates following the introduction of ePMA. Indications for treatment were also more accessible on paper charts. Limitations of the paper charts were noted through the process however, for example paper charts may be replaced prior to a new prescription being written, meaning the information might not be as readily available as this study suggests. Overall, it is clear that prescribers will need to adjust to ePMA to ensure good antimicrobial stewardship. This might be achieved via simple dialogue boxes as prompts.

Aims: Guidance from the Mental Welfare Commission for Scotland (2013) and the Scottish Government’s Best Practice Guideline for Admission to Adult Mental Health Wards for Under 18s (2013) states that young people should be admitted to age-appropriate settings, with admission to adult psychiatric units occurring only in exceptional circumstances. The United Nations Convention on the Rights of the Child (UNCRC) also advocates for age-specific mental health services.

This audit examined the frequency, legal compliance, and contributing factors of under-18 admissions to an adult psychiatric unit over six months. It aimed to assess adherence to mental health legislation, including the Mental Health (Care and Treatment) (Scotland) Act 2003, and identify areas for service improvement.

Methods: A retrospective review was conducted of all under-18 admissions to the adult psychiatric unit at Royal Cornhill Hospital, Aberdeen, Scotland, between June and December 2024. Data on demographics, referral sources, diagnoses, legal status, duration of stay, and completion of the ADM form (mandatory for notifying Scotland’s Mental Welfare Commission of under-18 admissions) were analysed.

Results: Five adolescents (aged 13–17) were admitted during the audit period. Primary diagnoses included substance misuse-induced psychosis (n=2), disordered eating (n=1), acute stress reaction (n=1), and personality disorders (n=1). Legal status at admission varied: 60% (n=3) were voluntary, while 40% (n=2) were detained under a Short-Term Detention Certificate.

Critical non-compliance with legal safeguards was identified: only 40% (n=2) had ADM forms completed, breaching statutory requirements under the Mental Health (Care and Treatment) (Scotland) Act 2003. Most referrals originated from regions lacking dedicated CAMHS beds, underscoring geographic inequities in service provision. The average stay was 20.4 days (range: 7–42), reflecting delays in transferring patients to age-appropriate units.

Conclusion: These findings highlight systemic failures in delivering developmentally appropriate care, compounded by non-adherence to legal protocols. Extended admissions to adult wards risk therapeutic harm and violate safeguards for vulnerable minors. Urgent measures are required to address service gaps, including investment in dedicated adolescent inpatient units, mandatory staff training on legal compliance, and improved regional coordination to streamline referrals. Policymakers must prioritise equitable access to CAMHS beds and reinforce accountability mechanisms to prevent inappropriate placements. This audit underscores the imperative for Scotland to align its psychiatric care practices with both ethical standards and mental health legislation, ensuring vulnerable young people receive safe, rights-based care.

Aims: The audit conducted at New Craig’s Psychiatric Hospital’s Intensive Psychiatric Care Unit (IPCU) aimed to evaluate the impact of the Smoke-Free Perimeter Law on patient care and staff well-being. It sought to understand how the law affected patient behaviour and health, particularly for those on medications like clozapine, and to assess the changes in staff workload and safety. The study also aimed to identify the operational challenges and necessary adaptations in the IPCU following the law’s implementation.

Methods: Utilizing a mixed-methods approach over three months, the audit incorporated both quantitative analysis of patient records and qualitative data from staff surveys. Quantitatively, the focus was on incidents requiring medical intervention, medication administration, and staffing challenges. Qualitatively, a comprehensive survey was distributed to IPCU staff, featuring structured and open-ended questions to capture insights into the impact of the law, challenges faced, and suggestions for improvement.

Results: Patient-Related Outcomes: The analysis of 58 incidents revealed a prevalence of agitation, with lorazepam being the most administered medication. A notable case involved a patient whose clozapine levels were affected due to changes in smoking habits, leading to increased psychiatric symptoms. This highlights the complex interplay between lifestyle factors, like smoking, and medication efficacy.

The data indicated diverse triggers for patient incidents, suggesting varied patient reactions to the smoking restrictions.

Staff survey: All nine respondents reported increased workload, primarily attributed to managing the new smoking restrictions. Staff observed changes in patient behaviour and experienced heightened stress, linking these to the law’s enforcement.

Significant challenges were reported in accompanying patients for smoking breaks, suggesting an added operational burden.

Conclusion: The audit findings illuminate the multifaceted impact of the Smoke-Free Perimeter Law on both patients and staff in the IPCU. The increased frequency of incidents, particularly agitation, and the case of altered clozapine levels due to changes in smoking habits, underscore the intricate relationship between psychiatric medication management and patient lifestyle choices. Staff reported an escalation in workload and stress, suggesting that the law’s implementation has significantly altered the operational landscape of the IPCU. These outcomes suggest that while the intent of the law aligns with public health objectives, its application in a psychiatric care setting requires careful consideration of patient and staff needs. Future policy implementations should incorporate flexible, patient-centred approaches to ensure the well-being of all parties involved.

Aims: Vitamin D deficiency is a widespread problem in older people with reduced ability for production, along with risk factors such as indoor living. Improving adherence to the vitamin D guidelines is a simple and cost-effective method of potentially reducing falls, morbidity and mortality in older patients with risk factors.

Aim is to assess whether vitamin D deficiency is identified and managed appropriately according to the 2022 NICE vitamin D guidelines.

Standard:

1. All patients to have vitamin D level tested on admission.

2. All patients with vitamin D level of 50 and below to be prescribed vitamin D as per guidelines.

3. If calcium deficiency co-exists with vitamin D deficiency, patients to be prescribed replacements for both as per guidelines.

4. All patients to be referred for specialist services if vitamin D deficiency presents with the following: eGFR <30, hypercalcaemia, or granulomatous conditions.

Methods: The audit was registered with the Trust following discussion with the ward managers and consultants. All inpatients on two MHSOP wards on the day of data collection were included. Using an audit questionnaire, retrospective data was collected from electronic patient notes, paper drug charts and electronic blood reporting system. Data was analysed on Excel. The re-audit occurred six months later following intervention.

Interventions following the initial audit involved designing a vitamin D awareness poster for the wards, meetings with the ward pharmacist and presentation at the local MHSOP clinical effectiveness meeting to raise awareness.

Results: First cycle: 34 patients were included. 30 out of 34 (88%) patients had their vitamin D levels tested on admission or had a recent level. Out of the 30 patients who had recent vitamin D levels on record, 15 patients had adequate vitamin D levels, seven had insufficient levels, and eight had deficient levels. Out of the 15 patients who had insufficient or deficient levels, nine patients (60%) were prescribed vitamin D. One patient who required specialist services did not get referred.

Second cycle: 33 patients were included. 31 patients out of 33 (94%) had vitamin D testing on admission. Out of the 31 patients, 12 patients had deficient or insufficient vitamin D levels requiring prescription. Nine out of these 12 patients (75%) were prescribed vitamin D.

Conclusion: Following simple interventions to raise awareness, the re-audit results showed improvements in vitamin D testing on admission as well as improved management. Ongoing communication with pharmacists and rotating resident doctors is required to sustain awareness and improve adherence.

Aims: Individuals seeking support from drug and alcohol services often experience significant physical health challenges, with many presenting with comorbid conditions such as liver disease. Early identification of these conditions is vital for ensuring holistic and effective patient care. This audit aimed to evaluate the proportion of clients with alcohol use disorders who had recently undergone blood tests, Fibrosis-4 (FIB-4) scoring (a non-invasive marker for liver fibrosis) and FibroScan. The audit also sought to identify gaps in current clinical practices and provide recommendations to optimise care pathways for this population.

Methods: The medical records of 200 clients, representing two-thirds of the total population with alcohol as their primary substance of use, were reviewed. Data were collected to determine whether clients had received necessary blood tests (including liver function and platelet count) to facilitate FIB-4 scoring, and whether FibroScan assessments had been offered or completed. Reasons for incomplete investigations were recorded to identify potential barriers to care.

Results: Out of the 200 clients, 175 (87.5%) had recent blood test results and 134 (67%) had all components required to calculate FIB-4 scores. A total of 90 (40%) had undergone Fibroscan testing. Several factors contributed to incomplete investigations, including client refusal or non-engagement, incomplete blood test requests and failure to reoffer FibroScans to those with abnormal liver function tests. With regards to incomplete blood tests, it was identified that aspartate aminotransferase (AST) levels were not routinely measured unless a specific request for this was made, something not all staff members were aware of.

Conclusion: The audit highlighted factors contributing to gaps in the completion of necessary blood tests and FibroScans among individuals attending alcohol treatment services. In response, we have implemented targeted clinician training, updated blood test request protocols to ensure all necessary components for FIB-4 calculation are included, and revised guidelines to ensure FibroScan is reoffered to clients with abnormal liver function tests. These improvements are expected to enhance the consistency and quality of physical health assessments for this vulnerable group. A follow-up audit will be conducted in six months to assess progress.

Aims: This closed-loop audit aimed to evaluate adherence to NICE guidelines for DEXA scans in a Tier 4 Specialist Eating Disorder Unit and assess the impact of structured recommendations to address gaps in care, including improved integration of scans into protocols, better documentation, and enhanced patient education.

Methods: Clinical notes of 54 patients admitted over two years were reviewed against six key standards derived from NICE guidelines. These guidelines recommend DEXA scans for individuals with anorexia nervosa after 9–12 months of illness, with follow-ups every two years while the eating disorder remains active. Scans should be interpreted by qualified professionals, with patients educated on maintaining a healthy BMI as the primary means of improving bone health. Initial findings informed the development and implementation of recommendations focused on integrating DEXA scans into standard admission protocols, improving documentation, and ensuring multidisciplinary collaboration for interpreting results and educating patients. A re-audit conducted seven months later assessed the impact of these interventions.

Results: Baseline compliance was poor: only 30% of eligible patients underwent scans, 6% had results explained by professionals, and patient education was documented in 50% of cases. Following the implementation of recommendations:

62.5% of eligible patients received scans, with gaps due to incomplete documentation or unperformed tests.

80% had results interpreted and explained, with pending results accounting for remaining gaps.

Patient education documentation increased to 80%, and adherence to scanning intervals remained at 100%.

However, no documentation was found on hormonal treatments or discussions on scan utility prior to use.

Conclusion: The structured recommendations significantly improved compliance with NICE guidelines, streamlining care processes and enhancing multidisciplinary collaboration. Future efforts should address documentation of scan utility and hormonal treatments while continuing audits to sustain progress and ensure high-quality care for individuals with eating disorders.

Aims: The re-audit aims to assess the improvements in patients’ experiences during ward rounds compared with the findings of the original 2022 audit.

It focuses on ensuring that all patients feel actively included in their ward rounds, fostering a more supportive and engaging experience.

The re-audit also examines whether patients’ physical health is given equal attention alongside their mental health and whether they are provided with appropriate and timely feedback regarding their progress during their inpatient stay.

Methods: The re-audit focused on 41 patients from Acute Adult Psychiatry, Psychiatry Intensive Care, and Perinatal Psychiatry Units, all of whom had participated in at least two ward rounds and had capacity to consent. Data was collected via face-to-face interviews with a questionnaire developed with input from the Patient Experience and Clinical Audit teams. The questionnaire used a modified Likert scale to improve clarity, ensuring confidentiality throughout the process. Standards referenced include NICE Guidelines (CG136) and Trust Policies.

Results: The re-audit highlighted several key improvements, including a higher percentage of patients receiving weekly consultant reviews, greater comfort speaking in front of professionals, an increased perception of attention to physical health, and a slight improvement in support provided before ward rounds. However, areas of concern emerged, such as decreased patient understanding of ward round discussions, worsened communication about schedule changes, lower satisfaction with the physical environment, and a higher percentage of patients feeling uninvolved in ward rounds.

Conclusion: Ward rounds are critical opportunities for service users to engage with professionals, seek clarity, and feel supported in their treatment journey. While the re-audit findings reflect some positive changes, particularly in consultant reviews, support, and physical health attention, there are clear gaps in communication, understanding, and inclusiveness. These areas are particularly critical in psychiatric wards, where effective communication and patient involvement are fundamental to care quality and outcomes. After analysing the re-audit results, finding out the root cause, focus on an improvement plan and implementing these plans accordingly and finally by monitoring the progress, there is a real potential to make this audit a quality improvement project.

Aims: Older adults often have multiple comorbidities associated with an increased risk of anticholinergic effects. Mental health medications increase this risk, contributing to cognitive decline, dementia, memory loss and confusion. Evidence suggests stopping these medications can reduce cognitive deterioration and progression of dementia. MediChec is an online tool that calculates an Anticholinergic Effect on Cognition (AEC) score. An AEC score above 2 and a total AEC score above 3 require a medication review for potential adjustment or deprescribing. This audit aims to determine whether the AEC scores were recorded at admission, during admission, and at discharge. Additionally, it assesses if further actions were taken to deprescribe unsuitable anticholinergics, resulting in a lower AEC score before discharge.

Methods: Data was collected using RIO (clinical system) and eMeds (prescribing system) for inpatients admitted to the older adult ward, from 1 August 2024 to 9 November 2024. Patients’ past and current medications, including their AEC scores documented in the Notes section, were reviewed on eMeds. RIO notes were used to determine whether side effects were reconsidered during ward reviews with the medical team.

Results: 24 inpatients were identified with AEC score assessments documented for 22 inpatients. 22.7% (n=5) of these assessments were performed within the first 7 days of admission. The AEC scores recorded were documented solely by the lead pharmacist.

Antidepressant use was noted in 45.5% (n=10) of those 22 patients. Among these, 90% (n=9) were prescribed medication with an AEC score of 1, while the remaining had a score of 2. Similarly, 50% (n=11) of the patients were on antipsychotic medication. On the AEC score assessment, 27% (n=3) of these medications scored 1, 64% (n=7) scored 2, and 9% (n=1) scored 3.

For the above patients whose AEC scores indicated a review, 0 patients went on to receive a documented medication review and follow-up AEC score.

Conclusion: Increasing awareness and understanding of the anticholinergic effect on cognition can help provide better patient care. This can be achieved by sending a poster about the importance of reviewing medication for higher AEC scores to the pharmacy team and the ward doctors. Likewise, implementing the AEC score in the ward-round template and recording any changes to the medication on RIO and eMeds. By utilising the AEC score to guide medication reviews and deprescribing regimes, the cognitive burden of anticholinergic medications may be significantly reduced and ultimately promote improved outcomes.

Aims: Early Intervention in Psychosis (EIP) services provide specialised support for individuals experiencing their first episode of psychosis. Psychosis can impair cognitive and motor skills, which may affect an individual’s ability to drive safely. If a patient’s fitness to drive may be impaired by their condition or treatment, both DVLA and the GMC advises doctors to (i) alert patients to this issue, (ii) inform patients of their legal obligation to notify the DVLA, and (iii) document advice regarding fitness to drive in the patient’s medical records. This audit aimed to assess the EIP teams’ compliance with these guidelines.

Methods: A retrospective audit of 52 patients referred most recently to the EIP services. Online patient case notes were reviewed for information on (i) driving status, (ii) licence status, (iii) information provided on driving, including the need to inform DVLA.

Results: 59% (n=31) patients had driving status recorded by the EIP team, 81% (n=42) had licence status recorded. 10% (n=5) had no information about their driving or licence status. 27% (n=14) of patients received general advice about driving by the EIP team.

31% (n=16) of patients held a current driving licence, 69% (n=11) of these received advice about driving, 56% (n=9) were advised to inform the DVLA.

Conclusion: The majority of patients with a current driving licence received driving advice. However, a significant proportion did not, posing risks to both patients and the public. The EIP team should aim for 100% compliance with the DVLA/GMC guidance.

Requesting information about driving status is already included in the EIP clerking proforma. To improve adherence to completing this documentation, the audit findings will be presented to the multi-disciplinary team to raise awareness and reinforce the importance of this section. In addition, a poster with proforma screenshots will be distributed to support colleagues in locating it this section. A re-audit in six months will assess progress and determine if further interventions are needed.

Aims: The primary aim of the re-audit was to identify specific areas where key components of the NCISH guidelines were not consistently applied in the care of patients who died by suicide. By addressing these gaps, the Trust seeks to ensure that NCISH-recommended standards are embedded into practice across all patient care pathways. Our objectives were to assess the level of compliance with NCISH standards across all localities where patients died by suicide, evaluate whether the care provided aligns with National Standards and extract key lessons from the cases audited to drive improvements in care delivery and patient safety.

Methods: This was a PAN Trust re-audit. A retrospective collection of data was done, and a sample was provided by the trust’s Serious Incident & Inquest Manager. The criteria were any patient known to the trust who completed suicide between April 2022 and March 2023, in line with NCISH guidelines. This collection saw 33 cases, however only 32 cases were audited, as one was withdrawn. This was an increase from the previous 2 years. The cases were split between team members for data collection, and for each case the RiO patient notes and incident reports were used to fill out the audit tool on Microsoft Excel. Data was analysed by the quality improvement team.

Results: The audit revealed that no patients died as psychiatric inpatients, but six suicides occurred within three months of discharge. Most were males in their 60s, single, unemployed, and living alone, with depressive illness as the primary diagnosis. Common methods included hanging and self-poisoning, with most suicides occurring at home. Many patients received treatment, though risk assessments and follow-up practices were inconsistent, with structured tools used in only three cases. Lessons learnt emphasize the need for timely, structured post-discharge care, better crisis intervention, enhanced staff training, improved communication between services, and increased access to dual-diagnosis and mental health resources.

Conclusion: Post-Review Changes:

Risk assessments now use formal tools, with improved documentation and training on difficult conversations. Collaboration between GPs and mental health services has improved.

Recommendations:

Strengthen post-discharge follow-ups within three months. Provide suicide prevention training for GPs and staff. Increase home monitoring for high-risk patients, especially in Dudley. Launch male-focused mental health campaigns addressing stigma. Enhance inter-service collaboration between GPs, community mental health services, and crisis teams for seamless care coordination. Address systemic resource gaps like staffing and waiting lists.

Aims: With the introduction of electronic prescribing (EP) to an older adult inpatient psychiatric ward after many years of paper charts, it was anticipated that unfamiliarity with the system would disrupt medication administration. This study sought to quantify that. The measure of disruption was defined as the deviation between the time of prescribed administration and the time medication was actually given.

Methods: A sample of ten patients was analysed across four dates. The first day of using EP was explored, followed by the final weekday of this week. The remaining dates were at week three and five of use. Data collected included the total number of drugs, doses and any deviation in the time administered from the time in the prescription (a delayed administration was recorded as a positive figure, and a premature administration was recorded as a negative figure, both in minutes). Using the time taken per dose and number of doses, the average time taken per patient was calculated for each date. This considered any changes made to treatment regimes, focussing primarily on timing of medication administration per dose.

Results: On the first day of using EP, a mean deviation of +10.6-minutes was seen across all patients (i.e. delay). By the end of week one, this dropped to a −11.5-minute deviation from the prescribed time (i.e. administered earlier). At week three, the mean was −9.7-minutes. By week five that fell to −5.3-minutes. The first day of using EP showed the longest mean delay seen for a single patient at 28.2 minutes. This dropped to 15 minutes by the end of the week, and further to 13.1 minutes at week three. The highest mean delay in a single patient however increased to 21.7 minutes by week five. In terms of individual doses, the number administered earlier than their prescribed time was lowest with initial use of EP, at 32 doses. By the end of the week, this more than doubled (75). The increased number of premature administrations dropped slightly in week three to 71 doses. At week five, it further fell to 66 doses.

Conclusion: There is no consistent evidence to suggest that the introduction of EP produces a sustained impact on the administration of medications. An understandable impact was noted on day one, however subsequent dates do not suggest any ongoing pattern. There is also no evidence to suggest that continued use improved adherence to prescribed times thereafter, with significant variability persisting.

Aims: Vitamin D is an essential nutrient for adolescents, playing a crucial role in bone health, immune function, and neurodevelopment. Its synthesis is highly seasonal, with production significantly reduced during the winter months due to limited sunlight exposure. This effect is further exacerbated in CAMHS inpatients, who may spend extended periods indoors with even less access to natural light. Recognising this, the National Institute for Health and Care Excellence (NICE) recommends vitamin D supplementation for at-risk groups, including those with restricted sun exposure. Given the high prevalence of vitamin D deficiency among adolescents with mental health conditions, all CAMHS inpatients should be offered maintenance vitamin D supplementation from November to March. This audit aimed to assess compliance with this standard on a Tier 4 inpatient unit.

Methods: A three-cycle audit conducted monthly from November to February, assessing vitamin D prescription rates and serum levels in CAMHS patients. Data was collected through single-point reviews to evaluate prescribing trends and deficiency management. Interventions included 1:1 psychoeducation from a doctor and a poster in the clinic room promoting opportunistic serum vitamin D testing and supplementation.

Results: The audit results show a substantial improvement in vitamin D prescribing over three cycles. Initially, only 1 out of 10 inpatients received supplementation (18/11/2024). By the second cycle (06/01/2025), this increased to 9 out of 11 patients, with a notable rise in prophylactic prescriptions (7 patients). By the third cycle (05/02/2025), the prescribing rate remained high (9 out of 10 patients), with 7 receiving prophylaxis and 2 on treatment doses.

Regarding vitamin D level monitoring, the number of patients with levels checked within the past three months remained consistent at 5 across all three cycles. However, the number of patients without recent vitamin D levels fluctuated, increasing to 6 in January before returning to 5 in February. These findings highlight an improvement in prescribing practices but suggest a need for increased consistency in vitamin D level monitoring.

Conclusion: The audit showed that the 1:1 psychoeducation intervention provided the most benefit, with notable improvements from cycle 1 to cycle 2. However, increasing vitamin D testing is needed to optimise supplementation and prevent sub-therapeutic treatment in CAMHS patients, potentially shifting from opportunistic to a more proactive approach.

Aims: UK National Institute for Health and Care Excellence Guidelines recognise the importance of effective family and carer involvement in ensuring good patient care and outcomes.

We aim to embed infrastructural changes supporting carer involvement through Cygnet’s Model of Acute and Rehabilitation Care (CMARC), embed rolling audit processes ensuring maintenance of standard adherence across wards and optimise carer support services at Churchill Hospital.

Methods: Triangle of Care (TOC) is an alliance between patient, carer and therapeutic staff. The Carers Trust’s TOC partnership (CTTOCP) accreditation was identified as a basis of the initial audit criteria.

Stakeholders were identified and on boarded which included: Cygnet Healthcare Senior Steering Group (CHSSG); Hospital Senior Management Team (SMT); Lambeth Carer’s Hub (local community services) and Carer’s Advocacy Service (CAS). Carer information packs and feedback forms were created by CHSSG and personalised by the Hospital Carer Lead Team (HCLT) for each ward (multidisciplinary clinical and administrative staff) with LCS/CAS sited.

Interventions implemented across 3 audit cycles included 3 areas: formalising communication across stakeholders (shared calendars; audit and carer communications in SMT/Heads Of Department Meetings and Clinical Governance Reports); increasing HCLT personnel (recruitment; Carer Awareness Training and intra hospital promotion); administrative changes (introduction of Carer Communication forms (CCF) clarifying consent status and Carer communication log tables created to improve consistency in record-keeping in ward rounds) and carer engagement initiatives (monthly inter-disciplinary topic-based carer events delivered by HCLT tailored to carer feedback).

Significant changes in results were achieved after the introduction and subsequent iteration of the infographic Carer Involvement Protocol, which aligns with CMARC and Audit criteria in achievable SMART steps. This was disseminated at Stakeholder and HCLT meetings.

Results: An audit was carried out in April 2024 with compliance to standards being 87% for rehabilitation and 68% acute wards. Limited carer communication was in place with ad hoc feedback provided. Triangle of care Accreditation was achieved in May 2024. Audit Cycles 2 and 3 in September 2024 and November 2024 both resulted in 100% adherence.

Carer engagement has significantly improved with an increase in attendance overall since conception of monthly events by 28%.

Conclusion: There has been significant improvement in the infrastructure of carer services at Churchill Hospital which has relied upon the inter-disciplinary, multi-tiered teamwork and resulted in positive feedback from carers and patient outcomes.

Expert-by-experience led carer events are being introduced in February 2025 with aims to further develop community links and achieve TOC 2 star accreditation.

Aims: The aim of this audit was to assess adherence to antipsychotic prescribing guidelines in one of the Older Adults Female wards at Kent and Medway NHS and Social Care Partnership Trust (KMPT). Specifically, the audit focused on the documentation of key parameters for patients prescribed antipsychotics, including metabolic and cardiovascular risks, baseline assessments, and monitoring, in accordance with NICE guidelines. A re-audit was conducted in June–July 2024 to evaluate improvements following initial interventions. The original audit was published in BJPsych and presented at RCPsych 2024.

Methods: The initial audit in 2023 identified areas for improvement in documentation and monitoring of antipsychotic prescribing. Key parameters were assessed based on NICE guidelines. An action plan was developed and implemented, including refinements to the existing ward round process and the introduction of a physical health monitoring poster for junior doctors. A re-audit was conducted in 2024, analysing compliance with these parameters for two months of patient records. Compliance rates from 2023 and 2024 were compared to evaluate the effectiveness of the implemented changes.

Results: The re-audit showed significant improvements in several areas. In 2024, compliance for documenting patient age, diagnoses, and MHA status remained at 100%. The documentation of antipsychotic indication improved from 80% in 2023 to 100%. Consent to treatment and the MCA tab improved from 66.66% and 53.33% to 100%. Baseline ECG compliance rose from 86.66% to 100% and repeat ECGs within the recommended time frame increased from 53.33% to 79.17%. Blood tests showed significant improvements: fasting glucose/HbA1c (73.33% to 88%), lipid profile (73.33% to 92%), and liver function (73.33% to 100%). Repeat blood tests, such as fasting glucose, HbA1c, and lipid profile, also showed notable increases. Monitoring for side effects improved to 100%, compared with 46.66% in 2023. GP follow-up recommendations for physical health monitoring were fully documented in 2024, compared with 50% in 2023.

Conclusion: The re-audit demonstrated significant improvements in adherence to antipsychotic prescribing guidelines in one of the Older Adults Female wards at KMPT, particularly in areas related to baseline assessments, monitoring, and follow-up care, all in line with NICE guidelines. The changes made in response to the original audit, including refinements to the existing ward round process and the introduction of a physical health monitoring poster, while accommodating the rotation of junior doctors, were effective in enhancing documentation and compliance. Continued monitoring and future audits will be essential to sustain these improvements and further refine practice and documentation.

Aims: To determine the quality of care received by young people (16–25 years) presenting with self-harm at the Norfolk and Norwich University Hospital Emergency department using NICE guidelines QS34.

Methods: Retrospective data collection from electronic patient records.

These patients referred via the emergency department of the Norfolk and Norwich University Hospital were assessed as a one off.

271 patients presented with self-harm behaviour to the Accident and Emergency of the Norfolk and Norwich University Hospital in July and August 2024. They were all referred for assessment to the Mental Health Liaison Service. 85 of these patients were of ages 16–25. All the 85 were audited.

Results: 84.7% of patients had a record of risk assessment to reflect if there were any immediate concerns about their safety while 11.8% did not have a record of risk assessment. 3% left before assessment.

81.2% had mental state examination done, 15.3% did not have a mental state examination. 3% left before assessment.

78.8% had an initial assessment of safeguarding concerns, 17.6% did not, and 3% left before the assessment.

82.3% had a collaboratively developed care plan, 11.8% did not and 5% of them either left before the assessment or did not engage with care planning.

80% had initial assessment of social circumstances, 12% did not and 5% either did not engage or left before the assessment.

More than 80% compliance was achieved within the areas of assessment except for safeguarding concerns which was only 78.8%.

Conclusion: Positively, the trust has a template which is aligned with NICE standards. If followed, the guidelines will be adhered to. Assessments that did not meet the guidelines did not use the template. Other NHS trusts should ensure their Electronic patient records have the same and provide regular training to staff.

It is useful to familiarize new/locum staff about the importance of the different aspects of assessment and to follow the guide of the template provided on EPR.

The content of these assessments varied, some had comprehensive assessment while others were less detailed. This should be investigated in the future to determine the definition of an adequate assessment across board.

Aims: Missed seizures (MS) are non-therapeutic, making their frequency a key measure of an ECT clinic’s efficacy. In our initial audit at the NHFT ECT clinic (October 2021–March 2023), an MS rate of 12.6%, a restimulation rate of 67.5%, and poor adherence to the stimulus dosing protocol were identified. To address this, staff training, discussions, and dose chart displays were introduced. A follow-up audit was then conducted to assess the impact of these interventions.

Methods: The audit was conducted retrospectively over 13 months (June 2023–July 2024). Data were collected on total treatments, patient demographics, and stimulus doses. According to the NHFT ECT protocol, MS is defined as stimulation that fails to produce motor convulsions or EEG activity. The protocol recommends that during the seizure-threshold (ST) determination phase, dosing should be titrated as per the stimulus dosing protocol, while in the treatment phase (TP), restimulation should involve a 10% dose increase. The MS rate was calculated as the ratio of MS to total stimulations, and the restimulation rate as the ratio of total restimulations to MS.

Results: The clinic administered 210 bilateral ECT treatments to 22 patients – predominantly middle-aged (40–60 years), 59.1% male, and 77% White/British. The MS rate decreased to 11.6%, and the restimulation rate increased to 81.5%. Of the 27 MS, 19 occurred in the ST determination phase, with 17 restimulated, while 8 were in the TP, with 5 restimulated. Compared with the initial audit, the ST phase saw MS decrease from 81% to 70%, with correct dosing improving from 36% to 88%. After establishing the ST, full compliance with the dosing protocol was achieved – contrasting with the earlier audit, where 84% either received the same or a slightly higher dose. In TP, the current audit achieved full compliance with the recommended 10% dose increase for all restimulations, whereas previously, 2/3 doses were suboptimally increased. Additionally, documentation of the protocol showed marked improvement.

Conclusion: Appropriate management of MS is vital, as they are linked to treatment failure and increased post-ECT side effects. Our interventions have improved protocol adherence, yet further progress is needed. The Bridgend ECT clinic has maintained an MS rate of ≤5% over six years. To achieve similar outcomes, we recommend that the NHFT ECT clinic restimulate rather than proceed with ‘doubtful’ seizures, as they often lead to MS. Additionally, restimulating at the same dose as the previous MS in subsequent sessions should be avoided, as it is ineffective.

Aims: Treatment-Resistant Depression (TRD) is diagnosed when patients fail to respond to at least two adequate trials of antidepressant medication. Patients with TRD are often referred for Transcranial Magnetic Stimulation (TMS) as a next-line treatment. However, delays in recognizing TRD and inappropriate medication management may prolong suffering and consume unnecessary resources.

Hypothesis: Patients with TRD experience prolonged delays in receiving effective treatment due to non-adherence to NICE guidelines, leading to extended suffering and increased healthcare resource consumption.

Methods: A retrospective audit was conducted on 50 patients referred for TMS with a confirmed diagnosis of TRD. Patients were classified as meeting criteria for TRD if they had received at least two different antidepressants at an appropriate dose for a minimum of four weeks during the current depressive episode. We analysed whether medication management adhered to the National Institute for Health and Care Excellence (NICE) guidelines for depression treatment.

Results: Among the 50 patients, 70% didn’t follow NICE guidelines for depression management, with a significant proportion remaining on ineffective antidepressant regimens beyond the recommended duration. This resulted in delays in initiating alternative treatments, prolonging the duration of depressive episodes, and leading to unnecessary resource consumption.

Additionally, the mean duration between the first and second antidepressant was found to be 46 days (approximately 1.5 months), while the mean duration between the second antidepressant and the initiation of TMS was approximately 751 days (almost 2 years). Furthermore, 21 out of 50 patients (42%) had comorbid psychiatric disorders alongside depression.

Conclusion: Both primary and secondary care patients remained on antidepressants for a prolonged duration beyond NICE recommendations. This delay increased the time patients struggled with depression without receiving effective treatment. The prolonged ineffective medication use led to unnecessary consumption of healthcare resources. Delays in adjusting treatment plans postponed further treatment approaches, such as augmentation strategies or referral for TMS.

To optimize TRD management, early identification and adherence to NICE guidelines are essential. Regular reviews help discontinue ineffective treatments and ensure timely referrals to TMS. Enhanced clinical training and integrated mental health pathways improve treatment access and outcomes.

Aims: This audit aimed to evaluate the length of detention (LOD) for patients admitted to Farnham Road Hospital under the Mental Health Act (MHA), 1983. The objectives were to compare local LOD data with national figures and explore variations across age, gender, and ethnicity. This work aligns with the MHA Code of Practice’s focus on reducing restrictive practices and promoting equitable care.

Methods: This retrospective audit included 242 patients initially detained under the MHA across Surrey and Borders NHS Trust between 1 June and 30 November 2023. Local data was obtained from the trust MHA office. After applying inclusion criteria, 91 patients from four working-age adult wards at Farnham Road Hospital, Surrey were analysed. Patients detained under Sections 2 and 3 with lapsed, rescinded, or Community Treatment Order (CTO) outcomes were included. Data on age, gender, and ethnicity were analysed using ANOVA and t-tests for local comparisons, while national data from NHS Digital (2021–2022) were used to compare median LOD and interquartile ranges (IQR).

Results: The mean LOD for the local cohort was 38.4 days (SD=33.8). Of the 91 patients, 18–34-year-olds had a mean LOD of 34.9 days (SD=26.7), 35–49-year-olds 37.6 days (SD=35.4), and 50–64-year-olds 48.1 days (SD=46.4), with no significant differences across age groups (p=0.359). Male and female patients showed no significant differences in LOD locally (median = 27 days for both, IQR = 21–49 for males and 23–42 for females). Ethnicity comparisons showed disparities, with Black patients having a median LOD of 24 days and Asian patients 32.5 days locally, but limited sample sizes precluded statistical significance.

Nationally, the median LOD was shorter (18–34 years: 21 days, IQR = 6–38), increasing with age. Local figures were slightly higher for younger and middle-aged adults but similar for older adults. Ethnicity comparisons revealed greater variability locally, reflecting small sample sizes in minority groups. COVID-19 likely impacted national data more significantly, given the earlier timeframe (2021–2022).

Conclusion: This audit found no statistically significant differences in the length of detention (LOD) across age, gender, or ethnicity locally, suggesting equitable application of the Mental Health Act at Farnham Road Hospital. Median LODs were slightly higher locally compared with national data, but differences may reflect sample size, data collection periods, and local population characteristics. Expanding future audits to cover extended periods, aligning local and national data collection timelines, and obtaining detailed national datasets could enable more robust statistical analysis. Additionally, comparing pre- and post-COVID data and assessing other restrictive practices, such as physical and chemical restraints or seclusion, could provide a more comprehensive understanding of restrictive interventions and their impact on patient care.