Patients with severe mental illness are at a significantly higher risk of poor physical health outcomes than the general population and die on average 15–20 years earlier. The Royal College of Psychiatrists has published extensively on how to improve routine physical health monitoring in this cohort. Despite this, there is little data or guidance on improving emergency medical care for this cohort. We aimed to analyse and optimise the process of patients being sent to general hospital on an emergency basis.

A review was undertaken of the clinical notes for medical emergencies over a 12 month period by two core psychiatry trainees. Site visits and interviews with local A&E department clinicians, the covering General Practitioner and pharmacy were completed. A questionnaire was distributed to all nursing staff to gather their perspective on the considerations for emergency medical transfers out of The State Hospital.

On review of the case notes, 44/44 emergency outings were deemed to be clinically necessary for investigations/interventions that would not have been possible on-site. Qualitative methodology highlighted a disconnect amongst staff groups and stake holders regarding thresholds for transfers relating to medical emergencies leading to a high level of staff dissatisfaction.

The interface between psychiatric and medical services is an area of risk to patients. Levels of staff confidence, knowledge and available resources all contribute to the risk of transfer. Further work is required to explore other aspects of patient care and treatment which can be impacted as a consequence of emergency transfers.

• • To improve safe medication prescribing by achieving a 25% improvement in the number of cases reported in the practice within six months.

• • To reduce human factors contributing to medication errors to improve patient safety and quality of care.

• • Retrospective data collection was done for Halton and Widnes patients from March 2022 to April 2023;

• • Retrospective data collection for Re-audit was done for a period between June 2023 to January 2024 to complete the audit cycle;

• • Liaised with medicine management team for local practices/policies;

• • Reviewed and verified Trust standardised local policies on medicine management;

• • Reviewed incident data and checked processes in other teams;

• • The findings were presented at the Medicine Management meeting in May 2023;

• • Training on safe prescribing was delivered to the Memory team in June 2023.

• • During the first data collection period, 14 incident forms were reported.

• • During the second data collection period, 1 incident form was reported which was an administrative error.

• • Prescribing errors for the first cycle accounted for 28.6%, administrative errors for 35.7%, dispensing errors for 21.4%, and other errors for 14.3%.

• • Specific error types included prescribing the wrong dose/medication, medication not prescribed, medication unavailable and double prescribing.

• • No incidents of restraint, seclusion, rapid tranquillisation, ambulance calls, or RIDDOR were reported.

• • Administrative errors accounted for the majority of the total reported incidents (35.7%).

• • Recommendations include safe clinical practice of prescribing medication (MDT lead to update medication card and inform GP promptly).

• • Other recommendations were medication card updates, aligning clinical systems, avoiding email requests and introducing Community EPMA (Trust objective to introduce EPMA to community teams in 2024/25) and to standardise procedures.

• • An improvement of 92.9% in the incident reporting was found in the re-audit following a training session to the team with improved practice of no email requests or chains.

• • The audit identified communication difficulties within memory services, primary care and care home.

• • It also highlighted challenges related to new staff, post-MDT meetings medication card updates, prescriber preferences, geographical disparities, and doctors’ availability.

The aims of the study were to illustrate the number and type of restrictive practices that were used across two inpatient wards within the Acute Mental Health Inpatient Centre in the Belfast trust over a two year period. This initially would highlight the prevalence and use of such practices and allow for comparison against the data collected after the implementation of the therapy cross. We hoped that with the implementation of the therapy cross we would see a decline in the use of physical interventions, use of IM medications and also the number of aggressive or distressing incidents and behaviours would also decrease.

We utilized a statistical process control to collate and illustrate data. Daily data collection was carried out and compiled over a 2–3 year period and is ongoing with regards to ward incidents of aggressive behaviour, use of physical intervention, use of IM medications. In early October of 2023 the therapy cross was introduced and the run charts and data collection continued allowing for comparison of such behaviours and interventions pre and post intervention.

A percentage decrease of 50% of the weekly average was noted in incidents of aggressive and violent behaviours on one ward in AMHIC following implementation of therapy. A percentage decrease in average weekly use of IM injections was noted to be 13%. A 12% decrease was found in the use of physical intervention on a weekly average following the therapy cross.

The implementation of a therapy cross in early October 2023 indicated improvement in the incidence of use of restrictive measures on two inpatient wards in the Belfast Trust, including the number of physical interventions such as holds that were required and also decreased the incidence of use of IM medications for rapid tranquillization. The data indicates a significant decrease in the number of cases of violent and aggressive behaviour on wards following implementation of a therapy cross.

We aimed to improve the care for people with intellectual disabilities (PWID) presenting to a community learning disability service (CLDT) with health needs relating to sexual wellbeing, sexuality, and/or gender identity (SSGI). A QI framework was used, focussing on staff education and service development.

We hypothesised that there would be a lack of confidence and staff knowledge around SSGI issues in PWID. We suggested that challenges exist because discussing sex in PWID still feels taboo.

PWID have the same sexual needs as those without any disability. Historically, this population have been discouraged from expressing their sexuality due to certain attitudes, fears, and prejudices. Stigmatising views have included PWID being viewed as asexual or conversely posing a risk of sexual violence, despite evidence showing that they are more vulnerable to sexual abuse. Important issues around capacity and understanding consent highlight the importance of psychosexual education for patients and carers.

Carers and health care professionals are key in educating and supporting PWID, however, our disinclination towards discussing SSGI openly can have unintended negative effects on the wellbeing of our patients. These issues are therefore paramount to understand and address.

Patient-facing staff in a London CLDT were surveyed, and staff focus groups held, to understand attitudes towards SSGI in PWID. Staff knowledge of local services was also explored. Using thematic analysis, we identified both staff and service development needs and devised a set of interventions to address these.

Four educational interventions for staff were developed and evaluated using QI methodology. Interventions included bitesize teaching, externally commissioned training, and resource packs.

Thematic analysis identified a number of barriers to delivering SSGI care, particularly staff's low confidence and a lack of training. Following the four educational interventions, average staff confidence to discuss SSGI increased from 55% to 77%.

Staff responses indicated a lack of SSGI services for PWID locally. In response to this, the QI team, service leads and management agreed upon various service development ideas. These include upskilling specific staff to become SSGI leads; auditing the CLDT caseload to understand the SSGI issues in our population; and trialling a clinical sexology service for a small subset of patients.

A QI approach to staff education demonstrated clear benefit, with staff more confident to address the SSGI needs of PWID. Combined with sustainable service improvement ideas, this can improve patient care.

Problem:

Around 10% of patients with an intellectual disability have a clinically relevant copy number variant in their DNA detected using microarray analysis. Adults with an intellectual disability may not have had access to genetic screening during their patient journey, or they may have had previous screening with now outdated technology.

Aim: to offer up-to-date genetic screening to adults with intellectual disability in an inpatient setting.

Strategy for change:

In collaboration with the clinical genetics department, confirm local capacity for genetic screening by microarray testing, and create a pathway for referral with a screening tool for detection of “high risk” patients. Develop processes and resources for consenting patients with capacity, and for acting in best interests with family agreement for those without.

Measurement of Improvement:

Increase in the number of patients with up-to-date genetic screening.

Effects of change:

This project has detected previously unknown genetic abnormalities in current inpatients, two of which were felt to be clinically significant. Further testing is underway and clinical discussions are ongoing regarding the implication of these findings for current patient care and management.

Discussion:

Patients with capacity, families and multidisciplinary healthcare professionals were overwhelmingly supportive of this project with the aim of improving understanding and ultimately the care of each individual. With further discussion and assistance, this project could be widened to the community setting to benefit a greater number of patients and their families.

1. 1. For all eligible general adult psychiatry and substance misuse inpatients at the Royal Edinburgh Hospital (REH) to be offered appointments at a pilot onsite sexual and reproductive health (SRH) clinic.

2. 2. To evaluate the need for this novel service using eligibility rates and attendance levels.

Eligibility of all inpatients on a substance misuse ward considered at admission, and a space in the clinic offered if appropriate. Reminder added to the clerking proforma.

Eligibility of general adult psychiatry (GAP) inpatients considered by their multidisciplinary team (MDT) weekly. Team 1 to trial this at ward round, and team 2 to trial it at rapid rundown.

A patient leaflet was created to explain the clinic.

General adult psychiatry: In team 1, 82% (120/147) of patients were considered by the MDT over 20 weeks, and in team 2, 65% (53/82) over 10 weeks. Of all GAP patients considered, 48% (83/173) were deemed eligible. Of those, 70% (61/83) were asked if they wished to attend, usually by the junior doctor leading the QI project. Thirty-six percent (22/61) of those booked into the clinic, of which 82% attended.

Substance misuse ward: Over 15 weeks, 85% (82/97) of patients admitted to the substance misuse ward were considered, deemed eligible and offered a space in the clinic at admission, of whom 15 accepted and 4 attended.

Nearly half of GAP inpatients were eligible to attend, with the total likely to be higher over time, as mental state improved. A high level of demand was demonstrated for SRH services in this population, where research also suggests a higher level of need and lower levels of access.

During weeks when the QI leads were absent, it was not recorded that any patients were considered at ward rounds or rapid rundowns. It was difficult to implement a process for this whilst the clinic was still at the pilot stage. The incorporation of a reminder into the ward round template would ensure that this is always considered.

A very high proportion of substance misuse patients were eligible for this clinic, highlighting higher levels of capacity. The main challenges for attendance were a high discharge rate, presence of withdrawal symptoms, and extensive passes off the ward.

Seclusion is a method used by mental health teams around the world to manage aggressive and disturbed behaviour in psychiatric patients in situations where there is immediate risk of harms to others.

A quality improvement project was carried out over two hospital in-patient sites containing 6 wards to see if seclusion reviews were completed safely and documented appropriately according to the guidelines set out by South West Yorkshire Mental Health Trust and the Royal College of Psychiatrists.

The quality improvement project was carried out to first audit data to see if seclusion reviews were being done to the local guidelines and standards set by the Mental Health Legislation and Royal College of Psychiatrists. This was followed by training junior doctors and reauditing date to see if any improvements were observed.

A retrospective quality improvement project was conducted assessing medical seclusion reviews carried out by on-call junior doctors between November 2022 and January 2023. Data was initially collected retrospectively spanning over a period of 4 weeks over the month of November 2023 including the analysis of 30 seclusion reviews. These results were presented as an audit to doctors and managerial staff at the end of November. Post training seclusion review data was collected over a period of 4 weeks over January 2023.

An overall improvement in 7/9 domains. The biggest improvement (54% rise) was checking for side effects and EPSEs which was only documented 4/23 times in the first pre-training run. 18% improvements were also noted for assessing and documenting if the patient had any distress or pain, clinical appearance in terms of the cardiac domains such as perfusion and colour of the skin and also their level of orientation in place person and Glasgow Coma Score.

The only two domains in which an increase was not observed was to document if seclusion should continue and justification for why this is the case. These two domains were already at 100% and the System 1 seclusion review template prompts doctors to do this at the end of the review which is possibly one of the reasons it was done well both before and after the training.

A great deal of interest and feedback was garnered and the idea was agreed that a further audit could be carried out after providing training for the current doctors and to gather post-training medical seclusion review data for comparison.

Rosewood Mother and Baby Unit (MBU) aims to provide inpatient psychiatric care to women with severe mental illness in Kent, Surrey & Sussex (KSS) in UK. Data from admissions during 2022 demonstrated discernible inequalities in admissions. A quality improvement project was undertaken to improve equity of access for admission of women with severe mental illness to Rosewood MBU, specifically, those under 18 years old, black and minority ethnicities, and across counties in KSS. The aim was to improve quality of care and patient experience for vulnerable groups across all ethnicities, not limited to their location or age.

Baseline data of MBU admissions in 2022 was collated, including demographics, age, origin of referrals, diagnosis, ethnicity, length of stay, parity, previous MBU admissions, safeguarding concerns.

The project group, inclusive of an expert by lived experience, presented the data at various network meetings and stakeholder events that helped to share information and gather experiences on barriers to referrals to Rosewood MBU, barriers for women of black and ethnic minority background accessing MBU, differences in service provisions for under-18-year-old women with perinatal mental illness in various counties.

Data for women discharged from Rosewood MBU in 2023 was collated and compared against the findings from the previous year.

In the first half of 2022, there were 20% more women admitted from Kent than Surrey and Sussex combined. This improved following interventions with a better spread of patients across counties in July–December 2023 and a 11% rise in admissions of women from Surrey and Sussex compared with Kent.

There was a greater number of ethnicities and a greater number of women from different ethnicities admitted to Rosewood MBU when comparing 2022 with 2023, and specifically across each of the 6-monthly periods. In January–June 2022, 3 women of non-White British ethnicity were admitted, compared with a 400% increase in July–December 2023 with 12 women. Overall there was 260% increase in admissions of women of Black, Asian, Mixed, White-Other ethnicity in 2023 compared with 2022. Also, in 2023, there were 2 referrals and 1 admission of a women under the age of 18, compared with no referrals in 2022.

Overall, the project demonstrates the positive impact of streamlining referral pathway, fostering collaborative working and integrating expertise from diverse professionals including experts by experience that can reduce service inequalities and improve patient outcomes.

The aim of this project is to improve the monitoring of patients on lithium under the South Gloucestershire Later Life Community Mental Health Team and to clarify the process for this monitoring with the aim of improving patient care and safety. We aim to try to achieve 100% compliance with agreed standards based on NICE and Trust guidelines.

Following a meeting with team medics we agreed a series of nine standards derived from local and national guidelines. We then used a locally held database of patients on the later life CMHT caseload on lithium therapy to identify our sample and devised a simple audit tool to collate the information. We used Rio electronic health records and ICE blood results to obtain baseline data from June 2022 to December 2022.

We used the plan-do-study-act (PDSA) cycle model for quality improvement. Following analysis of the baseline data, we planned and implemented key changes of the physical health nursing team taking over investigations from primary care and utilising a bespoke database. We also completed an education session for staff. Following these changes, data was collected and analysed from June until November 2023. From the analysis of these results, a further change was planned for PDSA cycle 2 and further data collection is planned.

Results from baseline data showed that six out of eight standards had compliance of < 60%, which included the time-sensitive investigations such as lithium levels every 3 months; kidney function tests every 3–6 months; calcium level every 6 months. Weight/BMI monitoring and documentation of side effects also had poor results. Average compliance across all standards was 57%.

Following the agreed steps to improve compliance, PDSA cycle 1 results showed improvement across the board, with average compliance increasing to 94%. Time-sensitive investigations now had 100% compliance (lithium level, kidney function, calcium level). Areas for improvement remain, namely in weight/BMI monitoring every 6 months and clear action plans for results falling out of range being clearly documented in patient notes.

By working closely with the physical health nursing team to devise a bespoke local database of information and taking over the investigations from primary care, we have shown an improvement across all standards, therefore improving the quality of care and patient safety.

Cognitive disorders, such as dementia, are a possible comorbidity and an important differential diagnosis to consider in older adults admitted to psychiatric wards with a functional disorder. Whilst cognitive assessment tools (e.g. ACE-III) and neuroimaging (e.g. MRI scans) are well established, there is significant variability in how and when they are used, which can result in inconsistences in their use. The aim was to identify the types of inconsistencies that may occur, and to provide a standardised framework in order for these tools to be used consistently on our functional rehabilitation ward.

This QIP retrospectively assessed data for all patients discharged over a 7-month period between October 2022 and May 2023, from an older adult functional rehabilitation ward. Clinical notes were reviewed to determine whether a cognitive assessment and neuroimaging had been considered, and if so, whether the assessment or investigation was appropriate and completed without delay. Correspondence to the GP or CMHT was reviewed to determine whether this had appropriate information about the relevant cognitive screening completed, and had included an appropriate follow-up plan. Data collected was checked for accuracy through screening by a second clinician, after which a consensus meeting was held to account for discrepancies.

25 patients were discharged during the 7-month period. 52% were identified as having an issue or delay in their cognitive screening and correspondence; 32% had a delay in completing a cognitive assessment; 32% did not have an appropriate follow-up plan communicated in their discharge summary regarding future monitoring of their cognition; and 8% had a delay in considering or requesting neuroimaging.

Team discussion identified that staff uncertainty relating to the use of cognitive tools and neuroimaging was a significant contributing factor to the issues identified in our results. We subsequently delivered training using a flowchart for doctors, nurses and allied healthcare professionals on the ward, which included information about the benefits and disadvantages of different screening tools and imaging modalities, in order to assist selection of the most appropriate tools on a case-by-case basis. The flowchart included the need for MDT discussion and senior psychiatrist involvement, but aimed to improve team confidence in understanding the rationale for these decisions. Based on the results of our post-intervention data, we will consider adapting the training and flowchart delivered to meet the needs of other older adult services in the trust.

To create a safe and effective induction programme for Higher Specialist Trainees (HST) at Nottinghamshire Healthcare NHS Foundation Trust.

An effective induction improves trainees' satisfaction, they feel welcomed and valued. It improves patient safety, retention, and recruitment (GMC Report 2020).

Based on GMC report, published in 2020, a survey was developed locally and data for 2021 HST induction was collected using digital platform. Initial stakeholder analysis completed, and relevant parties were invited to share the results. Two key deliverables were identified after consultation, one was a dedicated induction programme for HST which was co-produced along with trainees and stakeholders. The other deliverable was updating the induction booklet. The proposed induction plan was implemented in August 2023, the survey was repeated to the new HST cohort following induction via digital platform. Results of the survey were analysed via mixed methods (qualitative & quantitative).

The surveys conducted in 2021 and 2023 were compared and there was an increase in response rate from 50% to 64%. The domains were devised from GMC standards and assessed by if staff had received everything in the domain within a week of starting their placement and results evaluated using a t-test.

Domain A is gaining access to places and system (keys, fobs, security passes, computers, ID badges, mobile phones, IT system). This significantly improved from 27% to 88% with a p-value of < 0.001.

Domain B is physical orientation of the setting (staff facilities such as lockers, parking, library, and site layout). This significantly improved from 45% to 88% with a p-value of < 0.018.

Domain C is gaining day to day knowledge (HR, rota, annual leave, study leave, pay-roll, mandatory training, e-expenses, and guardian of safe working). There was no significant change between 9% and 19% with a p-value of < 0.48.

Domain D is an understanding of expectations (duties and responsibility during working hours, on-call, team introduction). This significantly improved from 9% to 69% with a p-value of < 0.002.

HSTs were given the chance to add comments and the responses in 2023 were more positive “excellent induction compared to previous years” compared with 2021 when HSTs felt isolated and devalued “worst ever induction in whole career in NHS”.

Overall, the results of the 2023 survey showed considerable improvement in all the key areas of induction within one week of starting the placement. Domain C demonstrates a challenge still and needs further work.

This pilot study addresses the implementation of trauma-informed practice within healthcare settings. Given the profound impact of trauma on individuals’ health and well-being, there's an increasing recognition of the importance of integrating trauma-informed care into healthcare systems. This project aims to evaluate and enhance healthcare professionals' understanding, awareness, and confidence in implementing trauma-informed practices through targeted interventions.

The project initiated with a baseline assessment through surveys among healthcare professionals to gauge their initial understanding, awareness, and confidence levels in applying trauma-informed practices in their work environments (n = 9). Subsequently, a structured teaching session was conducted to provide education and training on trauma-informed care. Post-session, a reassessment survey measured improvements in awareness, understanding, and confidence levels (n = 5).

Following this, a visual aid – a comprehensive poster summarizing key aspects of trauma-informed practice – was created and displayed prominently in healthcare settings. A second cycle of the quality improvement initiative was undertaken, measuring outcomes after the implementation of the poster. Surveys were administered again to evaluate the impact of the visual aid on sustaining and further enhancing healthcare professionals’ adherence to trauma-informed practices (n = 3).

Post-teaching session assessments demonstrated a notable improvement in levels of awareness (44%), and confidence (56%) among healthcare professionals regarding trauma-informed practices, as well as recognition of signs & symptoms of trauma (44%). Subsequent to the poster's introduction, the second cycle of assessments showcased sustained levels of awareness, understanding, and confidence among the participants.

The project underscores the effectiveness of targeted interventions – educational sessions and visual aids – in augmenting healthcare professionals’ understanding, awareness, and confidence in implementing trauma-informed practices. The improvement in these metrics post-interventions emphasizes the value of ongoing education and visual support tools in fostering a trauma-informed approach within healthcare settings. Embedding such practices can significantly impact patient care, fostering a more supportive and empathetic environment for individuals affected by trauma.

1. 1. Identify changes in the services rendered in the Enhanced access/emergency service following the previously suggested modifications.

2. 2. Identify areas of possible improvement within the service to provide seamless emergency and out-of-hours mental health support to patients.

3. 3. Evaluate adherence to current guidelines for the Enhanced access/emergency service.

An audit of a total of 100 patients on the list was selected in chronological order. Patient documentation was reviewed against the current criteria for patients on the list, which included having a documented care plan in place, remaining open to a community mental health team, and having been reviewed at least within the last 6 months.

The data was then analysed and compared with the previous year's results to see if there was any significant change year over year.

Year on Year improvement:

1. 1. Total number of patients on the list had increased by 16.7%.

2. 2. The number of patients without a care plan on the list reduced by 6.

3. 3. The number of discharged patients on the list was also reduced by 1.

4. 4. The number of patients who had not been reviewed in six months reduced by 9.

While there had been some improvement in the service provision and adherence to the guidelines, there was still ample room for improvement, which would be achieved by adherence to the guidelines and protocols, to ensure better service improvement for enhanced access and out-of-hours emergency services to patients.

Clinical Global Impression Scale (CGI) is a recognised scoring system used to assess patients across a variety of medical specialties. In this study we aim to evaluate the use of the severity scale (CGI-S) in a female adult mental health unit. We aim to explore how frequently it is used to assess patients on admission and discharge and investigate its utility in predicting a variety of patient outcomes. We hypothesise that gaining a greater understanding of the significance of CGI-S scoring can enhance in-patient care by offering insights into factors such as probable length of stay and potential benefits of in-patient admission.

Patient data was collected retrospectively for the last 60 patients discharged. The resulting population data from an inpatient female ward which was then analysed using Microsoft Excel and Jamovi.

59 patients were included in the final data set. Population age at time of admission ranged from 18–68 years with a mean age of 38. The mean length of stay was found to be 40.2 days. 80% of patients had an admission CGI-S recorded with a mean score of 2.77. 71% had a discharge CGI-S recorded with a mean score of 1.79. 58% of patients had both admission and discharge CGI-S score recorded. The key findings of the study were a mean reduction of 1.09 in CGI-S scores, indicating an overall improvement in patient presentation by the point of discharge. Length of admission was increased by 14 days per 1 integer increase in admission CGI-S score. The data also suggests that the correlation between admission CGI-S and length of stay is statistically significant (p value of 0.016). It was also noted that patients with a discharge diagnosis of ‘Emotionally Unstable Personality Disorder’ had a smaller reduction in CGI-S score at point of discharge and required shorter hospital stays, compared with other diagnoses.

The results of this study imply that use of CGI-S scoring in adult inpatient units is beneficial. However, its value can be better seen with improved adherence to regular completion of scores during patient reviews and is an important step to prioritise. Increase in utilisation of this tool will also likely provide clinicians with guidance in predicting which patients are likely to benefit from lengthier admissions and those that might fare better with community support.

1. 1. To assess the current video gaming provisions on an inpatient CAMHS ward.

2. 2. To gather feedback from young people on the ward on the current provisions and gather suggestions for improvements.

3. 3. To implement any suggestions of improvements.

4. 4. To organise regular group gaming sessions for groups and to allow access for individual use.

5. 5. To gather feedback following implementation on how to improve further.

Using surveys, we gathered feedback on attitudes to recreational gaming, interest in gaming social events, preference for individual gaming and on thoughts of the current gaming facilities in a London inpatient CAMHS unit, from a cohort of young people admitted to the ward.

Based on this feedback we sourced funding for a Nintendo Switch from Gaming the Mind Charity and purchased a Nintendo Switch for the Unit along with preferred games.

Regular group gaming sessions were integrated into the ward activity schedule. Additionally, access for individual use was also facilitated.

Further feedback on implementation was gathered from the young people.

Based on initial survey feedback, a majority of young people on the ward indicated that they enjoyed gaming and that it was a good way to “have fun, relax or socialise”.

Feedback suggested the current provisions on the ward (consoles and games) were outdated and not used frequently.

Nintendo Switch received most suggestions for best new addition to the ward.

Game suggestions included: Mario Kart 8 deluxe, Wii sports, Splatoon 3, Mario super smash bros and Minecraft.

After implementation of social gaming events into ward timetable, follow up feedback was positive, suggesting that the majority of young people who engaged in recreational gaming activities on the ward benefited from this. Feedback suggested it was beneficial in terms of mood, socialising, and as a distraction from difficult emotions.

Improving access to recreational video gaming consoles and games within inpatient settings is a valuable way to offer activities to improve mood and social interactions between young people in an inpatient CAMHS setting. Follow up research into efficacy would be of benefit.

Mental health professionals are very likely to experience a patient death at least once in their careers. The Royal College of Psychiatrists published a framework for supporting mental health staff following the death of a patient by suicide. It states that ‘how the news about a patient's suicide is imparted influences the emotional impact of the death and is therefore very important'. We sought to explore how healthcare professionals are informed about patient deaths within Birmingham and Solihull Mental Health NHS Foundation Trust.

A 25-question survey was devised to explore how staff have been informed about patient deaths and the impact it had on them. This was emailed to all grades of doctors, nurses and allied healthcare professionals within the trust and results were collected over 11 days.

83 healthcare professionals completed the survey.72 respondents had experienced a patient death within the trust. Of 72, 48.6% of respondents felt they had not been informed about their most recent patient death in a sensitive manner. There was wide variability in the method by which staff were first informed. 27.8% of respondents first learned of the patient's death via an email from the trust lawyers, patient safety team or another party. Of these 20, 17 felt they had not been informed in a sensitive manner. 63.9% (n = 46) reported that they had not been signposted to any support. Qualitative data suggested that the way in which people were informed had a wide-ranging impact. Many respondents felt shocked and upset. With hindsight, people would have appreciated being informed face to face and being given time to reflect. Of the total 83 responses, 82% (n = 68) felt that there should be a specific policy about how staff are informed about patient deaths.

Results from this survey demonstrate a large scope for improvement in the way that staff are informed of patient deaths. Using these results, we will generate change ideas for a quality improvement project which aims to inform staff more sensitively about patient deaths. Feedback suggested implementation of a new protocol to guide team managers and consultants on how to inform staff; it may help to standardise the process and the support provided. Patient deaths have a significant impact on the mental health of staff; communicating this matter compassionately may help to alleviate immediate feelings of distress and mediate the long-term impact on staff wellbeing and satisfaction.

The key aim of this project was to update and modernise the hospital procedure on how patients access pornographic material whilst detained at Wathwood Hospital. Within the update, we aimed to promote inclusivity and acceptance of all patients’ sexual identities as well as utilising the opportunity to emphasise healthy consenting sexual relationships.

Patients in Forensic Mental Health settings are often inpatients for a significant amount of time, with multiple restrictions imposed on their private and family life. Current policy allows patients to purchase pornography for private use in their own room. It must be material of the same nature available in a main street outlet. In practice, material is usually purchased in DVD format from the Amazon website and subsequently screened for suitability by Security staff and finally approval by the Responsible Clinician. There have been numerous incident reports involving the trading of pornographic material.

Qualitative semi-structured group interviews (up to 5 people at a time) were conducted with patients in the medium-secure forensic services of Wathwood Hospital. They were recruited from the fortnightly Patient Forum. Anonymised questionnaires involving Likert scales and free text response spaces were also distributed at the Patient Forum. Data gathered investigated the percentage of patients who were aware of the current procedure, if they felt it worked well and what they thought the impact of accessing pornographic material might be. Staff were invited to complete a similar anonymised questionnaire, again considering their opinions on the positive or negative impacts of pornography for patients. In addition, we gathered data on whether there was a difference on the degree of comfort/discomfort about pornography, depending on whether the material involved opposite sex or same sex couples. In total, there were 40 survey participants.

Some key areas for concern were found, for example, only 17% of staff and 16% of patients thought the current policy works well despite 69% of staff and 84% of patients feeling it is a patient's right to access pornography. Free text and focus group feedback established many benefits to it. It was clear that there were some areas of difficulty in the hospital policy, which would benefit from being refreshed.

Staff and patients overall feel that access to pornography is important for many of the patients. We identified areas for improvement in how this is accessed and a need to continually be considering the need to consider meeting the holistic needs for the patients.

Child and Adolescent Mental Health Services (CAMHS) is a highly specialised service to which children with severe mental health problems are referred. The COVID-19 pandemic brought with it a lot of uncertainty, and healthcare systems across the UK struggled to cope with the added pressure. The aim of this systematic review is to analyse the literature exploring the effects of the COVID-19 pandemic on the severity of mental health conditions and referral rates to CAMHS services in the UK. The findings from this study will help the services understand the impact of the pandemic on referral rates to CAMHS, the severity of various mental health conditions, and how the services are managing.

An extensive search, following PRISMA guidelines, was undertaken across multiple electronic databases using a predetermined search strategy. Studies reporting on mental health conditions in children post-pandemic and on referral rates to CAMHS in the UK were included. Subsequently, data extraction, quality appraisal and qualitative analysis were performed in a descriptive style.

Initially, referrals to CAMHS decreased during the first lockdown, followed by a significant increase in referrals throughout the pandemic period. The referral rate to CAMHS remains steady until adolescence, with a rapid increase in referrals to the services during the teenage years. More adolescent girls were referred to CAMHS compared with boys and are at an increased risk of developing mental health conditions. A higher number of children and young persons presented with urgent referrals and heightened symptoms during the pandemic compared with the pre-pandemic levels. In particular, there was a significant increase in children presenting with eating disorder problems, accompanied by an increased severity of symptoms. Furthermore, there was an observed rise in depression and anxiety among children and young people, along with an increase in the use of antidepressant medication.

Referrals to CAMHS increased during the pandemic, with increased severity of symptoms observed, particularly in children and young people with eating disorders and neurodevelopmental conditions. Future research should explore the enduring impact of the pandemic on referral rates and presentations to CAMHS. This exploration is essential to aid senior managers and policymakers in decision-making, enabling the implementation of appropriate measures to manage the pattern of demands on CAMHS and shape the future service delivery of CAMHS in the UK.

To improve the detection of delirium amongst patients aged over 65 in Queen's Hospital, and then incorporate a clearer management pathway for these patients to be treated safely with more appropriate intervention and better follow up care. As part of the management pathway, the aim was to increase the delirium referrals made to the local Dementia and Delirium Team for quicker implementation and education regarding non-pharmacological interventions in treating delirium, whilst ensuring that Psychiatric Liaison Service (PLS) referrals for delirium were also appropriate.

A multi-phase approach to quality improvement and service development for patients with delirium has been adopted, and the first step is to improve the screening of patients over 65 years old with delirium and then to refer to appropriate teams accordingly. Our first intervention was changing the PLS referral form. It has been simplified with less input data required, and now includes a mandatory 4AT screening score for delirium, as well as a mandatory referral to the Dementia and Delirium Team for any patient with positive screening for delirium. The intervention was implemented in November 2023, with pre and post intervention data collected in October and December 2023 respectively. Data was collected prospectively and retrospectively using medical notes.

Queen's Hospital PLS received a total of 60 older adult referrals in October 2023 and 49 referrals in December 2023, of which the total proportion of referrals diagnosed with delirium was 47% and 35% respectively (12% absolute reduction). The proportion of patients referred to the PLS team with delirium, who did not require further intervention after initial assessment, had reduced by 29% (87% to 58%). The proportion of patients with delirium referred to PLS, who had also been appropriately screened and referred to the Dementia and Delirium Team prior to PLS assessment, has also increased by 4%. There has been a marked increase in total delirium referrals to the Dementia and Delirium team after intervention, from 31 referrals in October to 85 referrals in December (174% increase).

There is an improvement in screening for delirium, with marked increase in referrals made to the Dementia and Delirium team. There is a decrease in uncomplicated delirium referrals who do not require further PLS intervention and can be appropriately managed with the Dementia and Delirium team input.

An evaluation of the service and care provided to eating disordered patients referred to Tier 3 CAMHS within NHS Lanarkshire. Eating disorders are recognised as a relatively common disease with preventable mortality. The primary aim was to determine if patients with eating disorders adhere to the assessment and management as outlined in MEED and SIGN 164. The secondary aim was to scope the number of eating disordered cases to plan recruitment and training of specialist staff.

The pilot study was carried out in November 2022 and repeated in January 2024. The Electronic Patient Record and paper notes of eating disordered cases assessed in 2023 were used to audit against MEED and SIGN 164. Additional patient demographics including patient's age, sex, median BMI at initial appointment, working diagnosis and suspected co-morbidity were also collected. The service was further evaluated on its processes from source of referral, time taken to be seen, therapies offered and duration within service.

A total of 46 cases were identified in the audit compared to 57 in the pilot study. Most of the cases seen in 2023 were girls in their early teens (89% between the ages 13–16). 10% have a median % BMI <80%. 15 were given a diagnosis of AN (33%), 4 with BN (9%), 4 with ARFID (9%), 2 with OSFED (4%) and 19 with no formal diagnosis (42%). There was a high level of suspected comorbidity (80%).

Referrals were mostly made by GPs (87%), followed by school (11%) and other professionals (2%). The average time taken for the initial assessment was 63 days (40% were seen within 4 weeks). 14 (30%) of cases were offered FBT only whereas 3 (7%) had CBT-E. 7 (15%) did not receive any intervention and 19 (41%) were given other therapies.

With respect to the MEED risk markers, there had been improved recording of weight changes (40% to 80%), hydration status (40% to 70%), temperature (5% to 30%), bloods, over exercising (85% to 90%), purging (75% to 85%) and self-harm behaviours (85% to 90%). However there had been reduction in the recording of BP/HR (80% to 50%), ECG (75% to 40%) and engagement with services (75% to 60%).

Overall, there's some improvement in assessment and management of ED cases but the standard remains inadequate. This project has helped understand the gaps in services and provisions available. Ongoing evaluation is required to help steer service development and optimise patient care.