Aims: Clinical governance ensures accountability for continuously improving healthcare quality. This audit evaluates governance compliance across hospital sites in the London & South region, highlighting best practices and opportunities for improvement to enhance patient safety, care standards, and clinical effectiveness.

Aims were to: Identify good clinical governance practices across hospitals to enable peer learning, knowledge sharing and implementation of best practices.

Support continuous improvement by implementing lessons learned from top-performing sites.

Methods: Data was collected from Local Clinical Governance meeting minutes (September–December 2024) across multiple hospital sites. Key assessment areas included:

Meeting frequency and leadership involvement.

Attendance and representation from MDT and Operations.

Adherence to governance agenda.

Safety.

Training.

Clinical effectiveness.

Experience.

Leadership.

Audit and research.

Lessons learned.

Standards applied: National Standards on Clinical Audit – NHS England Clinical Governance Framework (2022); Local Clinical governance standards including the STEELL agenda (Safety, Training, Effectiveness, Experience, Leadership, Lessons Learned).

Results: Key findings:

Safety and Incident Reporting: Enhanced training programmes contributed to a decline in incidents, across different service lines including Acute, PICU, Rehabilitation, Learning disability and personality disorder units.

Patient and Carer Experience: Positive patient experience achieved with least restrictive practices and removing blanket restrictions with structured feedback from patient councils, advocacy services and Experts by Experience (EbyE).

Clinical Effectiveness and Governance: Higher compliance in care plans and activity programmes were noted in wards with good training and supervision and adherence to clinical models of care

Staffing and Workforce Development: Recruitment strategies helped fill critical vacancies in nursing, psychology, and occupational therapy, ensuring consistent service provision.

Patient Engagement and Activities: Structured activity programmes led to better engagement, particularly where collaborative interdisciplinary teams facilitated therapeutic and skill-based activities.

Areas for Improvement:

Standardisation of digital tracking for patient engagement to ensure accurate compliance data.

Increased MDT participation in governance meetings for enhanced multidisciplinary oversight.

Conclusion: Recommendations:

Standardise incident reporting and documentation protocols.

Enhance security for AWOL risk and contraband prevention.

Ensure hospitals share their best practices with the wider group.

Conclusion: This audit highlights significant progress in governance, patient engagement, and structured safety interventions across multiple hospital sites. By implementing targeted improvements in data tracking, workforce development, and interdisciplinary collaboration, hospitals can achieve greater compliance, patient-centred care, and long-term service effectiveness. A follow-up audit will assess the impact of these interventions on clinical outcomes and governance excellence.

Aims: Behavioural and psychological symptoms (BPSD) such as agitation and psychosis, are a common challenge faced in the management of dementia. Despite NICE guidelines prioritising non-pharmacological interventions, according to an audit conducted in 2022, antipsychotics were frequently used first-line by the React team at University Hospital Llandough, raising safety concerns. Following this audit, a care pathway for managing challenging behaviour in dementia was implemented. This study aims to evaluate adherence to BPSD management guidelines and assess improvements compared with the 2022 audit.

Methods: This is a retrospective audit that includes all patients referred to the React team between June 2023 and May 2024 with a dementia diagnosis and prescribed antipsychotics for BPSD. Data was extracted from case notes using the PARIS database, guided by Oxford Health’s BPSD management recommendations, derived from NICE Guideline 97. Information gathered includes dementia type, consideration of other causes for presenting symptoms, use of non-pharmacological methods, antipsychotic prescribing practices, and adherence to monitoring guidance. Results were compared with the 2022 audit using chi-square tests to assess statistically significant differences.

Results: 40 patients (mean age: 81, range 68–95) were included and compared with 73 (mean age: 79, range 63–95) from the 2022 audit. Alzheimer’s disease accounted for 30% of cases, while 33% had unspecified dementia. Consideration of other causative factors was documented in 23% of cases, with treatment provided in 20%. Non-pharmacological approaches were utilized in 35% of cases, a substantial increase from 1% in 2022 (χ2 (1,113) = 25.386, p<0.001). Antipsychotics were used first-line in 65% of cases compared with 99% in 2022. Risperidone was prescribed in 75% of cases, and 85% were started on the lowest dose (χ2 (1,102) = 10.891, p<0.001). Monitoring adherence improved from 12% to 45% (χ2(1,113) = 15.168, p<0.001).

Conclusion: Since the implementation of the care pathway there has been increase in non-pharmacological interventions, appropriate dosing, and monitoring of antipsychotic use. However, there was no significant improvement in considering and treating other potential causes for symptoms, and documentation gaps persist. To enhance guideline adherence, React’s processes for assessing underlying causes and documenting patient management require review. A checklist in patient notes could further standardise care and ensure comprehensive documentation. Collaboration with primary care and memory services is essential to prioritise early-stage non-pharmacological interventions, potentially reducing crises and antipsychotic reliance. Further studies are needed to evaluate long-term outcomes of these initiatives.

Aims: Safety planning has been identified as best practice for suicide prevention and is used to support patient who are at a high risk of suicide. A key aspect of safety planning is collaborative involvement with the patient and their family/carers.

Aims were to audit current compliance with safety planning standards for patients admitted to an acute hospital under the Exeter Psychiatry Liaison Team.

Methods: A snapshot audit was carried out for patients that had been admitted to Exeter Liaison Psychiatry caseload as inpatients over a two-month period. 25% of patients were reviewed, the patients being selected through a random number generator to ensure minimal bias. Initial assessment and discharge summary documents were reviewed, and data collected onto an Excel spreadsheet to record compliance with three standards.

Standard 1: Safety plan recorded – target compliance 95%.

Standard 2: Documentation that safety plan was collaboratively generated – target compliance 95%.

Standard 3: Documentation that patients were provided with a written copy of the safety plan.

Results: Data was collected from 25% of inpatients (n=29). Following initial assessment, safety plans were created with 69% of patients, 15% of these were documented to be co-created, and 0% were evidence to be provided in writing. At point of discharge, safety plans were created for 52% of patients, with 40% evidence to be co-created, and 33% were evidenced to be provided in writing. Duration of time under Liaison Psychiatry varied from 0–54 days, 35% of patients were discharged to a psychiatric admission and 38% discharged to their usual place of residence.

Discussion: There are clear gaps to collaborating with patients to create safety plans, with minimal evidence they are being provided in writing. This could be impacted by the nature of the workload of the Liaison Psychiatry department, and the unpredictability of awaiting availability of mental health beds. Patients awaiting psychiatric beds may have been too unwell to engage with safety planning. There should be consideration for how to keep this document live and accessible by patients, their regular clinicians and those who may encounter the patient at a time of crisis (GP, mental health teams, liaison teams, emergency department staff and emergency workers).

Conclusion: Prolonged inpatient admission due to either mental health or physical health reasons provides a good opportunity to engage patients with safety planning, an opportunity which is not being utilised within this Liaison Psychiatry department. Within this department there needs to be further uptake of engagement in safety planning.

Aims: DNACPR All-Wales policy for adults was launched in 2015 by the deputy minister for Health. It was revised in 2017, 2020, 2022 and 2024. DNACPR decisions should be clearly recorded and communicated between health professionals.

This audit aims at assessing the quality of DNACPR on older adult psychiatric wards in ABUHB to identify any deficits and to improve the quality of documentation in the future.

Methods: Inpatients’ notes from all four old age psychiatry wards in ABUHB were examined; patients with DNACPR were identified. To gather data, we created an audit tool based on all-Wales policy.

Results: 24 DNACPR decision forms were identified.

“Decision date” was missed in 2 forms.

DNACPR decision was not clearly “signed with date and time” in 1 form.

In 10 forms, decision was not “documented in clinical notes” because the decision was made by another team and their notes were not available to examine.

“Discussion with patient” only took place in 9 forms while “discussion with IMCA/attorney or family/carers” took place in 20 forms.

“Patient demographic details” were recorded in all forms but with some errors; one patient’s name was incorrectly spelt and one patient had missing details.

For “reason of decision”, 1 was “not in the best interest, natural anticipated and accepted death and patient refused CPR”, 1 was “patient refused CPR” and 1 had no stated reason. The remaining 21 forms stated “not in the best interest”.

For “signatures in section 5 and section 6” where section 5 is for “the health care professional completing the form” while section 6 is for “the senior responsible clinician”. The signatures were appropriate in 17 forms. 7 forms were not countersigned in section 6; 5 of these are signed in section 5 by a consultant while 1 is signed by a junior doctor and 1 is signed by a registered nurse.

Different versions of the DNACPR form were being used in some instances.

Conclusion: Identified deficits represent deficient forms which could lead to inappropriate CPR attempts. This could lead to physical and emotional distress and possible litigation.

To avoid this, our audit concludes that DNACPR forms must be completed thoroughly and that a unified version of DNACPR form is to be used. It is also good practice to document the DNACPR discussion in the clinical notes of the patients.

As secondary outcomes, we recommended to add DNACPR status and treatment escalation plan status to our ward round proforma.

Aims: Discharge letters from liaison services to General Practitioners (GPs) are critical for ensuring continuity of care. These letters should contain essential clinical information that aids GPs in managing patients post-discharge. The purpose of this audit is to assess the quality and completeness of discharge letters from South of Tees liaison services and ensure they meet the necessary standards for effective communication.

Methods: Obtain a list of all patients discharged from South Liaison team during the period of 1 September to 30 September.

Randomized selection of 35 GP letters.

Establish availability of discharge letter on the electronic systems.

Appraise discharge letters for patients discharged using audit tool.

Results: Discharge letters on CITO: Only 40% of the letters were available on electronic system. RED.

Lack of GP credentials on the letter: 44% had a clear address and name of the GP practice. RED.

Date of referral to and date of discharge from PSL services: 18% of the letters had a clear mention regarding date of referral while none of the letters mention date of discharge. RED.

Reason for referral: 62% of the available letters had a clear reason for referral. AMBER.

Background history: 44% of the letters noted background history, with majority of them only mentioning psychiatric history. RED.

Summary of clinical assessment: 19% had a section for summary of clinical assessment which is useful to the user, especially the GP, to have an overview regarding psychiatry liaison service involvement. RED.

Risk assessment: 75% of the letters had an easy to identify risk assessment with majority not covering all 3 main groups of risks which include risk of self-harm/suicide, risk to others and risk from others. AMBER.

Diagnosis: 66% of the letters had a clearly defined diagnosis or clinical impression which were at times (43%) not concise. AMBER.

Medication: Only 12% of the letters had a list of medications and any changes to medication by psychiatry liaison services clearly documented. RED.

Actions for GP: Only 29% of the letters had an identifiable list of actions for the GP to undertake. RED.

Conclusion: The audit highlighted that lack of a local service specific guidance and a lack of a standardized GP format led to marked variability, lack of consistency and missing of vital information from GP discharge letters; furthermore it became apparent that some letters were not uploaded to the electronic system.

Aims: Following initial audit on trust policy for section 17 leave in 2023, this second cycle aimed to reassess staff adherence with the trust section 17 leave policy as well as monitor the change in practice. The first cycle of audit was presented at the clinical forum, and all the professionals agreed about documentation of reflections on leave and urine drug screen (UDS) in electronic notes.

Methods: Data was collected retrospectively from electronic case notes/patient portal in July 2024, for all detained patients on both units. Fifteen patients were included in this audit. Section 17 leave was a Multidisciplinary team (MDT) decision.

Results: For all patients, a clear discussion regarding appropriateness of leave including current presentation and risk were documented. A clear physical description and photographs were completed for all the patients. The patients involved in the audit had utilized a total of 197 leaves in a one-month period. This included 33 escorted, 155 unescorted, 9 accompanied leaves. For accompanied leave, the accompanying person, and the purpose of the leave was recorded. For all leaves, restrictions and contingency plan were clearly documented on the leave prescription.

At the end of any leave period, staff reflection on the leave period were documented in 7.6% as compared with 20.14% in the first cycle of the audit. Staff scored 100% in recording patient feeling after the leave on patient portal. Out of 155 unescorted leaves, 92 leaves had search restriction. 100% searches were conducted which was an improvement from 95% in first cycle. UDS required as per leave prescription for 62 of unescorted leaves were completed and documented in 53.20%, which was an improvement from 17.20% in the first cycle.

Conclusion: The audit results show effective completion of risk assessment, physical description and making leave decisions as an MDT. There had been slight increase in the post leave search and UDS in comparison to the first cycle of audit (2023). However, staff reflection on electronic notes and UDS compliance still needs improvement.

Recommendations include increased training of staff in documentation, regular audits, and encouraging post leave evaluations to enhance the safety of section 17 leave process.

Aims: Osteoporotic fractures are a major cause of mortality and morbidity in older adults, often leading to long-term disability and reduced quality of life. The National Institute for Health and Care Excellence (NICE) guidelines (2012) recommend that women aged ≥65 years and men aged ≥75 years be assessed for fracture risk using tools such as FRAX and QFracture. These assessments help identify high-risk individuals, enabling timely interventions like lifestyle changes, bone density scans (DEXA), and pharmacological treatments, including calcium and bisphosphonates, to prevent fractures. This audit aims to assess compliance with these NICE guidelines by General Practitioners (GPs) in a hospital setting and determine whether high-risk patients received appropriate management.

Methods: Retrospective audit was conducted using electronic patient records. The sample included 20 patients admitted to the ward in the month of December 2024. The audit focused on determining whether fracture risk assessments were performed using FRAX or QFracture for service users (women) aged 65 years and older. Additionally, the audit examined whether high-risk patients received appropriate management, including bone density scans (DEXA), lifestyle changes, and pharmacological treatments. Secondary risk factors such as chronic kidney disease, diabetes, and smoking were also evaluated for their impact on fracture risk.

Results: 0% had documented FRAX/QFracture assessments or evidence of a DEXA scan.

Over 90% of the audited patients were classified as having intermediate or high risk for major osteoporotic or hip fractures within 10 years.

Despite the high fracture risk, only 19% of patients were actively treated with bone-protecting medications, and none had documented assessments for fragility fracture risk prior to admission.

60% of the patients had secondary risk factors, such as chronic kidney disease, diabetes mellitus, rheumatoid arthritis, glucocorticoid use, smoking, or low BMI, which further increased their fracture risk.

Approximately 70% had a history of falls, and 57% had a history of previous fractures. However, none had undergone orthopaedic surgeries.

Internal barriers to initiating bone-protecting medications, largely due to the mental health-focused nature of the care team, were noted, with responsibility for prescribing remaining with GPs.

Conclusion: The audit revealed significant gaps in the implementation of NICE guidelines, with none of the patients receiving documented fracture risk assessments or appropriate interventions. Despite a high prevalence of secondary risk factors and fall histories, the management of fracture risk was insufficient. Addressing internal barriers and improving follow-up care is critical to ensuring better adherence to guidelines and preventing fragility fractures in high-risk patients.

Aims: Creating an optimal ward environment for autistic inpatients is essential for their well-being and therapeutic progress. This audit aimed to assess the inpatient ward environment of two autism rehabilitation wards – Spring Center (a locked rehabilitation ward) and Spring Wing (an open rehabilitation ward) – against the Gold Standard Environmental Standards for Learning Disability (LD) and Autism Spectrum Disorder (ASD) inpatient hospitals, as well as the Quality Network for Learning Disability (QNLD) standards.

Methods: A structured questionnaire was developed based on gold-standard guidance for autism inpatient wards. The audit was conducted by a Staff Grade Doctor and a Specialist Occupational Therapist (OT), who inspected both wards, interviewed staff and patients, and evaluated adherence to 22 key environmental standards. The OT’s input was crucial in assessing the sensory needs of autistic individuals.

Results: Out of the 22 assessed parameters, both wards failed to meet 7 critical requirements, including:

Lack of consultation with autistic individuals regarding the design and assessment of sensory spaces.

Absence of active patient and family feedback regarding the ward environment.

Insufficient autism and sensory sensitivity training for all staff, including non-clinical members.

Lack of soft furnishings and carpets to reduce background noise.

No structured process to identify and minimize strong odours in patient areas.

Limited bedding options catering to individual sensory preferences.

No use of unscented cleaning and personal-care products.

The remaining 15 parameters were met in both wards. The findings were shared with the ward manager, hospital manager, and medical team, with plans to present them in a clinical governance meeting to develop a business case for environmental improvements.

Conclusion: The audit identified several areas requiring immediate attention to enhance the sensory environment and overall ward quality for autistic inpatients. It also highlighted the importance of specialized spaces and therapy rooms tailored to sensory needs. A re-audit is planned in six months to assess the implementation of recommendations and ensure continued improvements in the ward environment. An autism ward environment should be designed to be calm, low-sensory, and predictable, with features like soft lighting, quiet spaces, minimal noise, clear visual cues, and a consistent routine to minimize sensory overload and create a therapeutic space for autistic individuals who can be easily distressed by overstimulation in a typical hospital ward; this often includes designated quiet areas, muted colours, and staff trained in autism-specific communication strategies.

Aims: Aim of this audit was to assess if VTE (Venous thromboembolism) assessments on admission to adult inpatient wards (two working age and one old age ward) at the Inpatient Psychiatry unit are carried out as per the local Trust’s Policy.

Methods: I made a questionnaire comprising 6 questions, based on the local Trust’s VTE assessment policy.

Data was reviewed for a total of 70 patients but collected for 54 patients between 17/04/2024 and 07/05/2024 admitted on all three wards at the Acute Inpatient Psychiatric Unit.

16 patients were excluded due to them being transfer patients from other units and not new admissions.

Data was collected from patients’ electronic records which included VTE assessment risk forms, progress notes, initial psychiatric assessment forms on admission, physical examination forms and Multidisciplinary team reviews.

Data entry and analysis was done using Microsoft Word and Excel.

Results: Based upon the Trust’s policy, the following practices/guidelines were checked for compliance against the expected standard:

1. Was the VTE assessment carried out on admission? Standard – 100%. Compliance – 68%.

2. Was the VTE assessment questionnaire completed correctly as per Trust’s Policy on patient’s electronic record system? Standard – 100%. Compliance – 66.6%.

3. Were the VTE related Examination findings documented in the Physical Examination section/form on the Electronic Record System? Standard – 100%. Compliance – 63.4%.

4. Was VTE risk re-assessed on consultant review? Standard – 100%. Compliance – 1.8%.

5. Were the patients assessed to be ‘at risk’ of developing VTE, re-assessed within 24 hours of admission or later if the patient’s condition changed? Standard – 100%. Compliance – 33.3%.

6. Were all patients assessed to be at risk of VTE offered thromboprophylaxis that is consistent with NICE and Trust guidelines unless contraindicated? Standard – 100%. Compliance – 100%.

Conclusion: Results showed that the current practice standards are below the expected standard in all areas except prescribing the correct prophylactic medication if indicated. Based on these results, the following recommendations were made:

Incorporate detailed information about the Trust’s local VTE assessment policy into resident doctor’s induction.

Duty doctors to handover incomplete assessments to ward team doctors to avoid missing the assessment in case patients refuse it on admission/unable to carry out for some reason.

Informative poster to be pasted on the board at Resident Doctor’s room to reinforce the practice.

Pop-up/Prompts are already being given every time on opening patient’s Electronic Records for incomplete VTE assessments. Duty doctors to please complete them as soon as possible if prompted.

Consultants to discuss about frequency of VTE assessments on MDT reviews during discussion at the end of the audit presentation.

Repeat second cycle of audit after 6–8 months.

Aims: Patients in acute psychiatric wards often require physical health assessments at associated medical hospitals. At Quinton Ward, Caludon Centre, we frequently transfer patients to University Hospital Coventry and Warwickshire (UHCW) for physical health concerns. However, their discharge plans are often not documented on CareNotes upon their return, leading to gaps in continuity of care. This audit aimed to assess whether discharge plans were documented and identify areas for improvement.

Methods: A retrospective audit was conducted on the last 10 patients transferred from Quinton Ward to UHCW for physical health concerns. Data collection focused on patient legal status, accompaniment by staff, presence of discharge documentation, and whether discharge plans were chased and recorded on CareNotes.

Results: 5 patients were informal, and 5 were detained under the Mental Health Act.

All 10 patients were accompanied by a staff member.

7 out of 10 visits were to A&E only, while 3 patients were admitted, including 2 readmissions.

Only 2 patients returned with a formal discharge summary.

No staff member actively chased a discharge summary or treatment plan for the remaining 8 patients.

Of the 2 patients with a discharge summary, only one had full documentation of their discharge plan on CareNotes, while the other had partial documentation.

Overall, only 1 out of 10 patients had a fully updated physical healthcare plan upon return.

No documentation was found regarding whether patients were satisfied with the care received at UHCW.

Conclusion: This audit highlighted a significant gap in the documentation of physical health treatment plans for psychiatric inpatients returning from UHCW. Given that discharge summaries are not always provided, relying on them is not a viable solution. To improve documentation, a structured form was developed for staff to complete while at UHCW or upon the patient’s return. This form ensures that essential information – diagnosis, investigations, treatment, and follow-up plans – is consistently recorded and uploaded to CareNotes. A follow-up audit will assess the effectiveness of this intervention in improving documentation and patient care continuity.

Aims: To evaluate DNA rates and contributory factors within CAMHS to propose interventions that improve appointment adherence and service delivery.

Methods: A retrospective review of appointment data and patient records.

Data sources:

RiO (electronic patient records).

Appointment scheduling logs.

Communication records (e.g. letters, SMS).

Audit Period: October 2024–December 2024.

Inclusion criteria:

All scheduled CAMHS appointments during the audit period.

Patients aged [5–18 years].

Exclusion criteria:

Appointments cancelled in advance by patients or clinicians.

Patients discharged prior to the scheduled appointment date.

Results: The high DNA rates, especially in the Generic Team (77–97 across three months), underline the wasted resources and delayed care. This validates the need to identify and address the root causes of DNAs.

Findings:

Generic team has consistently higher DNA rates.

ADHD and Adolescent Outreach teams also show engagement challenges.

Conclusion: The audit highlights significant DNA challenges in CAMHS. Addressing these issues through improved communication, flexible scheduling, and robust follow-ups can enhance patient engagement and resource efficiency. Future re-audits will track improvements and refine interventions.

Aims: In child and adolescent psychiatry, particularly within Child and Adolescent Mental Health Services (CAMHS), monitoring the physical health of patients on ADHD medications is of paramount importance. Medications such as stimulants can have significant impacts on physiological processes, including cardiovascular health. This audit aims to assess current practices in monitoring physical parameters in children and adolescents prescribed ADHD medication at St Ann’s Hospital (Haringey), identify gaps in practice, and recommend improvements based on recent research.

Methods: Study design: Retrospective audit.

Sample: Medical records of children and adolescents diagnosed with ADHD and currently on medication.

Data Collection: Frequency and documentation of weight, height, blood pressure, and heart rate measurements over the past year.

Analysis: Descriptive statistics will be used to compare current practices against established standards.

Ethical considerations: Ensured patient confidentiality throughout the audit.

Literature review.

Results: Of the 50 clients reviewed:

46 clients had their blood pressure, pulse rate, height, and weight measured at every appointment.

2 clients were referred for shared care, impacting tracking of their monitoring.

1 client’s height was not checked at appointments, though other parameters were monitored.

1 client did not have blood pressure and pulse rate monitored during follow-up.

Conclusion: The audit highlighted significant adherence to monitoring standards but identified gaps in certain areas. Implementing the recommendations and maintaining a strong commitment to regular audits will enhance the quality of care provided to children and adolescents with ADHD in CAMHS. A re-audit will be planned to evaluate the impact of changes made from this audit.

Aims: PRN (pro re nata) medications are widely used in mental health settings but are prone to misuse and prescribing errors. A serious incident involving a patient’s death linked to excessive PRN medication supply prompted an initial audit to evaluate compliance with prescribing standards. A re-audit was conducted to assess progress and identify ongoing challenges.

Methods: Two prospective audits were conducted across an inpatient acute ward and a rehabilitation centre. The initial audit (29/07/2024–06/08/2024) and re-audit (29/01/2025–06/02/2025) reviewed medication cards, Rio (electronic patient notes) and EPMA (Electronic Prescribing and Medicines Administration) for 31 patients prescribed PRN medications. Compliance was assessed against 13 predefined standards, including generic naming, dose intervals, BNF compliance, and regular reviews.

Results: Sustained Full Compliance:

Both audits demonstrated 100% compliance in key areas: generic naming, specified administration routes, separate prescriptions for multiple routes, adherence to BNF limits, clear indications for use, and rewriting altered prescriptions.

Key Improvements:

Minimum dose interval specification improved from 64.5% to 93.5%.

Maximum dose documentation increased from 96.7% to 100%.

Regular ward round reviews rose dramatically from 3.2% to 64.5%.

Discontinuation of unused PRN medications (>1 month) improved from 0% to 22.2%.

Review of PRN medications used regularly (>72 hours) increased from 0% to 28.5%.

Documentation of regular vs. PRN use improved from 33.3% to 44.4%.

Ongoing challenges:

Review of PRN medications used regularly (>72 hours) remained low at 28.5%.

Discontinuation of unused PRN medications (>1 month) was only 22.2%.

Documentation of regular vs. PRN use remained below 50%.

Conclusion: The re-audit demonstrates significant progress in dose interval specification, maximum dose documentation, and ward round reviews. However, challenges persist in the regular review and discontinuation of PRN medications, as well as in documenting regular vs. PRN use. Continued focus on these areas is essential to ensure patient safety and adherence to best prescribing practices.

Recommendations:

Key recommendations include integrating PRN standards into doctor inductions, involving pharmacists in ward rounds, and conducting regular re-audits to monitor progress and sustain improvements. Disseminating guidelines and providing feedback to medical teams are essential steps toward achieving full compliance and enhancing patient safety.

Aims: Our audit aimed to assess the quality of care received by patients undergoing Electroconvulsive Therapy (ECT) treatment in one of the largest psychiatric hospitals in Pakistan. The current practices regarding the consent process, recording of vitals during ECT, and monitoring of clinical response and cognitive side effects were assessed. Adherence to guidelines set forth by the Royal College of Psychiatrists was examined.

Methods: In a retrospective analysis, a record of 31 patients who received ECT treatment between April 2024 and September 2024 was examined.

The aspects of consent process reviewed were:

Completion of consent form by the patient or carer.

Documentation of ongoing valid consent.

Right to withdraw consent.

The aspect of ECT administration process reviewed was the documentation of pulse, blood pressure and pulse oximetry readings.

The aspects of the monitoring process reviewed were:

Assessing and recording clinical response at baseline and between sessions.

The use of validated rating scales in assessing response.

Assessing and documenting cognitive side effects.

Results: Although the consent forms were completed by 100% of the patients or carers and ongoing valid consent was checked for all the patients before each ECT treatment, none of the patients were informed about the right to withdraw consent. The vital signs including the pulse, blood pressure and pulse oximetry readings were robustly documented before, during and after the administration of ECT. Unfortunately, no validated rating scale was used for assessing the symptomatic improvement during the course of ECT treatment, and the evaluation of improvement was solely based on the clinical judgement of the psychiatrist. With this reliance on clinical judgement, the clinical status of all the patients was assessed at baseline but the clinical response between each treatment session was assessed for only 45% of the patients. Regrettably, there was a lack of documentation regarding assessment and review of the cognitive side effects and no standardised cognitive assessment tool was used for this purpose.

Conclusion: This audit highlights several areas for improvement, including the failure to inform patients about the right to withdraw consent, irregular clinical evaluations, and the neglected use of standardised assessment tools for monitoring clinical response and cognitive side effects. We suggest updating the consent forms to include the right to withdraw consent. Culturally validated assessment tools should be designed for more structured and objective monitoring of clinical response and side effects. Finally, a re-audit should be scheduled in one year’s time to assess improvement.

Aims: To assess the antipsychotic burden and adherence to the Trust policy on HDAT and physical health monitoring for patients under the Liverpool Homeless Service.

Methods: Patient records were assessed for a three-month period between July to September 2024 to look at the antipsychotic burden for patients under the Liverpool Homeless Service. Sources of information included patient electronic records, and General Practitioner summaries. A two-stage process was then carried out depending on the HDAT calculations. For patients found to be HDAT, records were checked to measure the adherence to the protocol. Trust Protocol would require bloods and ECG to be done, followed by repeat tests at 3 and 6 months. For the rest of the patients on the caseload we assessed whether physical health monitoring had been done per policy. Trust policy on this was yearly Body Mass Index, full blood count, Liver function tests, Renal profile, HBA1C level, lipid profile, serum prolactin. Compliance to these standards was set at 100%. A total of 40 patients were included in this audit

Results: We found that 2.5% of the patients in the service were receiving HDAT. HDAT protocols were not followed for these patients. With regards to physical health monitoring 62.5% of the patients had received the stipulated yearly bloods tests. 55% had Body Mass Index done. Reasons given for non-compliance to these checks included lack of engagement from service users, lack of timely reviews. 77.5% of patients assessed had ECG monitoring done, and this was on time in 60%.

Conclusion: Use of high-dose antipsychotics in the service was low, at 2.5%. There was low uptake of HDAT protocol in these patients. Physical health reviews were noted to be adherent to the policy in about half the caseload. To this end recommendations were made for a system to identify patients due for their physical health checks. Awareness was also to be raised in the team regarding HDAT.

Aims: Attention Deficit Hyperactivity Disorder (ADHD) is more prevalent in adults with an intellectual disability (ID). NHS Digital reported the prevalence of ADHD in the ID population to be 9% in 2023–2024, compared with 1.2% in those without ID. Understanding the prevalence of ADHD within our Mental Health of Learning Disabilities (MHLD) team is crucial for tailoring our services accordingly and improving patient care. We decided to complete an audit across Kent and Medway to assess the degree of service demand arising from the diagnosis and treatment of ADHD in patients already open to the MHLD service, and to assess our adherence to NICE guidance for medication monitoring for ADHD medications.

Methods: A cross-sectional study of all patients currently open to MHLD was conducted. Total numbers across MHLD were recorded, as well as the split between the East and West Kent caseloads. All case notes, clinic letters and GP records were reviewed to identify whether a diagnosis of ADHD (or possible ADHD) was present. Once identified, a deep dive of patient records took place to check medication history and GP monitoring. Information was collated about the type of medication prescribed and length of prescription and whether monitoring had been carried out over the past 6 months in accordance with NICE guidance.

Results: We found that 15% (N=97) of all MHLD patients (N=629) had a confirmed diagnosis of ADHD, with 65.5% male and 34.5% female. The mean age of these patients was 24.6. Of those with confirmed diagnoses of ADHD, 43% (N=42) were prescribed medication. The most commonly prescribed medication was methylphenidate (62%), followed by atomoxetine (14%) and lisdexamfetamine (9.5%). Most patients had been on ADHD medication for less than 1 year (31%), with only 7% of patients being prescribed ADHD medication for over 10 years. With regards to medication monitoring, for those prescribed ADHD medication, 83% had their weight measured in the last 6 months, 76.5% had their pulse measured and 64% had their blood pressure measured.

Conclusion: This audit suggests that the rate of ID and ADHD in our clinical sample is higher than the estimated population prevalence. This will have implications for service development and training requirements, meaning that clear pathways will need to be established, with available resources and adequate monitoring in place to ensure the needs of our patient group are being met, and current NICE guidance is adhered to.

Aims: Paediatric inpatients often face both physical and mental health challenges, yet the extent of their mental health needs may not always be recognised. At the Royal London Hospital (RLH), we observed a high prevalence of mental health distress among paediatric inpatients, with many scoring above the distress threshold on the Strengths and Difficulties Questionnaire (SDQ), a validated screening tool for emotional and behavioural difficulties. We aimed to assess the prevalence of undiagnosed mental health concerns in paediatric inpatients using the SDQ, hypothesising that 80% would exhibit elevated distress scores, indicating potential unmet mental health needs.

Methods: Between 25 November and 22 December 2024, SDQs were administered to all paediatric inpatients across four wards, using parent or self-rated formats (depending on the child’s age and ability). Exclusion criteria included children already receiving mental health support or those not fluent in English or Tamil. Of 62 families approached, 49 (79%) participated, with 43 included in the analysis after excluding incomplete forms. Reasons for declining participation included language barriers (5), fatigue/stress (7), and perceived irrelevance of the study (1).

Results: Of the completed SDQs, 74% of children showed elevated scores in one or more categories, with 28% having a high Total Difficulties Score. Parent-reported data identified emotional (39.3%) and peer difficulties (39.5%) as the most prevalent concerns, while self-reports revealed that 59.9% of children reported greater difficulty in prosocial behaviour. Notably, discrepancies were observed in seven children, who reported higher difficulty scores than their parents.

Conclusion: The high prevalence of elevated scores across multiple domains suggests that a significant proportion of paediatric inpatients at RLH have unmet mental health needs. Discrepancies between parent and child reports highlight the value of incorporating multiple perspectives in assessments. The proportion of families declining participation underscores barriers to engaging in mental health screening. Routine, systematic screening during admissions could help normalise assessments and improve access to timely support.

Aims: It is incumbent upon psychiatrists to manage cognitive and physical health sequelae during a course of ECT. Monitoring post-seizure orientation and the stability of Montreal Cognitive Assessments (MoCAs) over time allows for dynamic changes to modality, frequency and energy settings in order to minimise side effects. Our service hypothesised that disparate electronic forms actually hindered this process and therefore conducted an audit.

An integrated paper-based treatment booklet for use within the ECT suite, with all forms bound together, was piloted as the quality improvement intervention. A new post-seizure orientation tool was also used.

Methods: The setting was South West Healthcare (SWH), Warrnambool, Australia. Standards were set a priori according to ECT guidelines from the Victorian Office of the Chief Psychiatrist and the Royal Australian and New Zealand College of Psychiatrists, with 80% compliance targeted. At a minimum, patients needed baseline bloods (full blood count; urea/electrolytes/creatinine), electrocardiograph, physical examination and MoCA, then physical/MoCA after every third treatment. Furthermore, a comment on orientation in the recovery suite after each treatment was required to meet standard.

Files were selected by 26/06/23 (cut-off date), capturing all ECT patients in the 6 months prior. 15 patients were identified, a combination of acute/completed and acute-continuation/maintenance ECT. Records, both paper and electronic, were audited against standards over 4 consecutive weeks by the authors. After the results were reviewed, the integrated treatment booklet (designed by the lead author) and post-ECT orientation questionnaire (licensed from the University of New South Wales) were introduced into clinical practice.

The audit cycle was completed a year later, with files selected by 30/08/24, capped at 20 patients and capturing all those who had had ECT since the pilot began.

Results: The baseline standard during the initial audit was generally met: bloods (79%), ECG (86%), physical (64%), MoCA (86%). However, the standard was not achieved once ECT commenced: physicals every 3rd treatment (60%), MoCAs (49%). Orientation status was documented in 90% of treatments.

During the post-intervention re-audit, compliance had vastly improved: baseline bloods, ECG, physical and MoCAs (100%); objective orientation scores (99%); ongoing physicals (76%)/MoCAs (72%).

Conclusion: Whilst not quite reaching the 80% compliance target overall, the integrated treatment booklet, with monitoring of re-orientation, significantly improved the cognitive/physical health tracking of patients undergoing ECT at SWH. With further operational change, full compliance is anticipated in the future. Returning to paper was universally supported by psychiatrists and managers, with clinical utility demonstrated within the ECT suite.

Aims: Research from the 2000s onward reveals significant digital access disparities for people with learning disabilities (LD). These individuals often have lower rates of computer ownership, internet use, and digital skills compared with their non-disabled peers. The situation is more pronounced for those with co-existing mental health conditions, leaving them further excluded from digital rights. Few studies have explored the reasons behind this digital divide or proposed solutions to improve internet access.

The study was aimed at gaining insight into the internet access and use of social media in patients with a Learning Disability in Wandsworth.

Methods: A retrospective cohort study was conducted involving fifty clients from the Psychiatry caseload of Wandsworth Mental Health and Learning Disability Team. The clients, selected randomly, had a range of intellectual disabilities and lived in different settings (e.g. with parents, independent housing with carers, or nursing homes). Data was gathered via an accessible paper survey between August 2024 and February 2025. Doctors filled out the forms in the presence of the clients or their carers to reduce recall bias. The survey collected demographic data and explored internet access, usage, and social media habits. It also included questions on internet safety and barriers to use. Chi-square tests were used to analyse relationships between variables.

Results: The study found that a significant number of clients had internet access. Most clients used the internet to watch videos on platforms like YouTube or Google, while some played online games. A smaller number used social media platforms, including Facebook, Instagram, and TikTok. However, many clients had limited understanding on cyber-safety and were unaware of accessibility features for those with visual or hearing impairments. Concerns were raised for a small group of clients who had shared personal or vulnerable information on social media. Thematic analysis identified four main barriers to digital inclusion: lack of access to devices, insufficient support from carers, lack of training, and physical/cognitive challenges.

Conclusion: The growing use of social media among individuals with intellectual disabilities highlights the need for targeted internet safety training. Without proper guidance, clients are at risk of online exploitation. In response, a one-day workshop on internet safety was organized with input from speech therapists, psychologists, and IT professionals. Feedback from participants will help assess the effectiveness of the training. The goal is to expand the study to other teams within Southwest London Trust and explore more objective data, such as device usage logs, alongside self-reported information.

Aims: To determine the number of mental health admissions to the Paediatric Assessment Unit in the Royal Aberdeen Childrens Hospital to provide a basis for implementing improvements to our knowledge and staffing so that we can provide a higher quality service for this group of patients.

Methods: Data was collected from 1 June 2023 to 31 May 2024. This period was used as any patient notes prior to 1 June 2023 were documented on paper, thus improving accuracy and consistency in collection method. Mental health admissions also included place of safety. Each patient who was admitted to PAU under these presenting complaints was noted from the nursing staff’s admissions book and the relevant information was then collected from medical notes on the online system 'Trakcare'.

Results: There were 4898 admissions to PAU from 1 June 2023 to 31 May 2024. 98 of these admissions were due to mental health. This was 2% of the total admissions to PAU. 38% of patients had a pre-existing mental health diagnosis. The most common presentation was mixed overdose with paracetamol-only overdose being the second most common. The average time spent in PAU was 2.1 days which ranged from 1 day to 20 days. 87% of patients received a psychiatry review from either CAMHS or liaison psychiatry. Of the 98 patients who were admitted, 27% required treatment for paracetamol overdose and 7% required treatment and/or monitoring for anorexia. The remaining patients either received observation only with or without monitoring of vital signs. No patients required emergency psychiatric medications, such as antipsychotics or sedation. 75% of patients were followed up by CAMHS, 3% were admitted and 22% received no follow-up.

Conclusion: Mental health accounts for 2% of PAU admissions and can have prolonged stays – up to 20 days found in the audited year. In line with the RCPCH, paediatricians are to have a role in prevention, early recognition and holistic care of mental illness to help with the growing demand in young adults and children. This audit highlights the growing demand of mental health and why health professionals within paediatrics need to develop the experience and confidence to help manage these patients.