A Quality Improvement project was conducted in Ty Llidiard, a 15-bed adolescent unit in South Wales, over a three-month period to introduce and embed outcome measurement from the perspective of young people (YP) admitted to the unit. This was done to meet two standards set by Quality Network for Inpatient CAMHS: 1. “Outcome measurement tools are completed from the perspective of young people”, 2. “The ward team use quality improvement methods to work on service improvements.” Through use of these measures we hoped to give the YP a stronger voice in the multidisciplinary ward round (MDT-WR) and to improve their experience of attending it.

A validated patient-rated outcome measure (PROM) and experience measure (PREM) were chosen and adapted in co-production with the YP on the ward. The measures were selected on the basis of being quickly and easily understood and completed. The PROM provided useful ratings in key areas (“school”, “home”, “family”, “me”) and the PREM measured how patients experienced attending the MDT-WR. Outcomes and completion rate of these measures were audited weekly for three months, and several Plan-Do-Study-Act (PDSA) cycles were completed to increase their usage and to improve the YP's experience of attending their MDT-WR.

From an initial baseline of 0% we achieved a maximum of 50% of YP on the ward completing a PROM each week, and a maximum of 100% of YP who attended MDT-WR completing a PREM. Three PDSA cycles improved our completion rate. PROM ratings were used as part of the clinical discussion in MDT-WR each week. Not all YP were well enough to complete it, but for those who were its clinical usefulness (and especially comparing scores in consecutive weeks) was reported in clinician feedback. PREM scores were presented and discussed a number of times in ward improvement meetings and management meetings and four PDSA cycles completed which incrementally increased the PREM average weekly scores.

We were successful in introducing and then increasing the completion rate of patient rated measures. Through use of the PREM we were able to make changes to the ward round and demonstrate the subsequent improvements to the experience of the patients attending. We have demonstrated that outcome measurement from the perspective of YP can contribute usefully to the MDT-WR and can improve YP's experience of the service. Use of these measures will continue as standard practice on our unit and could contribute usefully in future service evaluation projects.

The Advancing Mental Health Equality Collaborative is an innovative 3-year quality improvement programme led by the Royal College of Psychiatrists’ National Collaborating Centre for Mental Health (NCCMH). The collaborative was launched in July 2021 and involves 18 organisations across the UK who, with quality improvement support from the NCCMH, are working to understand the needs of their population and identify communities at risk of experiencing inequality to improve access, experience and outcomes of mental health care, support, and treatment for those populations.

An overarching driver diagram for the Collaborative was developed in collaboration with a wide range of stakeholders through steering group meetings, design workshops and remote consultation. This overarching driver diagram informs the development of population-specific driver diagrams, based on the population segments organisations selected to focus on. Each organisation was allocated an experienced quality improvement coach who supports them to apply a quality improvement approach to plan and deliver their projects, including support to generate insights based on data, staff and community engagement, carry out assets mapping, develop the project's aim and key drivers organisations need to work towards, identify measures, generate change ideas to be tested, and sustain successful changes.

Members of organisations taking part also attend quarterly learning sets where they come together to network, share challenges and ideas, and learn from each other.

Populations identified by organisations include children and young people; Black, Asian and Ethnic minority men aged 18+ years; carer population; neurodivergent individuals with comorbid mental health diagnoses; Muslim women/Black women; refugees and forced migrants; women military veterans in Greater Manchester and Lancashire; Bangladeshi and Pakistani men and women in Oldham; Traveller community in Somerset. A number of initiatives are being tested by teams to improve access, experience and outcomes of mental health care, support, and treatment for these populations, such as offering mental health awareness sessions for refugees in a range of languages.

Addressing inequality in mental health care is a long and complex process. The AMHE collaborative is supporting teams to take an innovative approach to tackle this issue, by ensuring their projects are fully co-produced with those affected by inequality. This includes engaging representatives from the communities they are trying to improve access, experience and outcomes for in all aspects of their quality improvement projects; from design to generating ideas to test, and ensuring they measure what is important to these communities to determine whether improvements have been made.

The Specialist Adolescent Mental Health Service at the Maudsley Hospital provides multi-disciplinary mental health care to adolescents in London. There is currently no policy by which non-medical members of the multi-disciplinary team can request a psychiatric review for their patients. Staff feedback revealed problems with the medical review referral process to be a lack of clarity on how to make referrals, and a lack of transparency (e.g. referral outcome, approximate waiting time).This projected aimed to improve the clarity of the process for requesting psychiatric reviews and to develop skills in leadership as a future child psychiatrist.

We designed and introduced a referral form and integrated waiting list. Next we developed a policy document for making referrals. Finally we modified the referral form so that when submitted, it automatically updated the integrated waiting list. At the outset and after each intervention we resurveyed the staff.

At the outset 71% of staff reported finding the process somewhat unclear, while 29% reported finding the referral process neither clear nor unclear. Following the final change 100% staff each reported finding the process very clear or somewhat clear.

The changes we implemented resulted in a clearer and more transparent referral process for medical reviews. We anticipate that this improved staff satisfaction will equally translate into some benefits for patient care, such as more clarity around when a medical review can be expected and what it might entail.

We aimed to arrange the local Postgraduate teaching in psychiatry as per the Deanery requirement/ HEIW requirement. We aim to achieve a better target with regard to local teaching as noted from the previous year's GMC trainee survey

The project started in 2019. 3 sets of audits and PDSA's were done- one each year, before the final PDSA. During these 3 audits, only non-consultants were participants.

During the 4th PDSA, in 2022-2023, a purposive sample was selected to provide the best information possible for the audit. It included Consultant Psychiatrists from all three sites in North Wales, Trainees( Junior/ Senior), SHO, speciality doctors, FY2, GP trainees and Clinical fellows. The criteria for participation were that the doctors should be working in Psychiatry and should have attended the local postgraduate programme. Access to the internet and appropriate device was mandatory as an add-on availability.

An online questionnaire was emailed to the participants. There were only 3 questions for the Consultants and 5 for the non Consultants’ group. 2 weeks window was offered to fill out the forms.

The 3 audits done initially revealed that consistent formal teaching was not provided. The candidates also found the current programme not fulfilling the criteria laid by the deanery and that their educational needs were neglected. The summary of the old audits suggested that the teaching had worsened eventually.

The final PDSA was done in 2022-2023. The overall time to fill out the form was 1.43 minutes. An equal number of Consultants and Non-consultants filled out the form. 31 Consultants rated the new programme as 4.23 for 5. The 31 non-consultants rated the programme 3.68 out of 4 and 95% identified that the new postgraduate programme covered the core trainees' requirements as per the MRCPsych Handbook from the Deanery.

Prioritisation of the most important facilitators and identification of ‘easy wins’ are important steps in this process.

The purpose of this study was to develop a national expert group consensus amongst a range of relevant stakeholders; senior doctors, residents, patients, allied healthcare professionals and healthcare managers allowing us to;

1. 1. identify important barriers and facilitators of learning in clinical environments and

2. 2. indicate priority areas for improvement. Our overarching objective was to provide information to guide policymakers and those tasked with the delivery of graduate medical education in tackling the provision of high-quality clinical learning environments in challenging time

Effective handover is a vital aspect of patient safety and continuity of care. On-call junior doctors (the Duty Doctor) in psychiatry inpatient wards in University Hospital Hairmyres (UHH) and University Hospital Wishaw (UHW) use an electronic handover tool (e-handover) to supplement handover. This lists outstanding jobs and information to be aware of. This project aimed to improve the handover process by making amendments to the e-handover.

A Plan, Do, See, Act (PDSA) cycle structured the project. An electronic survey was sent to all 30 Duty Doctors. This contained a Likert scale, 1 being negative and 10 being positive, to rate the handover process, alongside space for free text comments to be given. Thematic analysis identified common themes within these comments.

Changes were implemented in response to the survey findings. Space was added to the e-handover for each patient's care team (parent team), as well as their contact details. The Duty Doctors were informed of the changes and a post-intervention survey was sent six weeks later.

There was a total of 22 responses (73.3%) to the pre-intervention survey. Themes identified from the free text comments included: Organisation of tasks; Ease of use; Reliability; Inappropriate use; Technical issues; Handover update; Task information and Ward information. The most common theme was inappropriate use of e-handover. It was identified that tasks were being added to the e-handover that would be more appropriately actioned by the parent team.

There was a total of 12 responses (40%) to the post-intervention survey. A demonstrable improvement in the rating of the handover process was found. Free text comments showed that the changes made were helpful. Common themes were identified from the comments. One theme was ‘Missing information’, which included a lack of clarity on the date a job was added to the e-handover. Future changes could include adding space to the e-handover for this information.

Following the adjustments made to the e-handover there was an improvement in the satisfaction amongst the Duty Doctors.

One limitation identified was the lower response rate for the post intervention survey. We postulated that this was due to the survey being distributed when junior doctors changed clinical rotations and left the Duty Doctor role. This could be considered for future improvement cycles.

Additionally, free text comments from the post intervention survey could be utilised to inform future improvements.

The purpose of this QI project was to assess risk of CVD (cardiovascular disease) in adults with SMI (severe mental illness) admitted to acute psychiatric ward as risk can be reduced by relevant changes in lifestyle, optimizing treatment of relevant comorbidities, and by drug treatment, if appropriate. Nice guidelines for CVD risk assessment and management were followed for those with CVD risk of 10% or more.

This QI project focused on patients with a diagnosis of severe mental illness admitted to ward Ty Cyfannol, YYF hospital, ABUHB in South Wales from 1st April 2021 to 30th November 2021. QRISK®3-2018 risk calculator used to estimate risk of cardiovascular disease. Patients younger than 25 years old at the time of QI project were excluded as QRISK tool is only valid for patients aged 25–84 years. Patients who already had a diagnosis of Ischaemic heart disease or stroke/transient ischaemic attack were also excluded as per criteria of QRISK3. Total number of patients included in this project was 43 patients. Data were collected from patients’ medical records including their weights, heights, routine physical examinations and laboratory investigations requested during their admission. In order to maintain anonymity, patients were assigned to their hospital number. This information was saved in a password protected Excel Spreadsheet.

The mean age of patients was 43.3 ± 11.06 years ranging from 25-69 years. Most patients were males (65.1 %). Schizophrenia was the most prevalent diagnosis (32.5%) followed by emotionally unstable personality disorder (18.6%). 72% out of total 43 patients were smokers. The mean BMI was 23.6 ranging from 17 to 31. 41.9% had their BMI ≥ 25, 8 patients out of those with BMI equal to or higher than 25 scored 10 or more on QRISK3. 13 (30.2%) patients were estimated to have high CVD risk using QRISK3 assessment tool, of whom 76.7% (n=10) aged 55 years or more. 69.2% (n=9) were current smokers, 23% (n=3) were diabetic and 15.2% (n=2) had hypertension.

The findings of this project conform the consensus that people with SMI are at a higher risk of having CVD. Therefore, this should emphasize the importance to assess CVD risk in patients with SMI and to manage modifiable risk factors accordingly and to incorporate the assessment of cardiovascular risk in patients with severe mental illness in day-to-day practice in mental health inpatient units.

Experiencing the death of a patient by suicide can be incredibly difficult, often associated with feelings of guilt and isolation, as doctors can hold themselves responsible. Most psychiatrists will be involved in a suicide/homicide on at least one occasion. This can lead to a variety of emotions and impact on clinical practice. The process of investigation can add to the overall stress of the incident and exacerbate the fear of legal retribution. Lack of support and understanding by an organisation may result in fewer discharges and increased defensive practice. Aimed at reviewing how supported involved clinicians feel following a serious untoward incident (SUI), including a suicide/homicide and consider improvement methods.

A webinar was organised with a guest speaker from Royal College of Psychiatrists, Dr Rachel Gibbons. Medical students and doctors across all grades were invited with 99 people in attendance. Anonymous feedback was received through survey monkey and analysed.

55 respondents found the seminar either extremely or very helpful. 40 respondents wanted to attend a similar future webinar. Of the 57 respondents, 36.8% (n=21) had been involved in an SUI during their medical career. 16 respondents (48.8%) had been involved in a suicide or homicide. Roughly a third of doctors felt supported by colleagues during an SUI and 21% felt they were not supported. In comparison, only 17% felt they were well supported by the Trust and 25% felt they were not well supported by the Trust. The bulk of respondents indicated that family/friends and colleagues were the most helpful support mechanisms. Others found defence unions, Trust support and counselling helpful. Respondents found out about the SUI in the following ways: from another team member or colleague (52%), manager/supervisor (22%), Trust investigation team (22%) and reading patient notes (13%). A third were dissatisfied with the way the found out. Finding out from managers/supervisors is preferable. A limitation to interpreting the results is that there were more responses to questions than those involved in a suicide/homicide.

This webinar was well received and indicated that clinicians preferred to find out about an SUI in a controlled and supportive environment. It appears that the most helpful support came from family, friends and colleagues which suggests that the Trust could be doing more. Our recommendations included to raise awareness on the trusts new People Well-being lead and other resources available locally and nationally, while ensuring adequate senior pastoral support and encourage buddying systems.

Culture refers to the way of life of a group of people and influences their value system. It affects virtually every area of life, unconsciously shaping one's outlook, behaviours and responses. As the world becomes more multicultural, it is essential that mental health professionals possess the much-needed awareness into the constructs of cultural variation and their impact on the expression of psychopathology and treatment. Black, Asian and Minority groups are a diverse group and make up 16% of the population in England & Wales. They are reported to have a less positive experience of mental health systems compared to white people. The common barriers ethnic minority groups face in accessing mental health care include: cultural barriers, stigma, language barriers, lack of cultural sensitivity from professionals, stereotyping, unconscious bias and so on. The aim of this quality improvement project is to improve the delivery of patient care and professional support to ethnically diverse groups.

A pre-workshop survey was set up to aid planning. The virtual workshop had over 80 people in attendance and included panel discussions, anchored by four professionals and three patients, all with lived experience. It lasted for 1-hour 15minutes, followed by a debrief. Feedback was obtained through survey monkey and the results were analysed with Microsoft Excel.

The pre-workshop planning survey identified that 91 % of respondents within the Trust (57 individuals) worry about being misunderstood when working with culturally diverse patients. 93 % feel more education on cultural diversity is needed and only 20 % felt they had sufficient knowledge and resources for day-to-day practice with a diverse patient group.The feedback survey results on the day explored five questions which included: awareness of barriers minority groups experience, awareness of available transcultural resources, awareness of transcultural issues, awareness of local protocols and resources, and likelihood to intervene against discrimination showed an improvement of 41.2%; with average pre-workshop scores of 55% and average post-workshop scores of 96.2%. Using thematic analysis, other areas of interest relating to transcultural psychiatry, at future workshops were considered as; greater awareness, practical approaches, culture/intersectionality, social justice, greater time allocation, spirituality, resources, gender/sexuality and age

Overall, majority of the feedback received was positive. Attendees valued the interactive nature of the panel discussions and choice of topics. Suggested areas of improvement were having more time for discussion and including other relevant topics. Recommendations include repeating workshops and raising local/national awareness.

The Royal College of Psychiatrists (RCPsych) Leadership and Management Fellowship Scheme (LMFS) is aimed at accelerating a fellows’ leadership and management development using a combination of structured leadership development programmes and a local apprenticeship model. It is open to all higher trainees, utilising special interest time over 12 months.In most establishments, certain groups are more prone to prejudice; whether due to age, gender, ethnic origin, sexual orientation, religion, career progression or disability. Leeds and York Partnership Foundation Trust (LYPFT) values diversity and strives to foster growth within a multicultural workforce and patient group. Equity accepts the difference between persons and ensures everyone reaches full potential, using individualised support. The aim was to create a culturally aware, inclusive and dynamic workforce. This project set out to achieve its objectives through four pillars.

Pillar 1-Initiating the local Medical Workforce Race Equality Standards (MWRES) LYPFT action plan: Appointment of the MWRES lead through advertisement and interviews. Pillar 2-Raising awareness on patient, carer and community involvement through a transcultural workshop: A virtual workshop anchored by four professionals and three patients, with lived experience was held, after which survey results were analysed. Pillar 3-Supporting International Medical Graduates (IMGs): Supporting IMGs through raising awareness on challenges and completing the regional handbook. Pillar 4-Interdisciplinary Undergraduate Education: Raising awareness on diversity and inclusion through undergraduate interdisciplinary education.

Pillar 1: An MWRES lead was appointed after interviews and is now in office. Pillar 2: Results of survey questions from the workshop around awareness of barriers minority groups experience, available transcultural resources, transcultural issues, local protocols and resources, and likelihood to intervene against discrimination; showed an improvement of 41.2%; with average pre-workshop scores of 55% and average post-workshop scores of 96.2%. Pillar 3: The Health Education England, Yorkshire & Humber IMG handbook has been completed and results from the survey included. Pillar 4: Students reported an improvement in their learning following the session. The weighted improvement on equity and transcultural issues for the pre and post teaching intervention improved from 5.391 to 7.126.

Overall, the aims of the four pillars of the project were successful achieved, with positive feedback received. LMFS encourages trainees to develop their leadership and management skills through local mentoring structures and should be encouraged. This is a clarion call to all professionals to adopt a culturally informed approach in all aspects of their practice; related to the workforce and patient care.

To achieve 90% of ward referrals to MHLS having adequate information provided on online referral system. To improve ward staff knowledge and confidence through education in order to empower them with ability to make appropriate and timely referrals.

Quality Improvement Project established at start of 2022 after discussion with MHLS with regards to referrals. MHLS acts at interface with acute medical wards and there were operational issues identified that could be improved. Driver diagram used to map these, to establish where intervention could be most effective. Lack of detailed referral often requires phone-call to the ward to seek further information, delaying patients’ assessment.

Criteria to be included on referral defined as: reason for referral, reason for admission, investigations performed, past psychiatric history, medications prescribed, and substance use history.

Two Plan Do Study Act (PDSA) cycles were established, the first in February 2022 that involved targeted lunchtime teaching of F1 doctors who are new to making referrals and may lack confidence.

Second PDSA cycle was established from December 2022 to January 2023 and focused on nursing staff as it was predominantly this cohort referring. A poster campaign on good practice and preferred information to be included in referrals was established on acute wards and discussed at nursing safety briefs. Data were then reanalysed.

We subsequently acquired data regarding wards which made the highest number of referrals and were able to specifically target the top ten as a third intervention. Further data collected end of January 2023.

Reason for referral inclusion improved (95.07% to 96.43%). Reason for admission to hospital similarly (92.56% to 100%). Past Psychiatric History inclusion improved (14.88% to 27.91%). There was an improvement in inclusion of prescribed medication (16.53% to 42.86%). Relevant investigations being included improved (9.92% to 17.86%) and substance abuse history improved (16.53% to 42.86%).

Overall number of referrals from same time period the previous year reduced from 349 to 307 post-interventions.

Whilst some clear improvements have been noted, there are still significant barriers towards the relevant referral content being included.

However, from speaking to ward staff there is evidence that thinking has improved in terms of appropriateness of referral, supported by reduction in referral numbers. This is possibly an impact of visual poster prompts, teaching and face to face discussion with staff.

Further work to help sustain improvement could include questionnaires distributed to wards, input at medical changeovers and prompting document circulated via email to all Trust staff.

To achieve 100% of digital handover records being completed by doctors at end of shifts in Holywell Hospital, Northern Ireland.

Transition to completion of digital handover record began in 2019. This was initially audited during 2020-2021 with slowly worsening results. After this, audit data were no longer recorded.

Since becoming trainee representative in February 2022, I investigated, along with my colleagues, reasons as to why this was not being completed nor being achieved. Reasons established included unaware of necessity, chronic culture of not being completed, a lack of access to shared drive and outside locums covering shifts as well as a higher percentage of doctors who were on shorter 4 month rotations. Literature review around junior doctor handovers in other sites was also completed and analysed.

A Plan Do Study Act (PDSA) cycle was subsequently established taking these factors into account from August 2022 to January 2023 with a focus on information sharing, training at specific junior doctor changeover points, liaising with administration to ensure adequate access to handover and regular audit and feedback amongst junior doctors.

From a new baseline of 5.36% of digital handovers being completed in February 2022 there has initially been a gradual increase noted at April 2022 to (35.00%) remaining relatively static into August 2022 (25.81%). Some of this related to doctors not having requisite access to shared folder.

However, percentage completed increased substantially after August 2022 with better administrative support and from September 2022 (70.00%) to December 2022 (88.71%) and into January 2023 (91.94%) handovers were completed.

Through a combination of better information sharing amongst junior doctors, signposting to digital handover, improvement of early access to requisite folder and specific teaching regarding handover at induction at all changeovers, stressing importance of completion from clinical governance perspective, there has been a genuine sea-change amongst junior medical staff that has included taking better ownership of the process and shared responsibility for it being completed.

This record-keeping improvement has been stark and maintained for a prolonged period, particularly from September 2022 and is now averaging over 90% being completed. There remains some issues regarding access if shift being covered by an outside locum doctor and this would be next targeted area with the goal of achieving 100% record of digital handover occurring.

To promote the Royal College's core principles of sustainable psychiatry, Junior Doctors at Ayrshire Central Hospital formed the Sustainability and Well-being Committee. The principle aim through 2022, following the COVID-19 pandemic, was to maximise junior well-being - knowing a sustainable workforce is one that feels supported and fulfilled by work and working conditions.

Through meetings with junior doctors, qualitative information on factors impacting well-being in the work place was gathered, and three targets for improvement were identified.

The following domains and interventions were implemented:

1. 1. Improve working environment: The doctor's office was sized for 2 staff maximum - despite staffing levels consistently in excess of 20 junior doctors. Additionally, there was no natural light. We obtained a new significantly larger office space, with natural light.

2. 2. Comfort break area – Doctors identified that having an area with comfort seating to take breaks and socialise away from patients and visitors would be beneficial. We obtained a seating area and a coffee machine, maintained by the junior doctors.

3. 3. Access technology – Absence of desktops and IT issues with older laptops was impairing productivity and morale. We obtained 4 new desktop computers, and personal laptops for core trainees.

A digital questionnaire was used to collect quantitative data retrospectively, from doctors currently working in the department, or who had done so in the last 6 months.

Likert scales were used to assess pre and post-intervention levels of well-being, and ranking intervention impact on this. Doctors also identified future areas of intervention going forward into 2023.

A total of 16 responses were obtained, and 100% of these agreed that feeling supported and good working conditions was important to maintaining wellness and productivity. Pre-intervention average wellness was rated 5.2 (with 1 being extremely poor, and 10 being extremely good), this increased to 8.1 post-intervention. Improved working environment had the most significant impact on well-being.

Respondents identified environmental sustainability as target for improvement in 2023, potentially through improved recycling, reducing meat consumption and car sharing. Further well-being interventions e.g., walks, promotion of Balint group and social events were also suggested.

Interventions from the trainee-led Sustainability and Well-being Committee through 2022 improved working environment and subjective well-being. This demonstrates that junior staff can successfully initiate and lead projects to promote and improve sustainability in psychiatry. Results indicate that junior staff are willing to actively participate in interventions to improve well-being, and environmental sustainability in 2023.

Although “to err is human”, human error in medical practice can be costly for both patients and the healthcare organisation. Different preventive methods have been developed and one of the approaches is the use of checklist. The conceptualisation of this quality improvement project (QIP) came about after a near-miss prescribing error occurred in the memory clinic. Therefore, the Memory Clinic Multi-disciplinary Team (MDT) Checklist has been created to make the documentation process of diagnosis, investigation, and treatment more systematic and structured, which will in turn reduce the risk of errors associated with it. The checklist is separated into the subtype of Initial Assessment and Follow Up. This article is aimed to share the outcome of the QIP.

The QIP was carried using the Plan-Do-Study-Act (PDSA) model. Version 1 of the checklist was made based on the guidance from the National Institute of Clinical Excellence (NICE) guideline NG97, which was tried in the Memory Clinic MDT discussion of Older Person Mental Health Community Team of Wrexham Maelor Hospital (OPCMHT WMH), Betsi Cadwaladr University Health Board (BCUHB). Microsoft Forms survey was performed to capture the feedback from the junior doctors using the checklist. The following five properties were ranked using a five-point Likert scale (with one as the lowest and five as the highest): ease of use, time efficiency, environmentally friendly, capturing important information and space availability. The checklist was then updated based on the qualitative feedback and PDSA cycle was repeated until the feedback was rated more than 4/5 on average for all domains.

Two PDSA cycles were needed to reach the version that was rated as more than 4/5 on average for all domains and the final version of the checklist was accepted as the completed version, i.e. the Version 3. There was a significant improvement in the ease of use, time efficiency, environmentally friendly and space availability. All versions of the Memory Clinic MDT checklists were good for capturing important information but not performing well for the other domains.

The Memory Clinic MDT Checklist are now fully in use in OPCMHT WMH BCUHB. Long term evaluation is still required to maximise the efficiency of the checklist. There is further plan of expanding the use of checklist in different memory clinic of BCUHB.

The poorer physical health of psychiatric versus non-psychiatric patients has been well-documented. Lifestyle and antipsychotic medications have an adverse effect on the cardiovascular system and are more likely to cause metabolic syndrome, obesity and diabetes. The purpose of this audit was to determine if Samphire ward is in 100% compliance with the Norfolk and Suffolk NHS Foundation Trust (NSFT) Physical Healthcare Policy (C84). The aim is to ensure minimum physical health investigations are requested within 24 hours of admission, including: 1) baseline blood tests, 2) physical examination, and 3) electrocardiogram (ECG). A re-audit was also completed, which aimed to determine if compliance improved following a quality improvement (QI) intervention.

A retrospective data collection (Lorenzo and WebICE) was compiled of all new patients admitted and transferred to Samphire ward from 01/06/21 to 03/10/21 (n=66). Data included baseline bloods, physical exam, and ECG documentation within 24 hours of admission. A QI intervention (A3 visual aid) was then placed on the ward. The policy was re-audited from 04/10/21 to 30/11/21, including all new patients admitted and transferred to Samphire ward (n=24).

Initially, 34.5% of new admissions had a physical examination or a patient refusal to consent that was documented on the physical exam form (NSFT Physical Exam Form v2.0) on Lorenzo completed within 24 hours of admission; post-intervention, this increased to 47%. 53% of new admissions had an ECG or a documented refusal in the initial audit; this increased to 61%. 68% of patients had baseline blood tests taken or a documented refusal within 24 hours of admission but only 4.5% had the correct blood tests taken; this increased to 71% and 33%, respectively, following the QI intervention. All 3 components within the 24-hour time period were met 0% of the time during the baseline audit; this increased to 33% post-QI intervention.

Overall, there was still poor compliance noted for all 3 physical health components required upon admission and fell far below the minimum standard as set out in the NSFT Trust Physical Healthcare policy. Further analysis showed ward doctors adhered to the standard significantly more than duty doctors. Recommendations include teaching regarding the physical health standard at junior doctor induction training and encouraging accountability among junior medical staff. A re-audit is recommended that includes further elements of physical health, including venous thromboembolism (VTE), height/weight, and nursing elements.

Anxiety disorders are a common presenting problem for young people under the care of Melksham Community CAMHS. Guidelines from NICE outline recommendations for best practice in assessment and treatment of these disorders. A local gap analysis in 2017 identified areas for improvement in assessment of anxiety disorders. Measures were implemented following this, including training for staff. A repeat audit was conducted in 2021 and results compared.

NICE guidelines were used to set audit standards, which were used for data collection in both 2017 and 2021. A proforma was developed. A pilot sample of five patients was used to test the proforma. A cut off of 80% compliance was used. Caseload screening by clinicians was used to identify all eligible patients, then a random sample of these was selected by the project leads. Case note review was then conducted. Patients with a diagnosis of autism were excluded from the sample. ROMS, SDQ, GAD-7 or general clinical observation was used as a measure of treatment response. In total in the 2021 sample, 22 patient records were audited.

Treatment and follow up for anxiety disorders was good or excellent in 2017 and remained so in 2021. Areas for improvement lay in the assessment of anxiety disorder. In the 2017 audit, there was poor documentation of: mental health history (this had improved from unacceptable to good by 2021), past treatments (improved from unacceptable to requires improvement by 2021), family history (improved from unacceptable to good by 2021), domestic violence/CSA (improved from unacceptable to requires improvement by 2021). Response to treatment was inconsistently documented in the 2017 audit. In 2021 there remained some inconsistencies in documentation. Improvements in recording response to treatment would assist with clearly evidencing compliance with the NICE standards.

Overall, treatment and follow up for anxiety disorders was good or excellent (and remained so in 2021). Areas for improvement lay in the assessment of anxiety disorder. Recommendations to promote ongoing improvement include: 1) Circulation of re-audit results to the team 2) Brief recap of guidelines on assessment of social anxiety disorder to the team 3) Written/ email reminder to consider and document the other areas that received less than 80% compliance 4) Continue use of ROMS. Effective assessment and management of anxiety disorder is an important area of clinical practice for all clinicians in the team; we would recommend this is re assessed in 2023 to ensure standards continue to improve.

To improve junior doctors’ satisfaction with handover process to >70% over a period of 10 weeks.

Baseline level of overall satisfaction with current handover practice was measured through a survey using Likert scale. Using the same scale, the team also looked at:

1. 1. Degree of confidence in tasks being completed

2. 2. Degree of confidence in handover being confidential

3. 3. Degree of confidence in handover being sufficient for medico-legal purposes

Part of the survey also asked junior doctors using free text comments on how handover is currently carried out between shifts. The results from the survey were analysed and suggestions were considered for improvement.

A new method of handover using MS Teams was trialled. During subsequent PDSA cycles change ideas were adopted to improve engagement with the new process and allow for safe handovers.

On a weekly basis, post-intervention level of overall satisfaction with the new handover process was measured using the same Likert scale. Other measurements measured weekly included:

1. 1. Percentage of handovers completed using the agreed template

2. 2. Percentage of handed over jobs being acknowledged to signify receipt of handover

Pre-intervention, verbal handover was the most frequent way of handing over (85.7%) followed by Whatsapp/text messaging (64.3%) and paper (42.9%).

Baseline level of overall satisfaction of handover process is 21.4%. At the end of PDSA Cycle 1, this increased significantly to 78% and by week 10 (end of PDSA Cycle 2) it rose to 92%.

Pre-intervention, 35.7% of junior doctors reported feeling confident in the handed over tasks being completed. 28.5% were confident that the handover process is confidential and 14.3% that it is sufficient for medico-legal purposes.

Post-intervention, 100% of the handovers are completed using a standardised template and 100% of the tasks were being acknowledged by the appropriate team members.

Prior to this intervention the process of junior doctor handover was not uniform and led to near-misses. This created confusion hence opportunities for errors to occur which can compromise patients’ care. Following the introduction of MS Teams as the handover platform, overall satisfaction from junior doctors on the handover process has increased significantly. Moreover, it provides a clear record of handovers taking place which ensures accountability, safety and continuity of patients’ care.

Patients under the Joint Homelessness Team (JHT) in Westminster have poor health outcomes as they face the double-hit of serious mental health illness (SMI) and homelessness. Many patients are on depot antipsychotic medication to manage their SMI. Depot antipsychotics are associated with increased risk of arrythmias and guidance advises annual electrocardiogram (ECG) monitoring for all (Maudsley: Prescribing Guidelines in Psychiatry, Taylor). However, a proportion of JHT patients are not well engaged with services and do not have an annual ECG recorded on SystmOne. In this QI study, we aimed to improve the percentage of JHT patients on depot antipsychotic medication who have a recorded ECG within the year on SystmOne, from current level to 80% over a 4-month period.

44 patients at JHT were identified as being on depot antipsychotic medication (1 patient was later excluded due to ongoing inpatient admission). PDSA cycles were used over a 4-month period from October 2022 to January 2023.

Intervention 1: Using available ECGs from GP or secondary care records to update SystmOne records.

Intervention 2: Email to GP requesting they invite patients for annual ECG.

Intervention 3: JHT inviting patients for targeted ECGs.

At baseline only 48.8% of patients had an ECG recorded on SystmOne within the last year. Intervention 1 increased our recorded ECGs to 72.1%. Intervention 2 increased completed ECGs to 74%. Finally, intervention 3 increased completed ECGs to 83.7% by Mid-January 2023. Overall, results show an improvement of 34.9% or relative increase of 1.71 times the amount of recorded ECG over 4 months.

As a result of incorporating dedicated liaison and clinical time, we have improved uptake of annual ECG monitoring of patients on depot antipsychotic medication. We found there was a lot of existing physical health data in the GP and secondary care records that was not readily accessible to JHT. In the future, with the development of shared clinical data systems, both primary and secondary care teams may be able to save time and resources by avoiding duplication of data.

There remains room for improvement with 16.3% of patients still without an annual ECG. This is due to accessibility and engagement difficulties for people with SMI & history of homelessness.

We propose further intervention with a portable ECG machine to improve engagement with

these remaining patients. This project is being used as a business proposal to secure funding for a portable ECG device currently.

This quality improvement project aimed to improve mental health professionals' understanding and confidence in management and support of patients in the general adult inpatient setting who have disclosed sexual assault. It also aimed to improve patients' experience of support following their disclosure of sexual assault.

Baseline knowledge and understanding was evaluated using an anonymous questionnaire sent to staff.

Stakeholders were identified from medical, nursing, police, FME and third sector agencies and patient advocacy – their expertise was utilised to develop standardised guidance.

The intervention included an education session delivered at site-wide teaching, and the creation of a procedure with associated resources for staff reference.

Teaching sessions and guidance were based on this expertise to fill knowledge gaps identified in the baseline knowledge questionnaire.

The questionnaire was subsequently redistributed and collected to analyse for an improvement in knowledge and confidence.

Initial questionnaires presented qualitative and quantitative data suggesting lack of confidence and understanding of the processes involved in reporting and management of disclosed sexual assault.

Post-intervention dataset analysis shows an improvement in staff understanding, confidence and access to appropriate resources in management of sexual assault in the general adult inpatient population.

Prior to the project there was no protocol for the management of disclosed sexual assault in the local general adult inpatient population.

This left uncertainty amongst staff regarding the appropriate steps to take. This resulted in an increased risk of crucial time windows not being considered associated with a potential loss of evidence.

The Quality Improvement project improved staff confidence regarding management of disclosed sexual assaults thus optimising patient outcomes and experience when reporting assault.

As the number of forced migrants continues to raise every year due to conflicts, wars, climate change, and other factors, mental health services need to find innovative and new solutions to meet the needs of these vulnerable groups. We present here our experience of establishing the first mental health clinic for asylum seekers and refugees in Norwich, Norfolk (United Kingdom).

The clinic was established as part of the Advancing Mental Health Equalities QI Collaborative, which the Royal College of Psychiatrists launched to reduce barriers to accessing mental health services for disadvantaged populations. QI methodology was used to promote equality, increase access and improve outcomes over the next three years.

The monthly clinic has no funding and is run by a consultant psychiatrist (Yasir Hameed) and GP (Hannah Fox). Two research assistant psychologists offered the administration support. Another assistant psychologist and two core trainees joined the small team to offer reviews and follow-ups for the patients.

The monthly clinics are based away from the mental health settings (as some patients might be reluctant to attend these clinics) and are held in a friendly well-being hub run by the MIND organisation close to the city centre, which is easily accessible.

The clinic receives referrals from primary care, social services, charity organisations (such as the British Red Cross), Well-being service (Psychological Therapies), and inpatient and Community Mental Health Teams.

The clinic aimed to offer a person-centred, trauma-informed approach and improve the communication between services (through regular meetings with various services on a monthly basis), and enable access to appropriate treatment.

In addition, the team of the clinic run drop-in session in local hotels where asylum seekers are housed to talk about mental health and access mental health services.

Finally, the clinic offered training opportunities in transcultural psychiatry and working with interpreters.

Between March 2022 to January 2023, 40 referrals were received, mainly from primary care.

Nearly 20% had a diagnosis of PTSD.

We followed nearly half of these patients in the clinic in subsequent visits and worked closely with the psychological therapy to refer patients for appropriate therapies.

The clinic improved the access of forced migrants to comprehensive, trauma-focused mental health assessments and improved communication and collaboration amongst services. It provided training opportunities. The drop-in sessions were a great opportunity to meet asylum seekers in their accommodation. Lessons learned and full data analysis will be shared in the poster.

Our aim was to investigate the extent and impact of poor audio quality during remote ward rounds using Microsoft Teams. We intended to compare attendees' audio quality experience with our expectation that a cardioid polar microphone would make it difficult for attendees to hear all members of the multidisciplinary team. We also hypothesized that switching to an omnidirectional recording system would improve perceived audio quality, communication, and patient care.

This study is a continuation of a previous quality improvement project carried out on a general adult ward within the same Trust. This iteration involved individuals who participated remotely in ward rounds at a dementia specialist ward over a four-month period in 2022/2023. Participants of the study included staff from the ward team, community care coordinators and patient family members, who completed a digital feedback questionnaire about the audio quality. Due to the nature of their illness, no patients completed the questionnaire.

There were no exclusion criteria. Data from Likert scale questions were analysed. Little demographic data were collected, and qualitative data were analysed by identifying themes and grouping responses based on thematic frequency.

In the pre-implementation survey, 12 responses were received from patient family members, 9 ward team members and 2 community mental health workers. Before the intervention, 3/12 participants rated the sound quality as "bad" and the same number were "dissatisfied" with the sound quality during ward rounds (modal response "neutral" for both, 6/10). Only 3/12 attendees reported being able to hear and understand everyone present in the ward round all the time, and one person reported only rarely hearing and understanding a single person in the room when they spoke.

All respondents agreed that the sound quality impacted their experience of the ward round. The three most common issues reported were people speaking too far from the microphone, voices sounding muffled, and poor internet connection causing gaps in speech.

Common themes identified in the qualitative data included: frustration, disengagement, and damage to patient care.

In summary, our findings indicate that when using a built-in laptop microphone with unidirectional pick-up, remote ward round attendees were not satisfied with the audio quality. However, this may be improved through the use of an omnidirectional system. Potential benefits from this technology may be optimised through the use of automatic transcription for individuals who may be hearing impaired, and ensuring optimal positioning for adequate sound detection.