High Dose Antipsychotic Therapy (HDAT) prescriptions and combinations of antipsychotic agents are not currently recommended as standard practice by the RCPsych. College guidance (RCPsych, CR 190) advises that there is “little convincing evidence that off-label prescription of doses of antipsychotic medication above the licensed dosage range has any therapeutic advantage in any clinical setting” and that “any prescription of high-dose antipsychotic medication should be seen as an explicit, time-limited individual trial with a distinct treatment target”. Despite this, both national and local data demonstrate that HDAT has continued to be used regularly across psychiatric inpatient settings, often out of hours and often secondary to the use of PRN Antipsychotics, without a clear treatment plan or rationale. My aim was to create a simple, accessible, online tool that would allow prescribers to quickly and efficiently calculate the BNF percentage of any antipsychotic prescription and that this will enable safer prescribing.

With the support of a web-developer, I developed an online tool quickly and easily calculate antipsychotic BNF percentages. The tool can be found here: www.hdat.co.uk

The HDAT Helper has been well received at local presentations and I have recently gained the support of senior management at Southern Health NHS Foundation Trust to develop an education programme on HDAT and the HDAT Helper to expand use of the tool across Southern Health.

The current expert guidance, clinical research and my own audit work demonstrates that there are ongoing issues with the prescription of high dose antipsychotics and that at times this occurs inadvertently when different agents are combined.

I believe that the HDAT Helper can make prescribing of antipsychotic agents clearer and more efficient and as a result significantly improve patient safety.

To determine whether there are any gaps in cardiometabolic monitoring within primary or secondary care for people prescribed antipsychotic medication. A well-established system of cardiometabolic monitoring and checks has been implemented for patients with psychosis and bipolar in secondary care. It was unclear whether patients without these diagnoses were receiving the same level of monitoring.

Data were collected retrospectively from case notes of service users under CMHRS Reigate. We included all patients from three GP practices (100 patients) and identified all who were prescribed antipsychotics and their diagnoses. The GP practices were contacted to determine whether a system was in place to flag physical health monitoring requirements for service users on antipsychotics regardless of diagnosis. The results were used to calculate the potential number of patients across the entire trust who were at risk of not receiving cardiometabolic monitoring.

24/100 patients were prescribed antipsychotics without a diagnosis of psychosis or bipolar. 11/24 had a diagnosis of Emotionally Unstable Personality Disorder. Quetiapine was the commonest antipsychotic. None received routine cardiometabolic monitoring.

The total caseload for all 11 adult community teams in the Trust is 2434. If prescribing and monitoring practices are similar 584 individuals may be affected.

2/3 GP practices responded. Both confirmed that they would only conduct cardiometabolic monitoring when taking over prescribing/on discharge from secondary care if specifically requested to do so.

This service improvement project has identified a significant group of patients who aren't automatically offered cardiometabolic monitoring in secondary care.

Private correspondence from Professor David Taylor confirms that these patients would also benefit from monitoring when prescribed doses that are more likely to cause adverse effects (Quetiapine > 150mg/Olanzapine >5 mg Risperidone >2mg)

Secondary services need to identify these patients and include them in routine cardiometabolic monitoring.

Secondary services need to work closely with primary care to ensure that responsibility for checks is agreed and handed over when necessary.

Background: The Driving & Vehicle Licensing Agency (DVLA) states: “Doctors and other healthcare professionals should: advise individuals on the impact of their medical condition for safe driving ability and also advise the individual on their legal requirement to notify DVLA of any relevant condition”. Within mental health, the guidance states that depression or anxiety associated with “Significant memory or concentration problems, agitation, behavioural disturbance or suicidal thoughts” must be reported to the DVLA. Aims: Identify whether information was collected on driving status of patients presenting with depression/anxiety and self harm. Identify whether accurate advice was provided and documented. Implement changes that would improve compliance with guidance.

We reviewed notes to collect baseline data for 3 weeks prior to commencing interventions, then weekly for 2 months from November 2021. Cases were defined as: those presenting to Liaison Psychiatry (LP) with an act of self-harm either on antidepressants or with a confirmed diagnosis of depression/anxiety on their record. Each week, the notes of 10 cases were reviewed for evidence of documentation of driving status and advice regarding DVLA guidelines.

Week 1: Email communication to team highlighting the guidance, responsibilities and where to document.

Week 2: Driving status discussed in handover daily to increase awareness and identify/address concerns.

Week 3: Repeat email to team.

Week 4: DVLA guidance posters placed in LP office.

Week 12: Teaching session by Occupational therapist from regional driving assessment centre.

Data were analysed for 90 patients over 9 weeks. 52% were female, and average age was 33 years. Relevant documentation was only made on week 1 (10%) and week 4 (20%). No documentation of either driving status or advice given were made in any of the other weeks analysed.

Achieving compliance with guidance was difficult. Email communication was the most effective intervention. A group discussion to identify drivers of poor compliance found that clinicians failed to ask as the questions were not routine practice, and some voiced concerns about the potential implications of advice (worsening therapeutic relationship or increasing social isolation/implications for employment). Future plans include adding a prompt about driving on the electronic risk assessment, and specific training in the staff induction.

Inpatient admissions during the COVID-19 pandemic went up in the regional unit by 18%. This included a 50% increase in Eating Disorder Presentations and more complex SMI requiring admission to Beechcroft. Beechcroft is the regional inpatient unit for CAMHS in Northern Ireland. This project aimed to improve staff joy in work by 30% by June 2021, following what was one of the most difficult years to be a health professional with the COVID-19 pandemic.

We used the IHI Joy in Work methodology along with our own rating scales in the inpatient unit.

Several PDSA cycles were carried out including focus groups, gathering baseline data from different wards, and our change ideas- Beechcroft stars nominations, Virtual Quizzes and Staff recognition certificates.

Baseline data on our run chart demonstrated a bad day median in Beechcroft with 4.3 being the score.

With the PSDA cycle we demonstrated a 33% improvement in good day scores with a median of 1.4.

We have learnt that Joy in work comes from recognising the work already being done and rewarding the efforts our staff go to.

Spread and scale with Beechcroft stars now part of fortnightly MDT meeting and management meeting. Also rolled out to a community mental health team.

Joy in Work comes from the team. Recognising the efforts of the team is central to this. In particular during a pandemic.

We sought to assess the degree, nature and impact of poor audio quality during ward rounds for individuals attending remotely using Microsoft Teams. We aimed to evaluate attendee experiences of audio quality against our expectation that due to the existing ward microphone system using a cardioid polar pickup pattern that attendees would have difficulty hearing all members of the multidisciplinary team, as well as the patient, gathered in the conference room. We also hypothesised that after switching to an omnidirectional sound recording system, we would observe an improvement in attendee satisfaction with audio quality during ward rounds.

Individuals who had remotely attended ward rounds at Lesney Ward, Oxleas NHS Trust between 01/11/21 and 01/01/22, mainly patient family members and community care co-ordinators, completed a digital feedback questionnaire regarding audio quality. There was no exclusion criteria. Data from Likert scale questions were analysed with descriptive statistical tests (mode and distribution of responses). As minimal demographic data were obtained, inferential statistical tests were not used. Qualitative data were analysed using thematic sorting based on prevalence of themes in the data.

Feedback was provided by three family members, one ward team member and six members of the community mental health team prior to the intervention. Pre-intervention feedback indicated high levels of dissatisfaction with 6/10 respondents reporting they were “dissatisfied” and 1/10 “very dissatisfied”. Only 3/10 of attendees reported being able to hear and understand all individuals physically present in the room. In addition, respondents agreed that the audio quality was poor (modal response “bad”, 6/10), and that the sound quality impacted upon their experience of the ward round (modal response “yes, greatly”, 6/10).

The three most common main issues reported by respondents were: people speaking too far from the microphone (7/10), voices sounding muffled (6/10), and too much background noise (4/10). Using their own words, respondents described how the ward round sound quality made them feel. Common themes identified through thematic sorting included: distress, difficulty in understanding information / management plan, ward round prolongation and inability to comprehend the patient or staff.

In conclusion, we found that when using an in-built laptop microphone with unidirectional pick-up remote ward round attendee satisfaction was poor, though this improved with the introduction of an omnidirectional system. Key areas for improvement include assessment of optimal positioning for adequate audio pick-up, and the introduction of automatic transcription for individuals with hearing impairments.

The aim of this QIP was to identify whether the information obtained during routine physical health reviews was being adequately handed over during discharge from the Sheffield Home Treatment Team within discharge summaries. Individuals with serious mental illness have a significantly higher all-cause mortality rate than those without, much of which is due to preventable physical health conditions. Due to this, the Home Treatment Team aims to complete a Physical Health Review (PHR) for every patient under their care as per guidelines. It is important that these examinations are performed, however, it is equally important that the results of PHRs are communicated to the patient's primary care physician upon discharge. Communication between services is vital for continuity of care and to ensure that identified problems are managed effectively. On discharge, relevant data from these investigations should be communicated to the service user's registered GP surgery for appropriate follow-up care. Performing investigations without informing the service user's primary physician is an inefficient use of resources and may result in unnecessary repeated investigations and procedures. There is not currently an official system in place to assure that the investigations and results of PHRs are summarised and communicated upon discharge.

There were two steps taken in this stage of the QIP. First, a questionnaire was distributed to all members of the Sheffield Home Treatment Team, including medics, nurses, and STR workers. The responses were compiled and analysed to form the criteria and standards for an audit of previous discharges. Following this, an audit was performed for the months of June-July 2021, data were kindly collected by junior doctors. This data looked to determine whether previous discharges met the criteria and standards set by the questionnaire.

The results of the audit showed that the discharges did not meet the standards set, with many containing little to no information. Only 49% of the service users with physical health reviews had any information provided on discharge. Of these, the contents of the summaries were varies and inconsistent, resulting in a significant amount of information becoming unavailable to the service user's GPs.

• 1. The current system is insufficient in terms of handing over physical health information collected during investigations performed by the Home Treatment Team.

• 2. A proposed solution will be implemented in the coming months.

• 3. A re-audit will be performed to complete the audit cycle and assess the efficacy of the proposed solution.

To reduce monthly bed days for children and young people (CYP) aged under 18 years admitted to adult psychiatric beds by 50%

QI tools used included driver diagram, stakeholder analyses, process mapping, ishikawa diagram, pareto chart and interviews with CYP and carers to gather qualitative data. Monthly data were collected on all admissions of CYP to adult mental health beds. Change ideas/ process changes included:

• • Early senior psychiatric CAMHS review for all CYP admitted to adult psychiatric beds (same or next working day)

• • Increased access to CAMHS medical records for out of hours staff

• • Admission of all appropriate under 16's to paediatric beds instead of adult mental health beds

• • Short test of change of staffing CAMHS specialist nurses over a weekend

• • Develop alternative non-health crisis support/bed for CYP

• • Develop Personality Disorder (PD) pathway

• • Early senior CAMHS psychiatric review was associated with a reduction in CYP admitted to adult mental health beds from a median of 20 days a month to 2 days a month without an associated increase in CAMHS inpatient admissions

• • Pareto chart showed that Personality Disorder (PD) was the commonest diagnosis

• • Access to CAMHS medical records for all out of hours psychiatric medical staff was increased from 13% to 100%

• • Routine admission to paediatrics for all under 16's was agreed with paediatric medical and nursing managers but not sustainably implemented

• • There were no acute referrals to the CAMHS specialist nurses over the single weekend short test of change

• • Development of an alternative non-health crisis support/bed and development of a Personality Disorder (PD) pathway is still in process

The primary outcome measure was successfully met with the median bed days of CYP admitted to adult mental health beds sustainably reduced from a median of 20 days to 2 days. This was associated with the implementation of routine early senior psychiatric CAMHS review and increased access to CAMHS health records for all medical staff providing psychiatric out of hours assessments. The change ideas including development of different admission pathways (paediatrics and non-health crisis bed), weekend CAMHS specialist nurses service and development of a personality disorder pathway were not implemented sustainably. The pathways of care around CYP presenting in crisis are complex. Making sustainable improvements in complex adaptive systems is complex and challenging but not impossible.

To establish a baseline of staff experience and confidence in autism/LD. To inform how we deliver training going forward. To collect good practice examples of reasonable adjustments. To ascertain knowledge about the appropriate recording for information related to Autism/LD

All clinical and non-clinical staff of Leeds &York Partnership Foundation Trust(LYPFT), Bradford District Care Foundation Trust(BDCFT), South West Yorkshire Foundation Trust(SWYFT), Voluntary sectors, Local authority and Leeds Community Health Care NHS Trust (LCH)were invited to take part in the anonymised “Staff Autism and LD Survey” through the various trust wide email bulletins. Smart Survey was the platform used. It took about 5–7 minutes to complete, and the survey period was from 21/09/21 to 01/11/21

A total of 225 members of staff across six organisations took part in the survey.

76% (170) were from LYPFT, 16(7%) from Voluntary Sector Organisations, 6%(14) from Local Authority and 3% from LCH 3%(7), Missing 14(6%), BDCFT 1%(2), SWYPFT 1%(2)

The majority were nurses 23% (52), followed by psychologists 10% (22).

18% (41) stated they would be interested in becoming an autism champion for their team/service.

Although 89% (200) had heard of the term “reasonable adjustments”, 36% (81) had never seen a ‘hospital passport’ for an autistic or learning-disabled service user.

Only 24 (11%) said they knew where to record reasonable adjustments on the electronic patient record

In general staff were marginally more confident in making reasonable adjustments for people with autism than those with LD

Majority of staff preferred : face-to-face training, followed by e-learning and then videocall.

Generally, respondents reported feeling neutral or confident with respect to their confidence in recognising, diagnosing, and working with patients with autism. The number of staff that have indicated interest at becoming Autism champions is a testament to the growing interest and increasing awareness about Autism.

Regarding learning disability, respondents generally reported feeling neutral or confident across the three areas of recognising moderate to severe learning disability, recognising mild learning disability, and managing/treating mental health problems in service users with learning disability.

The very high number of staff (89%) that have heard of the term “reasonable adjustments” is quite commendable and is useful to know when planning what level to ‘pitch’ training in this area.

It is interesting however that staff feel more confident at making reasonable adjustments for people with Autism, rather than for LD. One wonders whether it is due to the increasing media publicity about Autism.

The paediatric wards support many children presenting with psychosocial crises. This has been increasing in recent years. NICE quality standards recommend that children who have self-harmed receive: a comprehensive psychosocial assessment, are assessed within 24 hours of referral if at high risk of suicide, a collaboratively developed risk management plan and monitoring to reduce risk of further self-harm. We aim to measure the number of referrals made by hospitals for acute psychiatric presentations and the adherence to the above quality standards by the Service for Adolescent and Families in Enfield.

We retrospectively audited inpatients referred by North Middlesex hospital and Barnet hospital. Referral data were collected over 5 years. Data collected between April 2018 and March 2019 were evaluated to review good practice and adherence to the NICE quality standards. For each patient, we collected data on whether they have had a comprehensive psychosocial assessment, if the assessment was completed within 24 hours, 7-day follow-up review and a documented risk assessment.

There has been a 141% increase in hospital referrals to the service from 2014/15 to 2018/19. The service had 130 referrals between April 2018 and March 2019. 72% of referrals came from North Middlesex hospital and 28% were from Barnet hospital. Ages were between 5 and 18. Girls formed 74% of all presentations. 87% of patients presented with deliberate self-harm, suicidal ideation or suicide attempt. Of all referrals 100% had a comprehensive psychosocial assessment, 93% were seen within 24 hours of being referred, 97% had a documented risk assessment and 92% had a 7-day follow-up review.

Self-harm and suicidal ideation in children are rising, especially among girls aged 13 to 16 years (increased by 68% between 2011 and 2014). The gender inequality in our referrals further supports these findings. Higher rates of self-harm have been shown in more deprived areas and could be associated with gang involvement, bullying, abuse, gender identity and family issues. We have developed an assessment protocol and safety plan, are liaising with hospitals daily to arrange assessments and follow-up. Paediatric nurses have been trained in the time to talk programme and a full-time crisis liaison nurse has been employed. This will be re-audited to measure effectiveness of interventions.

To ensure an appropriate treatment pathway is available to patients diagnosed with Depression a STEPPED care model where different types of intervention are offered depending on the patient's experienced severity of Depression. However, a great percentage of patients continue to experience disabling symptoms and fall into the Treatment Resistant Depression (TRD) category. There was a need to review the options available within local Mental Health Services (MHS) for the treatment of patients with depression and TRD.

A new clinical pathway was designed to provide access to patients to emerging treatments, such as EsKetamine, Vagal Nerve Stimulation (VNS) and repetitive Transcranial Magnetic Stimulation (rTMS). After calculating the local impact of depression to patients, trust resources and society we extrapolated our calculations to neighbouring Trusts covering the South West. A newly developed business plan demonstrating the need for new treatment options and the benefits, financial and otherwise, was presented and underwent various approvals levels by the Trust Governance and Executive Committees and local commissioning groups, before being able to proceed. Within the original business plan, rTMS and VNS were offered in addition to the existing ECT as parts of a new treatment pathway. We are now in the process of incorporating EsKetamine and Transcranial Direct Current Stimulation (tDCS). The clinic was set up in March 2020, just at the beginning of the pandemic, which halted operations for quite a few months before being able to resume recently

We have managed to treat patients with both VNS and rTMS from our Trust, as well from surrounding areas. Patients have already experienced benefits in the recovery from symptoms. The new service has provided another line of support for colleagues in offering bespoke treatment plans to their patients and patients have appreciated having access to new non-traditional treatment options.

Although there has been a primary result in improving patient care, income generation is also possible by positioning the Trust in the forefront of new therapeutics and allowing the provision of service to expand to neighbouring Trusts and private patients. Other benefits are associated with the Trust's reputations and kudos being enhanced and include the forging of new pathways within the developing alliance with General Hospitals, increased ‘visibility’ for training and research opportunities, improved patient satisfaction and improved CQC standing.

This quality improvement project aimed to introduce a staff communication tool, ‘the morning huddle’, to Goddington ward (Green Parks House, Oxleas NHS Foundation Trust). The huddle's purpose was to share key information between members of the ward's multidisciplinary team (MDT) regarding patient risk, diagnosis, mental state and treatment progress.

The project team worked with the Oxleas Quality Improvement (QI) team to create a structured huddle with agreed goals that commenced at 9am each morning. The team sought views from ward staff on the existing communication process before implementing the huddle via a series of weekly questionnaires. The morning huddle was introduced on 26th May 2020 and all members of the team were invited (including the ward consultant, junior doctors, ward manager, nursing staff, healthcare assistants, psychologists, occupational therapist, and ward administrator).

Following multiple PDSA (Plan, Do, Study, Act) cycles, the team further refined the morning huddle into a meeting with a set template that included COVID-19 test results, psychiatric risk concerns, medication adherence, and barriers to discharge. The project team also timed the huddle, aiming for it to last a maximum of 30 minutes. A questionnaire was distributed to ward staff weekly after the huddle was implemented to ascertain their views on the process. Data collection for the project ended on 2nd August 2020.

The project's main outcomes were based on two questions from the weekly staff questionnaire:

1. “How effective did staff members find the morning huddle in addressing their concerns about patients and promoting safety of patients and staff?”

This improved over the course of the project, starting with 20% of staff finding the huddle “good” or “very good” in its effectiveness to 77% finding it “good” or “very good” in the final questionnaire.

2. “How effectively do staff feel that their concerns about patients are addressed by the rest of the team?”

This also improved, starting with 40% of staff selecting “well” or “very well” to 100% in the final questionnaire.

Goddington ward introduced a huddle that was valued by the entire MDT. The huddle improved how well staff felt their concerns about patients were addressed and a noticeable improvement in team morale was observed. While the project succeeded in implementing a huddle that staff appreciated, patient outcomes also need to be considered in future

Evidence suggests that individuals with serious mental illness (SMI) die up to twenty years prematurely compared to the average population without SMI with the main causes of death linked to preventable cardiovascular disease, respiratory failure, and endocrine disorders. This early mortality remains despite national efforts to recognise the issue and promote development of processes to enhance quality of physical health care in patients with SMI. The National Institute for Health and Care Excellence (NICE) clinical guidelines (CG178) recommendation 1.5.3.5 states that healthcare professionals in secondary care should ensure individuals with SMI receive physical health checks from primary care. This idea may be suitable for patients in the community setting or those who undergo shorter hospital admissions, however the process of psychiatric rehabilitation in secure mental health hospitals is challenged by long average stays resulting in no access to routine primary care facilities. The aim of the project is to introduce tailored measures that would aid in delivering high quality physical health care to patients within secure mental health hospitals.

Ravenswood House Medium Secure Hospital supported a project to improve the physical health of individuals with SMI. An audit was completed to evaluate the assessment and management of baseline physical health measures that would have usually been completed in primary care as per the standards set out in NICE guidelines. The results showed that not all measures were being met and there was room for improvement.

Based on these NICE recommendations, an annual health check template and a centralised documentation toolkit were implemented and integrated within a new Physical Health Care Pathway in collaboration with General Practitioners, Dentists, Physiotherapists and other Allied Healthcare professionals.

Following implementation of the Physical Health Care Pathway, the number and quality of annual physical health checks in Ravenswood House Medium Secure Hospital increased resulting in significantly better-quality outcomes for patients by completing appropriate referrals and follow-up care.

This collaborative approach of providing a high-quality physical health care was delivered in-house by arrangement with external healthcare practitioners. This pathway of providing care assisted us in overcoming several challenges faced within secure hospitals due to legal sanctions and related security protocols involving the patient group.

A quality improvement project was undertaken to counteract obesity in patients with mental health morbidity. The exponential trend of increased antidepressant prescribing (SSRI, SNRI and anti-psychotic medication) has created a trend towards weight gain in patients. An audit of the Serious Mental Illness (SMI) register and depression registers was conducted in a population of 591 patients. Those patients identified as obese were offered referral to the local authority weight management services.

Patients have a body weight and BMI calculation with their twice yearly mental health and medication review and those whose BMI met the obesity criteria were offered referral to the local authority for 12 weeks weight management services.

Of the SMI and depression register 189 (32%) patients met the criteria for referral to the weight management program. Of these 154 (81%) patients accepted the local NHS weight management program, 35 (18%) of patients declined the NHS weight management program.

Weight gain is a known side effect of antidepressant medication SSRI and SNRIs and Anti psychotic medication resulting in increased risk of obesity and cardiovascular and metabolic disease. The QI program was undertaken to counteract these changes with referral to weight management services to address the weight gain the patients were experiencing.

This quality improvement service was done to help patients across three surgeries lose weight in an effective and educational manner. We found a high rate of acceptability of referral to weight management services when offered as patients themselves were aware of the weight gain. A review of positive changes in the BMI after referral to the weight management program will be undertaken at 6 and 12 months to evaluate its acceptability and effectiveness. We advocate sensitive counselling of the risks of weight gain and regular monitoring of body weight throughout the span of the prescribing of these weight gaining agents.

1. To assess quality of VTE risk assessment and recording; particularly to look at the impact of COVID-19 on VTE (Venous Thrombo-embolism). 2. To ensure VTE criteria have been adhered to from Tees, Esk and Wear Valleys NHS foundation trust 2019 ” Risk assessment for Venous Thromboembolism (VTE) (Ref: CLIN-0085-v 1.2)Specifically, due to additional risks posed by COVID-19 on increase in risk of VTE.

The Audit was conducted in Secure inpatient service in Teesside, Roseberry Park Hospital, TEWV NHS trust audit team.

This was done on the back of a scheduled Quality improvement reaudit of VTE risk assessment and recording review in Forensic SIS.

One of the main results was that VTE risk assessment and recording, post finding of a COVID-19 positive result was less than 100% in the records we checked. Other results are included in the poster.

The main conclusion is the need for increased vigilance in assessment and recording of (and any actions thereof) in the VTE risks, particularly in those with COVID-19 positive tests.

We propose that this increased vigilance will enhance patient safety and deliver effective and timely care. We highlight some challenges of conducting an Audit and how to embed results and improve practices in a timely manner. This describes how we did both- acted on results and followed process; rather than just one or the other!

To reduce incidents of inpatient violence and aggression at Nile Ward Psychiatric Intensive Care Unit (PICU), St Charles Hospital by at least 30% between December 2019 and December 2021. Reducing inpatient violence is a major quality improvement (QI) priority for CNWL NHS Foundation Trust.

Nile Ward refined a number of their successful change ideas within this project and a number of new innovative ideas were tested and successfully implemented as part of the Violence Reduction QI Project:

1. 1. Improved risk assessment tool: Risk assessment tool to predict/manage violence in the ward was further improved using evidence based observation and best practice recommendations over the course of 2021.

2. 2. Brand new Staff Photo Board: Regularly updated photoboard with non-hierachical list of all staff.

3. 3. Patient Feedback Board: Patient experience, comments and feedback displayed in common areas.

4. 4. Co-produced Mutual Expectations: A set of expectations created in co-production with patients displayed in the communal areas of the ward to be followed by both staff and patients.

5. 5. Gardening sessions: A safe socially distanced space for patients to be involved in growing and caring for the Nile Ward garden with our Activities Coordinator, including a brand new herb garden.

6. 6. Tailored Physical Fitness Programmes: Focus on physical activity through garden fitness sessions and 1–1 fitness sessions in the gym. Average weight gain for patients has declined from 4.4 kg to 2.8 kg (39% reduction) during hospital stay. Tailored physical fitness sessions created for patients who are frail, diabetic or have significant cardiometabolic risk factors.

7. 7. Celebrating Diversity: Special events hosted throughout the year to celebrate diversity and promote tolerance.

8. 8. Enhanced Clinical Reviews: Consultant led patient reviews every weekday to optimise treatment and enable quick recovery using a multidisciplinary, holistic, trauma informed approach.

9. 9. Weekly Cooking Sessions: Patient led cooking sessions using healthy ingredients every week. The food is eaten as a communal meal by patients and staff. A ‘Friday Fry-Up’ takes place monthly where patients and staff share a health fry-up in the ward's dining area.

10. 10. Mindfulness Meditation: A QI intervention introduced to embed mindfulness and meditation as core therapeutic intervention to improve emotional regulation and to reduce violence.

11. 11. Triangle of Care: Carers strongly encouraged to attend ward rounds and care planning from the very beginning of a patient's journey at Nile Ward using a triangle of care approach.

Between December 2019 - December 2020, Nile Ward reduced violence in the ward by 35% and the MDT continued to make further innovations to reduce violence further, as demonstrated in this poster.

Between December 2020 - December 2021, Nile Ward reduced violence in the ward by 51%.

Further details about the results will be published in the poster.

Nile Ward has successfully implemented innovative interventions using a QI methodology to successfully reduce the level of violence and serious incidents in the ward by 51%. The number of rapid tranquillisations and use of restrictive interventions such as restraints has reduced significantly. Our patients are able to recover in a safe environment and their feedback is testament to their positive patient experience during their inpatient stay. Reduced verbal and physical assaults on staff have improved staff confidence, retention, well-being and overall satisfaction. Our work has been recognised internationally through the delivery of keynote presentations at conferences National Association of Intensive Care Unit (NAPICU) National Conference 2021 & the Royal College of Psychiatrists National QNPICU Conference 2021 to discuss their Violence Reduction best practices with mental health teams in the United Kingdom and abroad.

To measure rates of racism experienced and witnessed by Junior Doctors working at Derbyshire Healthcare NHS Foundation Trust.

Surveys were sent out via e-mail and WhatsApp to all Junior Doctors from 22 November 2021 to 1 December 2021.

Questions asked about personal experiences of racism, witnessing racism to/from patients and/or staff whilst working in Derbyshire, knowledge of how to report incidents and if routinely reported. Doctor race and gender recorded.

88 Junior Doctors contacted. Response rate 55% (48 out of 88). 63% female, 35% male and 2% gender undisclosed. 37.5% White, 12.5% Black, 37.5% Asian, 6.3% Mixed-race, 4.2% Arab or other ethnic group and 2% Race undisclosed. 13% of doctors experienced racism from staff: 75% of the Black female population, 50% of the Black male population, 8% of the Asian female population and 17% of the Asian male population. 27% of doctors experienced racism from patients: 50% Black female population, 50% Black male population, 58% Asian female population, 16% Asian male population, 100% Mixed-race female population and 1 Race unspecified male. 13% of doctors witnessed racism from staff to other staff: 75% Black female population, 50% Black male population, 11% Asian female population and 16% Asian male population. 63% of doctors witnessed racism from patients towards staff: 75% Black female population, 50% Black male population, 67% Asian female population, 33% Asian male population, 100% of the Mixed-race population, 58% White female population, 83% of the White male population and by 1 male Race unspecified. Two reports of racism witnessed from staff towards patients. 50% of doctors do not know how to report racism. 54% of doctors would report racism if they knew how.

Black, Asian, and Minority Ethnic (BAME) Junior Doctors are disproportionately affected by racism with female gender as an additional vulnerability. Mixed-race females, Asian females, and Black doctors gave highest reported experience of racism from patients. Black doctors gave a higher reported experience of racism from staff and reported witnessing the most racism from staff towards other staff. Mixed-race and White male doctors represent a high number of those that witness patients be racist towards staff. Additional support is required in encouraging allyship, confidence and ability to report racism.

Patients with Functional Neurological Disorder (FND) often endure low quality of life. Understanding the diagnosis is critical to management, but patients with FND do not always receive appropriate information about their condition. The patient journey through healthcare services can be complex, with often long waits for specialist attention. Creating psychoeducation resources for patients is important to improve patient experience and outcomes. We developed a symptom self-management patient education booklet with an FND symptom recording template, using a co-production model, in a community neuropsychiatry setting.

We used co-production as part of a quality improvement project (QIP) at East Kent Neuropsychiatry Service, to produce a patient education booklet with symptom self-management information and a symptom recording template. The QIP cycle involved input from 11 participants. Initially, 3 medical students and 4 multi-disciplinary team members adapted an existing booklet, removing medical jargon and simplifying diagrams. The adapted booklet was distributed to patients with FND who were attending psychoeducation/Cognitive Behavioural Therapy group sessions. One week later, four patients discussed the booklet with a medical student facilitator; both quantitative and qualitative feedback was obtained. Feedback was gathered using an adapted 20 point Ensuring Quality of Information for Patients (EQIP) tool. Patient responses were recorded, and qualitative themes identified.

Four themes were found from qualitative feedback during co-production: need for a glossary; an expanded resource list; more diagrams to simplify text; and for the booklet to also address family, friends, and carers. The EQIP questionnaire feedback emphasised that the booklet contained too much medical jargon and that it didn't personally address the reader. On average patients scored the booklet 53.33% using the EQIP questionnaire.

The booklet was further adapted and a glossary, further diagrams and a section addressing family, friends, and carers was added. Further resources were added and the text was simplified for clarity.

This QIP shows the value of co-producing information for an underserved patient population. Patient psychoeducation is a key part of treatment; involving patients at an early stage of the development of information and self-management tools will increase their acceptability to patients and improve the accessibility of patient psychoeducation.

Clinical Team Meetings (CTM) are weekly multidisciplinary (MDT) meetings to review and discuss patients’ clinical care at Reaside Clinic, a medium secure inpatient forensic unit. Last year, there were significant difficulties in releasing nurses from ward duties to attend CTM, with effects on CTM efficiency and patients’ involvement and satisfaction in care. Furthermore, a hospital ‘protected mealtimes’ deadline commencing at 1230 meant additional pressure and further impacted patient attendance when meetings overran. The MDT (comprising doctors, nurses, psychologists, occupational therapists, pharmacists and admin staff) worked together to generate solutions, formulating a QI project to try to make improvements. Three primer drivers were: increasing patient satisfaction, increasing staff participation and increasing CTM efficiency.

The MDT generated multiple change ideas to test to improve CTM experience and outcomes. Actions implemented included review of timetabling of patients to ensure adequate timekeeping and ensuring availability of attending ward staff, defining patient expectations from CTM through increased communication, and seeking patient feedback on satisfaction or engagement after each CTM through anonymous questionnaires. Data were collected at CTMs from February to April 2022, retrospectively compared to reference data collected before QI actions were implemented. A Microsoft OneDrive document was shared between the MDT to ensure accurate data collection, with information collected on CTM finish time, number of patients offered to attend, number of patients who did attend and anonymous patient satisfaction feedback from questionnaires.

Early indications show improvement in meeting timelines and increased staff satisfaction with the CTM process, with data collection ongoing. Baseline results from September 2021 show an average of only 2 of between 13–15 patients attending weekly, in addition to finishing beyond the 1230 target on almost all occasions. Anecdotal evidence from the MDT showed poor patient satisfaction and engagement with the process before QI changes were implemented. Full results will be available by the time of presentation; currently, an average of 4 patients have attended CTM each week with all sessions finishing on time since implementation of changes.

Patient involvement in care and person-centred care are key to improving engagement and satisfaction with inpatient psychiatric management in forensic settings. Targeted multiple change ideas implemented by the MDT through this QI aim to improve patient satisfaction through enabling increased opportunity to attend weekly CTM, with modifications to the CTM process from key staff. Preliminary results show increased opportunity of patients to attend CTM, increased staff and patient satisfaction, and increased CTM efficiency.

Adolescence represents a critical life stage in which there is rapid physical, cognitive and psychosocial development. It is the time where the patterns and foundations for future health are laid and thus presents a unique opportunity to promote health and subsequently improve life-long well-being and reduce health inequalities. Mental health problems represent the greatest contributors to disease burden for this population and this contribution is forecast to rise. The World Health Organisation state that adolescents and young adults (AYAs) need health services that are supportive, equitable and effective. The project aims to scope out Adolescent care at London North West University Healthcare NHS Trust (LNWH) with a view to improve quality of care for this group of patients.

Quantitative data obtained assessed patterns of presentation to the Emergency department (ED). Qualitative data were obtained through stakeholders Interviews with professionals, adolescent patients and their caregivers. As of January 2022, 113 stakeholders were interviewed. The data obtained informed the creation of the ‘LNWH AYA Manifesto.’ This was converted into a questionnaire for all professionals involved in the care of AYA patients to assess organisational culture around AYA Care.

It was found that AYA care at LNWH lies across a complex cross-sector system. The commonest code for presentation to the ED for those ages 13 to 25 was ‘depressive disorder’. Key themes from stakeholder interviews included: 1) AYAs are not always provided with age-appropriate care 2) Acute Trusts may serve as a catalyst for change for AYA patients and Youth workers may be better placed to connect with them 3) There is a need for an integrated approach to physical and mental health with better relationships needed between the Acute teams and CAMHS. The ‘LNWH AYA Manifesto’ questionnaire found disparate opinions regarding the approach to integrated physical and mental health; of the 34 responses obtained 23.5% reported not feeling confident with recognising and managing mental health and social issues in AYAs and 41.1% believed that physical and mental health problems should be addressed separately by the relevant specialties.

AYA care lies across a complex cross-sector system and thus requires a multifactorial approach to create a culture change towards prioritising this population. One such intervention proposed is the introduction of a Youth Worker outreach model similar to the King's Adolescent Outreach Service as a way to create a shift towards an integrated approach to physical and mental health care.

Childhood and adolescence is a time in which the patterns and foundations for future health are laid. The World Health Organisation advocate for providing opportunities for children and young people (CYP) to meaningfully participate in the design and delivery of services. Co-production, in which professionals and citizens collaborate together in an equal partnership, is recommended as an approach to achieve this and is linked to better community relations. Few co-production models exist that are specific to CYP and address the relevant practical and ethical challenges. We propose a new framework which can be used by organisations wishing to engage in meaningful collaboration with CYP.

To create a model for co-production with consideration of the specific needs of CYP.

The following methodology was used:

1. i) Identification of common themes from ten existing co-production frameworks

2. ii) Detailed analysis of three co-production frameworks with reference to CYP

3. iii) Identification of key issues from critique of the literature

The key themes incorporated into the model using the above methodology were as follows: Purpose, Assets, Capabilities, Reciprocity, Networks and Relationships, Power, Catalysts, Diversity and Inclusion and Safety and Protection. This co-production framework can be used by organisations that wish to meaningfully collaborate with CYP and assess the depth of co-production of their initiatives.

The new model takes into account the socio-cultural challenges that must be considered when co-producing with CYP including power relations, safety and diversity and inclusion. We advocate for the model being tested, validated and further developed ideally with the collaboration of CYP.