This evaluation aims to understand if Cognitive Behaviour Therapy (CBT) cases for Core Psychiatry Trainees (CPTs) in Sheffield provide good training in therapy skills and if these can be integrated into general psychiatric practice.

Completion of psychotherapy cases part of the curriculum for CPTs, with cognitive behavior therapy being one of the common modalities used. Whilst there is evidence that trainees often provide competent therapy it is unclear what cases are appropriate and how these contribute to wider CPT learning objectives.

CPTs who had completed a clinical case in CBT at a tertiary psychotherapy service were identified. All were surveyed and patient demographics and outcomes also collated.

The results showed a significant impact on trainees understanding of CBT, applying theory to clinical context, and changed future practice. Despite being complex, 64% of patients needed no further therapy and 42% were discharged from mental health services.

The evaluation demonstrates the positive outcomes for patients, trainees, future clinical practice, and a move towards collaboration as laid out in the Five-year forward view for mental health. This suggests that medical trainees have a valuable contribution, and role despite minimal experience in CBT.

We audited practice at the Meadows Inpatient Unit regarding physical health assessment, against standards set by Surrey and Borders Partnership and NICE.

SABP policy states that within 24 hours of admission to inpatient services, physical health assessment should be offered. It should be completed within 72 hours. Refusal should be documented.

These guidelines state that within 2 weeks of admission blood tests should be completed, and for specific individuals an ECG should be performed.

NICE guidelines state that “physical healthcare needs” should be discussed with newly admitted patients. NICE guidelines regarding physical health monitoring for individuals with psychosis or schizophrenia recommend that assessment includes “full physical examination to identify physical illness”.

NICE suggests use of antipsychotics for individuals with dementia who have severe distress, or are at risk of harming themselves or others. Those with behavioural and psychological symptoms of dementia (BPSD) should therefore be physically assessed to ensure safe use of antipsychotics may be implemented.

All admissions to The Meadows over seven months were audited retrospectively. The clinical notes were accessed from Systm1.

Consensus medical opinion was reached that full examination should include: GCS/level of consciousness, cardiorespiratory, abdominal and neurological examinations.

Age, gender, diagnosis and prescriptions of psychotropic medication at time of admission were recorded.

The sample included 35 patients.

55% of patients had a diagnosis of dementia.

63.8% of patients were prescribed antipsychotics on admission, more than other psychotropic medication. This may reflect that the most common diagnosis was dementia, commonly with associated BPSD.

97% of patients had a physical examination completed within 24 hours; most excluded neurological examination. 91% of patients had blood tests completed in two weeks, with the most commonly excluded tests being lipids and glucose. 86% of patients had an ECG in two weeks. In general, documentation of reason for not completing an examination was completed.

We found good compliance with recommendations for physical health assessment. Areas for improvement include better assessment of neurology and more thorough blood tests.

Recommended physical health examination for new admissions is not outlined in SABP policy. We recommend the following:

GCS/level of consciousness, cardiovascular, respiratory, abdominal, and neurological examinations, and baseline observations.

ECG should be a requirement of admission. In order to facilitate this, staff need to be trained to perform ECGs.

NICE guidelines refer to HBA1c rather than glucose, which should be reflected in SABP policy.

It is trust policy that the Basic Clinical Equipment for Physical Health Assessment should be available on each unit. The standard for this audit is therefore 100% completion.

This was a cross-sectional study of six mental health units across Mid Essex. We audited equipment and consumables in comparison to trust policies. For the purpose of the audit we designed an audit tool.

Overall compliance across all wards for all audited items was 77.5% (64.9% – 87.5%). Average compliance for equipment provision 83.3% (73.9 %– 91.3%) was greater than that for consumables 72.1% (58.8% – 82.4%).

When looking at the compliance on each unit separately, our data show that no unit has met the standard of 100% for equipment or consumables. From all units, one of the two older adults’ inpatient units had the highest overall compliance and highest compliance for consumables at 87.5% and 82.4% respectively while the perinatal unit had the lowest overall compliance and lowest compliance for consumables at 64.9% and 58.8 respectively. For the equipment compliance, intensive care unit and one of the older adults tied for the highest compliance at 91.3% while male inpatient unit and perinatal inpatient unit were tied the lowest compliance at 73.9%.

This is an audit to assess the availability of Basic Clinical Equipment for Physical Health Assessment on inpatient units in Mid Essex. With an audit standard of 100% completion, it shows that overall compliance on all units was 77.5% which is not meeting our standard.

It is trust policy that the VTE risk assessment should be completed for every patient admitted to wards. The standard for this audit is therefore 100% completion. We completed the audit in October 2018 and closed the loop in September 2019.

This was a cross-sectional study of all patients on all the wards according to patients’ list on the electronic system (Paris) on certain date. In the first audit we used an audit tool from a similar audit performed in another area in the trust. For the purpose of re- audit we designed an audit tool to reflect the changes made in the electronic form.

In the re-audit, there was noticeable improvement in the completion rate compared to initial audit (95% vs. 82%); however, there was still under-performance. An interesting observation of the re-audit is that 74% percent of admissions had VTE risk assessments forms completed on same day of admission or next day compared to only 45% in previous audit.

When looking at the completion of individual components on the VTE forms there are still some room for improvement as well. For example, in 26% of the patients there was no documentation about the use of prophylactic anticoagulants before admission compared to 34% in our previous audit. Also in 7% of the patients there was no documentation about the outcome of the assessment compared to only 3% in previous audit.

This is an audit to assess the completion of electronic VTE forms as per trust policy. Following the initial audit we made recommendations to improve completion rate. In the re-audit there was an improvement in total completion rate but we have not met the goal of 100% yet.

This study aimed to assess the impact that the COVID-19 pandemic has had on the Hertfordshire Community Perinatal Team (CPT) group interventions and the innovations made.

The CPT is a multidisciplinary mental health service that runs three groups: Circle of Security (CoS), Emotional Coping Skills (ECS) and a peer support group - Wellbeing and Lifestyle. The service has received an increase in referrals during the COVID-19 pandemic.

Methods: Team member and client semi structured interviews were conducted with answers transcribed in real time and analysed. Patient clinical records were accessed via PARIS and analysed in order to identify patient demographics within each group and whether these had changed during the pandemic. Clinical outcome measures and client feedback were evaluated to see whether the change in groups is impacting their clinical effectiveness.

Results: Innovations made by the CPT include: groups becoming virtual, launching of the new Circle of Security Group which helps women tackle the ‘Ghosts in the Nursery’ and strengthen maternal bonds, restructuring existing groups, breakout room forums and incorporating communication platform apps such as Whatsapp. The Wellbeing and Lifestyle Group increased in size and reach (7 women from 7 areas in 2019 vs 12 women from 12 areas in 2021) with an increased retention rate (71% in 2019 vs 100% in 2021) and a decreased attrition rate (29% in 2019 to 0% in 2021). The Emotional Coping Skills group experienced similar changes (10 areas represented in 2019 vs 15 different areas in 2021) with an increased retention rate (58% in 2019 vs 100% in 2021) and decreased attrition rate (42% in 2019 vs 0% in 2021).

The Hertfordshire Community Perinatal Team has responded to the pandemic by innovating existing groups and creating new forums; many of which will continue on even after the pandemic ceases. The groups have acted as a lifeline for women breaking up the monotony and isolation of lockdown life and providing an invaluable space for women to be heard.

The poster focuses on the reduction, and eventual eradication, of waiting times within a community-based NHS psychology service in the North East of England. The poster aims to demonstrate the effectiveness of strategies implemented within a secondary care psychology service whilst examining patterns of help-seeking behaviour and treatment compliance in those waiting for therapy, and also the care needs of this cohort following a wait for services.

Secondary care waiting lists for psychological therapy, as highlighted by a recent British Medical Association audit, remain a so-called ‘blind-spot’ in mental health care provision and a national problem. Tackling waiting lists within this sector has been stated as a priority within the Five Year Forward View, however “core ingredients” of waiting list eradication methodologies and the components leading to such, have yet to be disseminated.

A historical audit and follow-up of clinical data were utilised to gather and analyse data of 208 individuals who were seen by the psychology service between October 2014 and March 2016.

No significant differences were found between individuals who successfully completed therapy compared to those who disengaged in regard to demographic or epidemiological variables, or mental health service input. Despite lengthy waiting times of up to 3.69 years, waiting time did not significantly impact whether someone engaged with psychological services. Any form of input from psychological services led to a significant reduction in distress, as measured by the CORE-OM. No individuals who completed therapy were re-referred for psychological input at 12-month follow-up.

If imposed appropriately over a suitable time-frame evidence-based, effective and efficient needs-led psychological input can be provided whilst eradicating a waiting list and still remaining flexible, formulation-based and person-centred.

The older adult is more likely to be prescribed a lot of medications (polypharmacy) on account of multi-morbidity and consequently being under the care of several specialists. Adverse drug events and reactions account for significant morbidity and mortality in this population group. Common sequelae include confusional episodes, dementia syndromes, falls, and higher rates of acute hospital admissions.

Medications are not routinely reviewed in elderly care. We sought to estimate the prevalence of polypharmacy, and potentially inappropriate medications (e.g. anticholinergics or medications with central anticholinergic effects) in those referred to the Cognitive Impairment and Dementia Service (Elm Lodge), Older Persons Mental Health, West London NHS Trust.

All referrals between 01/10/2020 and 30/11/2020 were screened for medications prescribed. Polypharmacy was defined as prescription of 5 or more medications. Medications with anticholinergic properties were considered examples of Potentially Inappropriate Medications (PIMs). The Anticholinergic Effect on Cognition (AEC) Tool, ‘Medichec’, was used to identify and rate anticholinergic burden. Anticholinergic load was also compared using the Anticholinergic Burden Scale (ABS).

Total number of patients referred – 193

11 patients excluded due to unavailable/incomplete medication records.

Study number: 182

Polypharmacy:

• 79.67% (n = 145) were prescribed 5 or more medications.

• 44.51% (n = 81) prescribed 5–9 medications.

• 23.08% (n = 42) prescribed 10–14 medications.

• 8.79% (n = 16) prescribed 15–19 medications.

• 1.67% (n = 3) prescribed more than 20 medications.

• 37.36% (n = 68) prescribed an anticholinergic.

• 6.59% (n = 12) prescribed more than 1 anticholinergic.

• 29.67% (n = 54) prescribed an anticholinergic.

• 7.699% (n = 14) prescribed more than 1 anticholinergic.

Polypharmacy and potentially inappropriate prescribing (e.g. anticholinergics) remain widespread within the older adult population. Anticholinergic load was broadly similar with the Anticholinergic Effect on Cognition tool and the Anticholinergic Burden Scale. Increased anticholinergic burden further compounds risks of cognitive impairment, delirium and death.

Other categories of Potentially Inappropriate Medications, including those no longer needed, ought to be identified and reviewed. Over-the-counter medications also need to be screened for.

Elimination or reduction of anticholinergic burden may improve quality of life for patients, as well as cost burden on services.

Pharmacovigilance, collaborative working, and regular training are needed across services providing care for the older adult.

The older adult is more likely to be prescribed a lot of medications (polypharmacy) on account of multi-morbidity and being under the care of several specialists. Adverse drug events and reactions account for a significant number of acute hospital presentations in this population group with increased risks of delirium, lasting cognitive impairment, falls and death.

Medications are not routinely reviewed or rationalised in the elderly, often contributing to preventable harm.

We sought to estimate the prevalence of polypharmacy and potentially inappropriate medications, anticholinergics in particular, in patients (65 years and older) referred to the St Mary's Hospital Liaison Psychiatry Department over a 3-month period.

Between 01/06/2019 and 31/08/2019 all referral forms (from in-patient wards and A&E) for patients aged 65+ years were screened for medications currently prescribed and administered. The medications were confirmed via the St. Mary's Hospital electronic records, pharmacists’ completed Medicines Reconciliation and GP Summary Care Records. Polypharmacy was defined as patients prescribed 5 or more medications. Drugs with anticholinergic properties were considered as an example of Potentially Inappropriate Medication (PIMs) using the Anticholinergic Burden Scale. 77 patients were referred in the time period. 9 were excluded due to incomplete/unreconciled medication information.

77.94% (n = 53) were prescribed 5 or more medications.

38.24% (n = 26) were prescribed over 10 medications.

10.29% (n = 7) prescribed over 15 medications.

69% of (n = 47) prescribed an anticholinergic.

42.65% (n = 29) prescribed more than 1 anticholinergic.

Polypharmacy and potentially inappropriate prescribing remain widespread within the older adult population.

Increased anticholinergic burden further compounds risks of cognitive impairment, delirium and death.

Other categories of Potentially Inappropriate Medications, including those no longer needed, ought to be identified and reviewed. Over-the-counter medications also need to be screened for.

Elimination or reduction of anticholinergic burden may improve quality of life for patients, as well as cost burden on services.

Pharmacovigilance, collaborative working, regular and systematic medication reviews, and on-going training are needed across services providing care for the older adult.

Testing the compliance and completion rate of a transfer checklist (proforma) created in accordance with local hospital policies.

The proforma was developed following serious incidents where medically unstable patients were inappropriately discharged to mental health hospitals, requiring readmission to acute medical hospitals. Frequently these events reported an inadequate handover from medical to mental health teams and patients were often prematurely deemed medically fit with evidence to the contrary.

Although parity of esteem between mental and physical health has been a high profile political issue in the UK since 2011, evidence indicates that parity is far from being achieved. This first ever checklist was designed to improve safety of patient transfer from acute physical health hospitals to mental health hospitals by ensuring patients are medically fit and better communication between the two trusts.

Data were collected retrospectively over a six-month period between August 2018 and January 2019 and retrieved from patient notes available at relevant trusts. Electronic notes were obtained from medical wards, accident and emergency and Mersey Care electronic systems. Notes were specifically scrutinised for presence of the proforma, quality of completion and, number and reasons for readmission from mental health hospitals to acute physical health hospitals following their medical optimization. Readmissions were considered as admissions to physical health hospitals up to one month following discharge with evidence of ongoing concerns.

6597 referrals were made to liaison services from Liverpool University Hospitals, of which 5–6 % were admitted to inpatient mental health units. 31% of admissions from Liverpool University Hospitals were readmitted to a physical health hospital within one month of discharge indicating inappropriate and unsafe discharges. Of all those readmitted, 10% had ongoing acute medical concerns prior to admission to a mental health hospital. The proforma was filled in 13% of admissions from Liverpool University Hospitals. None of the forms were fully complete.

10% of patient admissions to mental health hospitals were identified as inappropriate due to ongoing acute medical concerns. The proforma served as structured guidance and evidence of medical fitness at time of transfer. However poor compliance was observed, which could be secondary to lack of awareness of the proforma and inadequate dissemination of the policy. Findings were shared and discussed with the appropriate teams both in acute physical health and mental health hospitals and steps will be taken to raise awareness of the proforma before completing a second audit.

The main concern of this research is to evaluate the performance of a new Mental Health Phoneline Programme, developed to facilitate access to Mental Health Services and to lower the impact of Mental Health Services disruption due to COVID-19 lockdown. Crisis resolution, new referrals, and patients’ reconnection with their former Mental Health Teams were recorded.

The data obtained from 11,406 calls made to the Mental Health Phone Line from April 14th, 2020 to March 1st, 2021 were analysed. Crisis resolutions, new referrals, and patients’ reconnection with their former Mental Health Teams were calculated.

Of the 11,406 calls registered, 72.2% of them were made by women. Mean age was 50.13 years, SD 18.51; median: 50. There was a significant difference between gender regarding age (males: mean 43.91 years, SD 18.88; females: mean 52.48 years, SD: 15.9), being the males who used the phoneline younger (t:23.75; p <0.000). 54.2 % of the users lived with a significant other. Crisis resolution represented 12.6 % of the sample, request for information 34.4%, psychosocial interventions 47.6% and, reconnection with former Mental Health Team 4.3%. New referrals for treatment were 2.9% of the total calls. Two main negative affects the74.2% of the total affect reported. Anxiety-Fear accounts for 49.3% of reported feelings and depression a 24.9 %.

To seek patients' feedback on their wellbeing and the service adaptations during the COVID-19 pandemic

To obtain carers’ views on service adaptations during the COVID-19 pandemic.

To establish impact on patients' wellbeing and progress in the context of COVID-19

The COVID-19 pandemic resulted in unprecedented challenges faced by healthcare systems worldwide. Public Health England (PHE) provided guidance to manage the spread of the virus. In response to the national lockdown, the Forensic Healthcare Service part of Sussex Partnership NHS Foundation Trust (SPFT) took measures that were considered necessary to prevent the risk of spread to patients and staff.

Restrictions necessary to contain the virus included immediate suspension of all patients leave except emergency leave, suspension of visits by family members and professionals including legal visits and restrictions on multidisciplinary (MDT) members physically present on the wards. It was necessary to adapt our existing model of care to reflect and represent the challenges faced by such restrictions.

A service evaluation project was undertaken to ascertain the patients' and carers’ perspectives of the management of restrictions.

Standards

It is noteworthy that no service standards in the context of this unique global pandemic were available internationally, nationally or regionally at the time of undertaking the project.

Methodology / Data collection

An anonymous patient feedback questionnaire was developed to collect data on voluntary basis from all the inpatients within the secure and forensic CDS. Patients' feedback was broadly divided in to three sections 1) personal factors, 2) satisfaction with access to information and 3) satisfaction with services to include mental and physical well-being.

Patients' feedback was collected during a 6-week period. For observation purposes, risk comparison anonymous data were also collected. Informal Carers' feedback was collected with regard to virtual visits.

During the data collection period 99 out of 105 beds were occupied. The response rate was 49% (49 responders).

Overall 73% of responders expressed that their mental health was affected. Approximately 51% of responders expressed that progress towards their discharge was very much affected. 91% of responders were not coping well with the new circumstances

Overall, carers' feedback was positive in regard to provision of virtual visits.

Our survey has shown that the necessary COVID-19 pandemic restrictions have in some domains resulted in a negative impact on patients’ mental wellbeing and progression. However, it also identifies positive areas of new practice, which have been maintained by the service.

To look at 14 EPUT out of area patient profiles, map their journey to the current locked rehab placements -To review the appropriateness of placement of 14 patients through reviewing whether the care provided is achieving the rehabilitation goals.

To look at patients’ needs and whether the local alternatives can provide the care

Rehabilitation services aim to help complex General Adult Mental health patients reintegrate in the community by promoting independent living skills. Some complex mental health patient's care needs mandate a specialist rehabilitation services. Currently there has been a nationwide shortage of local rehabilitation services. This resulted in placing complex needs patients out of area in locked rehabilitation hospitals and miles away from their local community connections. Families and local community team providers travel miles to keep in contact with their complex need persons. The NHS five year plan includes minimizing the current out of area placements and for local services to work together as per CQC recommendations to work together and bring those individuals closer to home.

We designed a tool and examined the electronic records for all 14 out of area placed patient profiles, mapping their clinical journey and reviewing whether the care provided is achieving the rehabilitation goals.

(N = 14), Patient profiles: 78.5% had residual symptoms (Psychotic symptoms 85%). Patient's Illness profile; treatment resistant with residual symptoms in 71.4% and 7% had comorbid illicit substance misuse, other illness profiles 21.4%. History of alcohol and illicit drug misuse was present in 78.5% and 45% of them were using illicit substances more than 5 years. .patients’ risk profile revealed 86.7% had history of non-compliance. Attempted suicide 21.4% has attempted suicide at list once in which 1/3 of them had more than one attempt. 64.3% Had positive history of offending behavior. All patients in the sample had history of violence 85.7% had risk of vulnerability and self-neglect, 28.5% has history of carrying weapons, 35.7 had a previous Custodial sentence. Average Duration of illness average 16.7 years, average distance from home was 149 miles though clozapine was considered in 92.8% only 35.7% of sample was on clozapine, and the other 64.3% were on combinations. Only 35.7% were on depot.

There is a need for expert input for advice regarding complex Management of residual symptoms and rehabilitation needs in the community. Health and social care joint working is needed.

To elucidate critical elements for effective outcomes in patients with complex and challenging behaviours admitted to specialist inpatient ‘locked rehabilitation’ intellectual disability unit (LRU).

People with intellectual disability of varying severity with or without associated mental disorder are at risk of deterioration presenting with problem behaviours at critical times of transition. In the context of their pre-set neurocognitive deficits, protective factors during early development include a robust psychosocial ‘parenting’ environment that optimises their strengths through nurturing and embedding a positive mind-set. Such environment is critical for the development of resilience as against reliance on external factors with high likelihood of change. The effect of early exposure to prenatal and or postnatal childhood adversities is a common denominator. The experience of abuse; from deprivation and neglect to physical violence and indeed sexual trauma predisposes to further perturbation and kindling effect on risks for early and later onset affective disorders. Specialist ID services become critical to the resetting of a distorted premorbid neuronal circuitry. A biopsychosocial approach to recreating a stable base and environmental enrichment may offer opportunities for enhancing neurocognitive remediation and enhance prosocial skills. Indicators for better outcomes may offer scope for focused intervention. This review highlights extent patients progress (response to treatment and symptom remission), length of Stay and discharge pathway could be predicated on their engagement with offered structured therapeutic activities.

Using a mixed model approach, 12-months data regarding patient characteristics, elements from HoNOs LD, with patient's self-reported experience and utilization of therapy, progress of patients in the service were reviewed to elucidate factors that may predict improved outcomes..

Of 48 patients, 18 females and 30 males identified in the 12-months from January 2019, 7 females were discharged/transferred with one stepped up to LSU and another side-moved to a LRU. 6 have identified places and 5 require ongoing care. Of the males, 8 were discharged and 5 have identified placements. 16 inpatients with support completed questionnaires (10 males, 6 females). Majority identified structured therapeutic activities as helpful in their progress. Data for length of stay ranged from 12 to over 120 months with a mean of 31 months ignoring potential discharges.

Findings suggest patients able to engage in structured therapeutic activities in conjunction with concordance to treatment are more likely to progress earlier in their care.

To evaluate the provision of services to patients with challenging behaviour in East Lothian Community Learning Disability population with and without specialist behaviour support team.

Behaviour that proves to be a challenge to manage (Challenging behaviour) is not uncommon in adults with intellectual disability and has a reported prevalence of 10–15%.1,2

Positive behaviour support (PBS) is recommended as evidence-based intervention for adults with intellectual disability who have challenging behaviour. East Lothian community learning disability team (CLDT) underwent a change in service model for people with challenging behaviour. This change followed a Health and Social care partnership agreement that behaviour support and management could be provided by multidisciplinary CLDT rather than region-wide specialist team.

Data collection was split into two cycles. First cycle looked retrospectively at six months prior to exit of Specialist Positive Behaviour Support Team (SPBST). Second cycle looked prospectively at 6 months after exit of SPBST.

In first cycle, data were collected doing retrospective review of cases known and referred to SPBST. This included calculating time spent on each individual case by SPBST and by CLDT. SPBST provided information in the form of hours spent on each individual case for patients identified by them. For CLDT, electronic medical records system (TRAK) was used by looking at appointment entries on TRAK. For second cycle, newly developed Complex Behaviour pathway was used to identify the patients. Data were collected by using TRAK system as in the first cycle for CLDT.

Data collected in both cycles was compared at the end of second cycle.

In first cycle, 5 patients were managed jointly by SPBST and CLDT in 96.4 hours over six months and average clinical time spent on each patient was 19 hours. SPBST spent a total of 59 hours and CLDT spent 40 clinical hours. In second cycle, 12 patients were managed by CLDT alone in 130 hours over six months and average clinical time spent on each patient was nearly 11 hours.

Results of this evaluation suggest that SPBST had been providing significant contribution to East Lothian CLDT not only with their expertise but also with clinical time. More than 50 % of total clinical time spent on the patients with challenging behaviour in first cycle, was provided by SPBST. This is also evidenced in second cycle where there is an increase in clinical time of some professions when SPBST was withdrawn.

Benzodiazepines and Z-drugs are used frequently in acute psychiatric wards, however long-term administration can result in undesirable consequences. Guidelines recommend prescription of the lowest effective dose for the shortest period and if possible to prescribe “as required” rather than regularly. The 25-beded inpatient unit at Cavan General Hospital admits adult patients requiring acute care from the counties of Cavan and Monaghan. Admissions are accepted from four community mental health teams, two psychiatry of old age teams and the rehabilitation and mental health of intellectual disability teams. In order to evaluate the potential to improve our practice of prescribing benzodiazepine and Z-drugs, it was decided to evaluate current use.

The NICE guidelines were consulted, and we retrospectively reviewed the use of these agents from mid-January to the end of May 2020. Demographic variables included age, gender, and county. Patients were stratified into three groups, the benzodiazepine group, the Z-drugs group, and the combined benzodiazepine and Z-drugs group. In each group therapeutic variables were recorded including the medication type, dose, frequency, prescriber, and duration of treatment. Other variables included psychiatric diagnoses, length of inpatient admission, status on admission, and recommendations on discharge

There were 101admissions during that period, and 74 of them were prescribed these agents (n = 74; 73.3%). Fifty one (n = 51; 68.9%) received benzodiazepines only, twenty-three (n = 23; 31.1%) were prescribed Z-drugs, and twelve (n = 12; 16.2%) received both benzodiazepines and Z-drugs. Forty two patients (n = 42; 56.8%) were commenced on hypnotics in the APU, 23 patients (n = 23; 31.1%) already received hypnotics from the CMHTs, and the rest were prescribed by both. Thirty two patients (n = 32; 43.2%) were discharged on hypnotics. Patients admitted involuntarily and female patients had longer admissions (mean of 16.62 ± 3.26 days and 16.16 ± 2.89 days respectively). Schizophrenia and BPAD were the commonest diagnoses.

It appears that large amounts of these agents are used in the Acute Hospital Setting which is not overly surprising given the severity of illness and clinical indications however improved awareness could still lead to more appropriate and hopefully reduced use. We therefore recommend:

A formal audit including appropriate interventions i.e., educate staff and patients, highlight guidelines, and review subsequent practice.

Train staff in safer prescribing practices including prn rather than regular use if appropriate.

Regularly review discharge prescriptions indicating recommended duration of use.

This study explores common themes emerging from root causes of Serious Incident (SI) reports of mental health service users who died by suicide under the care of a mental health trust.

Suicide is a global health problem. It is estimated every year about 800,000 people die by suicide worldwide. Previously, the United Kingdom (UK) reported a significant reduction. However, the latest report in 2018 indicated a marked increase. Furthermore, 28% of people who died by suicide in the UK were under the care of mental health service 12 months prior to their death. The causes of suicide are not usually straightforward, but sometimes could be preventable. Thus exploring the root causes is a step in the right direction to preventing this global problem.

Thematic analysis was carried to identify themes emerging from the Root Causes (RCs) within the Serious Incident (SI) reports of patients who died by suicide while under the care of the Trust between January 1st, 2017 and July 31st, 2018. Over the 18 month period, there were 71 deaths, of which 36 were ruled as suicide by the coroner. A further 16 were considered by the review team as possible suicide and were therefore included to increase the scope of learning. This review is therefore based on 48 cases.

Three main themes emerged from this study. They are patient, professional and organisational factors. Majority of the death were patient related factors, particularly exacerbation of patient's mental health condition. Furthermore, the most frequently occurring professional and organisational factor were issues around patient risk assessment and management and inadequate psychiatric bed respectively.

The findings of this study have helped gained an understanding of the perceived causes of death of patient who died by suicide. It is hoped that this will in turn influence the manner in which, decisions, policies and resource allocation are carried out to further prevent and reduce the incidence of suicide, particularly amongst mental health patients.

Post-Traumatic Stress Disorder (PTSD) is a mental health disorder characterised by symptoms of re-experiencing, avoidance and hyperarousal that may develop after exposure to a traumatising event. The prevalence of PTSD within the refugee population is ten times higher than in the general population. This audit was carried out in Cardiff Health Access Practice (CHAP) which is the main provider of primary health care for refugees and asylum seekers who are sent to Cardiff. The main objective of this audit was to evaluate current PTSD prescribing practice for patients presenting to Cardiff Health Access Practice (CHAP) against a pharmacological prescribing algorithm which has been developed for the Cardiff and Vale Traumatic Stress Service based on NICE and International Society for Traumatic Stress Studies guidelines

A retrospective audit of patients with PTSD seen in the last 12 months at CHAP. Data were collected from patient notes and information on age, sex, trauma, comorbidities and medication dose was collated and analysed using SPSS statistics.

130 patients with PTSD were identified and their medications assessed for the audit. The mean age of these patients was 33 years and there was a 1.5:1 male to female ratio. Of the 130 patients only 10 were initiated on a first line medication, 117 were started on a fourth line medication. No patients were prescribed either the second- or third-line medications.

The low rates of compliance with the All Wales Pharmacological PTSD pharmacological prescribing algorithm are disappointing although not unexpected as it has yet to be fully introduced to the service. Following discussion of the results and teaching about the algorithm with clinicians in Cardiff Health Access Practice rates of evidence-based prescribing should improve. This audit focuses on a patient group (refugee and asylum seekers) which has been identified as a priority group by the Welsh Government. Through further implementation of this algorithm there should be improved evidence-based prescribing and continuity of care for refugees

To re audit the monitoring of Plasma Clozapine levels in Rehabilitation setting in CNTW Trust as per Trust Guidelines PGN on “Safe prescribing of Clozapine”.

Objectives:

To determine if

1. The reason for a clozapine plasma level request is recorded.

2. Results are recorded correctly.

3. Appropriate action is taken and recorded when results are significant.

Clozapine plasma level monitoring is useful when assessing adherence, adjusting the dose, monitoring the effects of changes in smoking habit, investigating clozapine side effects and when toxicity is suspected.

An initial audit was carried out within the Trust in 2015 and the following recommendations were made:

Check and record clozapine plasma level

At baseline (a level should be taken once the patient has been on the target dose for at least a week)

Annually.

When clinically relevant to optimise therapy.

An entry must be made in the patient's progress notes recording the reason of requesting the test.

On receipt of results, the paper copy must be scanned & an entry made in progress notes.

The clinician should comment on the significance of the results and propose an action plan.

We re-audited compliance with the guidance in Rehabilitation (inpatients and community) by reviewing patient notes for a 2 year period of 2017–2018.

The audit work involved a review of 31 case records of patients prescribed Clozapine whose last plasma level was taken between 2017–2018. Patient's details were identified from a randomly generated list by the Trust pharmacy.

<50% compliance was seen with baseline, annual monitoring, reason for recording and proposed action plan by clinician.

>50% compliance was seen with scanned results and levels checked when clinically relevant.

No significant improvement from the previous audit except improvement in compliance with documentation of levels.

Dissemination of Clozapine Key cards within teams.

To assess level of compliance with national and local guidance with regards to the recording of service users smoking status and offering of interventions.

Across the general population, prevalence of smoking is decreasing but in those with severe mental illness, the prevalence hasn't significantly changed. LYPFT are working towards becoming a smoke-free trust. The Trust Guidance expects that Trusts should ask 100% of service users if they smoke (which should be recorded on their physical health CQUIN) and of those that do, should be offered nicotine replacement therapy and cessation advice. Public Health England is working towards all hospital trusts across the UK being Smoke-free.

All service users on each of the 4 adult inpatient wards at the Becklin Centre, Leeds, were included in the audit. A total of 78 service users were included in the audit.

We reviewed the digital records for every service user, specifically looking at the physical health CQUIN. We recorded if smoking status had been documented and what interventions (if any) had been recorded as given. Possible interventions included offering brief advice and offering Nicotine replacement therapy. We then reviewed medication charts to see if any nicotine replacement therapy had been prescribed.

The audit found that approximately half of all service users in our audit smoked cigarettes and that the vast majority of these had their smoking status documented in their digital medical records.

Three quarters of those that smoked were offered brief cessation advice and half of them were offered Nicotine Replacement Therapy. Only a third of service users that smoked had NRT prescribed on their medication chart. This represented 65% of those recorded as being offered NRT.

There are numerous possible reasons for the above outcomes. These include a lack of knowledge and confidence in delivering smoking cessation interventions, conversations having taken place but not recorded and confusion regarding the appropriate staff member to deliver the intervention. In addition, whilst only medical professionals typically prescribe NRT, the physical health CQUIN is recorded by nurses. Therefore, this may reflect a lack of communication between staff groups.

Our trust will become smoke free in the near future. To facilitate this, we hope to reduce the discrepancy between the number of service users who smoke and the number prescribed NRT.

The number of people over the age of 65 attending Emergency Departments (ED) in the United Kingdom (UK) is increasing. Those who attend with a mental health related problem may be referred to liaison psychiatry for assessment. Improving responsiveness and integration of liaison psychiatry in general hospital settings is a national priority. To do this psychiatry teams must be adequately resourced and organised. However, it is unknown how trends in the number of referrals of older people to liaison psychiatry teams by EDs are changing, making this difficult.

We performed a national multi-centre retrospective service evaluation, analysing existing psychiatry referral data from EDs of people over 65. Sites were selected from a convenience sample of older peoples liaison psychiatry departments. Departments from all regions of the UK were invited to participate via the RCPsych liaison and older peoples faculty email distribution lists. From departments who returned data, we combined the date and described trends in the number and rate of referrals over a 7 year period.

Referral data from up to 28 EDs across England and Scotland over a 7 year period were analysed (n = 18828 referrals). There is a general trend towards increasing numbers of older people referred to liaison psychiatry year on year. Rates rose year on year from 1.4 referrals per 1000 ED attenders (>65 years) in 2011 to 4.5 in 2019 . There is inter and intra site variability in referral numbers per 1000 ED attendances between different departments, ranging from 0.1 - 24.3.

To plan an effective healthcare system we need to understand the population it serves, and have appropriate structures and processes within it. The overarching message of this study is clear; older peoples mental health emergencies presenting in ED are common and appear to be increasingly so. Without appropriate investment either in EDs or community mental health services, this is unlikely to improve.

The data also suggest very variable inter-departmental referral rates. It is not possible to establish why rates from one department to another are so different, or whether outcomes for the population they serve are better or worse. The data does however highlight the importance of asking further questions about why the departments are different, and what impact that has on the patients they serve.