Most children 2 years and older with uncomplicated acute otitis media (AOM) are prescribed 10-day antibiotic durations, despite national guidelines recommending antibiotics for 5–7 days. Costs are often cited as a barrier to stewardship efforts. As part of a larger clinical trial including 2 systems and 46 clinics, we developed a low-intensity and a high-intensity intervention aimed at reducing antibiotic duration for AOM and evaluated implementation and sustainability for the interventions.

Costs associated with each implementation activity were recorded over time, including material/supply costs (eg, printing) and personnel time costs. Sustainability costs were estimated based on ongoing implementation expenses. For each system, we assessed total intervention, activity-specific, and sustainability costs. Aggregate results were reported as the median across systems.

The total median implementation costs were $3,606 (range $2,540–$4,672) for the low-intensity intervention and $9,203 (range $7,557–$10,849) for the high-intensity intervention. For the low-intensity intervention, the primary cost driver was electronic health record modifications totaling $2,292 (range $1,615–$2,968). For the high-intensity intervention, the primary cost driver was audit and feedback system activation totaling $5,597 (range $2,885–$8,309). Personnel time accounted for over 90% of costs in both study arms. Sustainability costs were $133/year (range $77–$190) for the low-intensity intervention and $764/year (range $628–$901) for the high-intensity intervention.

Overall costs were low. The high-intensity intervention resulted in higher costs compared to the low-intensity intervention.

Over an 18-month collaborative at CNWL, Thames Ward an acute mental health ward at St Charles Hospital in the Royal Borough of Kensington and Chelsea, aimed to reduce high-level observations by 50% and decrease the frequency of continuous observation. Baseline data showed 18 high-level observations per week and use of continuous observation every 2.5 days.

With support from an Improvement Coach and workshops, the team tested three PDSA-cycle changes: safety huddles including all staff in observation decisions, prioritising risk assessments over automatic observation for new admissions, and improving patientcommunication. Seven in-depth interviews by an Expert by Experience informed communication practices.

The project achieved a 50% reduction in high-level observations (18 instances down to 9) sustained from January–September 2025. Continuous observation frequency decreased, with up to 43 days between episodes. Violence and aggression incidents did not increase, and bank staff costs fell to £0 in September 2025.

This work demonstrates that restrictive practices can be reduced without compromising safety, highlights the importance of challenging entrenched routines, and shows that Expert by Experience involvement is central to meaningful improvement.

1. To evaluate the completeness and quality of admission clerking documentation for psychiatric inpatients on Ward F, Neath Port Talbot Hospital.

2. To identify areas for improvement to ensure compliance with national psychiatry standards.

A retrospective audit was conducted on 13 December 2024, reviewing admission clerking proformas for all 23 inpatients on Ward F. Documentation was assessed across key domains including patient identification, presenting complaint, psychiatric and medical history, forensic and substance misuse history, risk assessment, mental state and physical examinations, medication history, investigations, impression, and management plan. Audit standards were derived from the Oxford Textbook of Psychiatry, Core Competencies for a Trainee in Psychiatry, and the Royal College of Psychiatrists (CCQI) Standards for Inpatient Mental Health Services: Admission–First 12 Hours (2022).

Core components of admission clerking were well documented. All patients had recorded identification, history of presenting complaint, psychiatric history, impression, and management plan. Mental state examinations and risk assessments were completed in 22/23 cases; however, documentation predominantly focused on current risk, with limited recording of past risk (4/23) and previous admissions (8/23). Physical examinations were completed in 18/23 cases, with frequent omissions in neurological, cardiovascular, and anthropometric assessments. Substance misuse history was inconsistently documented, particularly with respect to alcohol intake and illicit drug use. Medication history was recorded in 16/23 cases, with variable documentation of dates, signatures, and electronic prescribing status. Investigations were documented in only 4/23 cases.

Although core elements of psychiatric admission clerking were generally completed, significant gaps were identified in documentation of physical health assessments, substance misuse history, past risk, investigations, and medication history. A revised admission clerking proforma has been introduced incorporating a structured clerking checklist, detailed substance misuse history (including alcohol units, smoking pack-years, and illicit drug use), and comprehensive physical examination with emphasis on neurological assessment. Re-audit following implementation is recommended to evaluate improvements in documentation quality, compliance with national standards, and patient safety.

To assess compliance with recommended standards for completion and documentation of risk assessment on admission and discharge in the psychiatry inpatient unit, and to evaluate the effect of targeted interventions on improving patient safety and continuity of care.

ET AL AUTHORS:

6. Dr. Ali Abbas Zahid - Internal Medicine PGR- aliabbaszahid004@gmail.com- Aleem Medical Collge / Gulab Devi Teaching Hospital, Lahore, Pakistan

7. Dr. Muhammad Zubair - General Practitioner-muhammadzubair1103@gmail.com

A closed-loop quality improvement audit with a repeated cross-sectional design was conducted over two months. Twenty-five consecutive patients were reviewed in each cycle (total n=50). Baseline data were collected retrospectively from clinical records, followed by implementation of interventions including staff education, display of risk-assessment checklists in the ward, and reminders during ward rounds to complete admission and discharge risk documentation. A prospective re-audit was then performed using identical standards. Criteria assessed included completion of risk assessment within 24 hours of admission, documentation in clinical notes, coverage of risk domains (risk to self, risk to others, risk from others, risk of absconding), documentation of a risk management plan, and review and update of risk assessment prior to discharge.

Admission risk assessment within 24 hours improved from 64% to 92% (absolute improvement +28%). Documentation in clinical notes increased from 84% to 96% (+12%). Assessment of risk to self improved from 84% to 96% (+12%), risk to others from 80% to 92% (+12%), risk from others from 68% to 88% (+20%), and risk of absconding from 80% to 92% (+12%). Documentation of a risk management plan increased from 72% to 88% (+16%).

Discharge-related safety showed the greatest improvement. Review of risk assessment prior to discharge improved from 40% to 84% (+44%), and updating of risk assessment before discharge improved from 40% to 80% (+40%). Overall, post-intervention compliance was high across all admission and discharge standards, with the largest absolute gains seen in safeguarding assessments and discharge safety processes.

This closed-loop audit demonstrates that simple, low-cost interventions led to substantial absolute improvements (12–44 percentage points) in multiple components of risk assessment, particularly in safeguarding domains and discharge risk review, which are critical for preventing post-discharge adverse events. Although post-intervention compliance was high, gaps remain in achieving universal documentation of risk management plans and discharge updates. Embedding standardized admission and discharge proformas and continued staff reinforcement are recommended to sustain and further improve patient safety practices.

To examine how musicians express mood states through music and how these expressions are interpreted by media narratives, and how cultural analysis can be used as an educational tool to enhance psychiatric understanding of mental state, stigma and patient engagement.

A qualitative analysis was conducted using a comparative cultural analysis approach. Publicly available materials related to four artists (Amy Winehouse, Kurt Cobain, Stormzy and Florence Welch) were used. These artists were selected to reflect variation across genres, eras, genders and cultural contexts. Materials, such as song lyrics, interviews and media reporting, were thematically analysed using the Braun and Clarke framework. Patterns in emotional expression, representations of mental distress, and media framing were found. Identified themes were mapped to core psychiatric training domains, including mental state variations, stigma and culturally informed care. As no primary clinical data were collected and all materials were in the public domain, ethical approval was not required.

Three consistent themes were identified. First, musicians frequently expressed emotional distress and vulnerability using metaphors, tone and narrative rather than explicit clinical language. This suggests music can provide insight into subjective emotional states and serves as a tool for understanding the meaning and the context of an experience or emotion. Second, media portrayals often simplified or moralised these expressions, particularly in relation to substance abuse, reinforcing stigma and overshadowing the complexity of co-occurring mental health challenges. Third, disparities were observed in how distress was framed, dependent on gender, race and genre, with some artists’ experiences pathologised to a greater extent, whilst others were relatively contextualised or minimised. These findings demonstrate how cultural material can be used in education to show the limitations of symptom-only interpretation and the importance of contextual formulation – including social environment, occupational pressures and media influence. This pedagogical approach aligns with the RCPsych curriculum by enhancing reflective practice and improving cultural competence, pivotal for managing complex presentations in diverse populations.

Music and media analysis offers a potentially useful framework to augment psychiatric training by highlighting how emotional distress is expressed, interpreted and socially constructed. While music cannot be used to diagnose mental illness, it can enhance engagement and facilitate conversations around stigma, identity and help-seeking. Incorporating culturally relevant case analyses through simulated formulation workshops into education may improve recognition of non-verbal expressions of distress, encourage reflective engagement with stigma and media narratives, and promote culturally informed practices.

Postgraduate psychiatry training varies globally in clinical competencies, patient exposure, trainee autonomy, and teaching methods. Teaching webinars can address gaps in training needs by facilitating knowledge and skills development, especially in low and middle-income countries. Having completed undergraduate medical training in developing countries and currently practicing psychiatry in the UK, the authors drew upon their direct experience of differing training structures to develop a webinar series. This series was delivered in collaboration with the British Pakistani Psychiatric Association (BPPA) to share key UK training curricula skills and workplace practices with international psychiatry resident doctors with an aim to further develop their clinical practice and improve patient care.

Seven interactive sessions covered reflective practice and Balint group principles, trauma-informed psychiatry, CBT frameworks, clinical skills (capacity and risk assessments) and ethical considerations of patient confidentiality and consent, designing research, audits, and quality improvement projects, and UK psychiatry career pathways, were delivered by UK-based doctors. Within one week of advertising through BPPA networks, 90 doctors from 19 countries applied (52.2% non-training, 47.8% trainees). Fifty participants were shortlisted based on expressions of interest. Post-series feedback was collected.

The survey response rate was 44%. The series received a mean rating of 4.59/5, with speaker line-up rated 4.55/5, accessibility 4.23/5, and topic relevance 4.68/5. Qualitative feedback reported sessions as highly informative, diverse in topic range, clinically relevant, and presenting concepts that were new to many participants, like Balint groups. Participants recommended more detailed sessions, increased case-based learning, pre-session access to slides and post-session recordings, and more focus on NHS-specific practices versus other healthcare systems. There was strong interest in future sessions with longer duration and increased frequency.

The feedback highlighted significant demand for accessible, high-quality psychiatric education. Topics like reflective practice and trauma-informed care, not universally integrated into existing curricula, generated particular interest. The positive response has motivated the authors to deliver similar initiatives for wider cohorts, incorporating participant feedback to enhance accessibility and educational impact. Such programmes offer structured educational platforms for early-career psychiatrists globally to access skills-focused learning opportunities, while facilitating cross-cultural exchange of psychiatric expertise. While traditional psychiatric education often overlooks cultural nuances in patient care, international collaboration among psychiatrists can improve patient outcomes and reinforce healthcare systems by fostering both cultural competence and cultural humility.

Systematic monitoring of antipsychotic side effects is essential for medication adherence and relapse prevention. To audit compliance with recommended GASS monitoring for patients receiving depot antipsychotic injections in a community mental health team (CMHT). Local Trust and NICE guidelines recommend use of validated rating scales such as the Glasgow Antipsychotic Side-Effect Scale (GASS), with completion at one month after initiating depot antipsychotics and at least every six months thereafter

Using a retrospective review, 20 randomly selected patients receiving depot antipsychotics at Swale CMHT were assessed. Electronic notes (Rio) and uploaded specialist assessment forms were examined to determine whether GASS assessments were completed at the minimum six-monthly interval. Initial one-month post-initiation GASS assessments were excluded as most service users had commenced treatment prior to the first audit cycle.

The 1st cycle of the audit was conducted from Nov 1st 2023 to Jan 30th2024 and six-month GASS monitoring were reviewed between Jan 2022 till Oct 2023. The 2nd cycle of the audit was done between 15thJan 2025 to March 30thand six-month GASS monitoring were reviewed between Jan 2024 till Dec 2024.

In the first audit cycle, only 5% (1/20) of service users had GASS assessments completed at the recommended six-monthly interval. Following staffing improvements, including new pharmacy team joining and increased awareness of guidelines, the re-audit demonstrated substantial improvement: 75% (15/20) of service users received GASS assessments every six months. Reasons for missed assessments were often undocumented.

The initial audit cycle identified a significant deficit in the objective monitoring of antipsychotic side effects using the Glasgow Antipsychotic Side-effect Scale (GASS). Following the implementation of increased awareness, and optimized staffing levels, the second cycle demonstrated a marked improvement in compliance. However, documentation gaps and patient refusals persist. These findings highlight the need for further targeted interventions to ensure full adherence to Trust clinical guidelines.

Risperidone is associated with a high risk of antipsychotic induced hyperprolactinaemia, and routine biochemical monitoring is recommended. This audit aimed to assess adherence to local hospital guidelines on prolactin monitoring for adult outpatients prescribed risperidone, which align with the National Institute for Health and Clinical Excellence (NICE) Guideline CG178 at the Behavioural Sciences Institute (BSI) in Al Ain,United Arab Emirates, and to identify priorities for improving monitoring and documentation.

We conducted a retrospective audit of adult patients (≥18 years) initiated on risperidone and followed in BSI outpatient clinics between 2023 and 2025. We reviewed electronic case notes and lab records. The inclusion criteria were at least six months of risperidone treatment and follow-up at BSI. Exclusions included short-term use (<6 months), death, loss to follow-up, or starting risperidone elsewhere. Audit standards were based on Al Ain hospital guidance: (1) baseline prolactin measurement before antipsychotic treatment, and (2) repeat prolactin at 4–6 months. For each patient, we recorded age, sex, diagnosis, and whether prolactin tests were done, with reasons noted if not. Data were analysed as counts and percentages.

Of 240 patients on risperidone during the audit, 159 were excluded (115 treated for less than six months, 24 lost to follow-up, 18 transferred, 2 died), leaving 81 for analysis. The sample included 53 males (65.4%) and 28 females (34.6%), aged 18–94 (mean 45.8). The most common diagnoses were schizophrenia spectrum and other psychotic disorders (55.6%), followed by developmental disorders including autism and intellectual disability (14.8%), major depression (11.1%), neurocognitive disorders (8.6%), bipolar disorder (4.9%), obsessive–compulsive disorder (2.5%), and single cases of adjustment disorder and cerebral palsy (1.2% each). Baseline prolactin was measured in 12 patients (14.8%), 69 (85.2%) had none, with a recorded reason in only one case (1.2%). At 4–6 months, prolactin was checked in 11 patients (13.6%), with reasons documented in 3 (3.7%).

Adherence to local prolactin monitoring for adults on risperidone at BSI was very low, with poor documentation of reasons for missed tests. Given the potential clinical consequences of unrecognised hyperprolactinaemia, these findings highlight an important patient safety gap. Targeted interventions like staff education, electronic reminders, and clearer documentation expectations are needed, along with a re-audit to assess progress.

No financial sponsorship was received for this project.