A psychiatric inpatient admission can be the most challenging part of navigating mental illness. Patients are often at their most vulnerable when facing the unknowns of an admission. Patients are usually oriented to the wards through conversation, a quick tour or written material provided at the time of admission. These existing interventions vary in delivery and uptake and standardised, accessible orientation materials remain scarce. This quality improvement project (QIP) evaluated the impact of a co-produced animated orientation video on patients’ perceived knowledge and anxiety around admission. Secondary aims included exploring experiences of existing orientation interventions, identifying anxiety sources and knowledge gaps, and gathering feedback.

This mixed-methods QIP was conducted at two acute mental health wards for adults at the Whiteleaf Centre, Aylesbury. An animated orientation video was co-produced by the in-patient transformation team, clinicians, and experts-by-experience. A brief questionnaire was designed with inputs from service users and administered to patients admitted between July and November. Pre-determined exclusion criteria were: declined participation, in seclusion, not oriented, and >48 hours since admission. Patients rated knowledge and anxiety on single Likert items pre- and post-video, and answered open-ended questions about anxiety sources, knowledge gaps, existing interventions, and video feedback. Quantitative data were analysed using Wilcoxon signed-rank tests.

Of 31 patients approached, 20 were included (14 male, 6 female; age range 17–63; mean 36.1 years); 80% were experiencing their first admission. At baseline, 55% reported anxiety and 35% reported that they did not know what to expect upon admission. Helpfulness of existing interventions varied: ward tour 82% (14/17), one-to-one chat 86% (12/14), patientinformation pack 50% (8/16). 85% (17/20) found the video helpful. Knowledge improved significantly (median 3.0 to 4.0; W=55.0, p=0.001); anxiety showed a favourable but non-significant trend (median 4.0 to 3.0; W=6.0, p=0.125), with no patient reporting increased anxiety. Themes that emerged highlighted reassurance, clarity about facilities, and structured orientation as strengths. Suggestions included adding content on leave arrangements, treatment types, and ward-specific information. The animated format was highlighted as a strength by some patients (2/20) and a distractor by others (3/20).

A co-produced orientation video is an acceptable and effective intervention for improving knowledge of what to expect during psychiatric inpatient admission. Iterative refinement of video design and content can further tailor it to meet patients' needs.

People with severe mental illness have a life expectancy that is 10 to 20 years shorter than the general population. Cardiovascular disease plays a major role in this gap. Additionally, forensic inpatient population often experiences prolonged admissions and has limited access to community physical health services. QRISK3 is a tool that estimates an individual's 10-year risk of having a heart attack or stroke. This project aimed to assessQRISK3 scores in forensic low and medium-secure male wards and offer atorvastatin for primary prevention when appropriate.

A snapshot review was conducted in November 2025 among 59 inpatients in Brockfield House low and medium secure male wards. 5 patients younger than 25 years old were excluded as QRISK tool is only valid for patients aged 25–84 years. QRISK3 scores were calculated for all eligible individuals using Mobius (an electronic record system) and patient interviews. Patients with a QRISK3 score of 10% or higher were informed of their increased cardiovascular risk and offered atorvastatin based on primary prevention guidelines (https://cks.nice.org.uk/topics/cvd-risk-assessment-management).The collected data was saved in a password-protected Excelspreadsheet.

A total of 54 patients were included in the analysis. The mean age was 41.98 years (range 25–69).14% of patients were current smokers (n=8), 50% were ex-smokers (n=27), 31% had diabetes mellitus (n=17), and 11% were prescribed antihypertensive medication (n=6). The mean BMI was 32.33 kg/m², 91% of patients had a BMI ≥25 kg/m² (n=49), indicating overweight or obesity. 16 patients had a QRISK3 score ≥10%. Of these, 11 patients were already prescribed a statin. The remaining 5 patients were offered atorvastatin for primary prevention; 4 agreed to commence treatment following consultation, while one declined. QRISK3 scores were documented in Care Programme Approach (CPA) reports for all patients in whom they were calculated. On average, it took 12 minutes and 36 seconds to gather information and calculate the QRISK3 score.

This QIP demonstrates that cardiovascular risk assessment using QRISK3 in forensic psychiatric inpatient settings is practical, time-efficient, and clinically valuable.Integrating QRISK3 scoring into routine CPA documentation may improve identification of patients at increased cardiovascular risk and increase appropriate statin prescribing for primary prevention in line with NICE guidelines.

A Quality Improvement Project (QIP) aimed to reduce the pharmacological interventions for behavioural and psychological symptoms of Dementia(BPSD) by 40–60% on Bryngolau Ward, a specialist Old Age Psychiatry unit in Prince Philip Hospital, Llanelli; through optimised non-pharmacological strategies.

Using the Model for Improvement and Plan–Do–Study–Act (PDSA) cycles, the project implemented a combination of interventions including staff education, sensory room utilisation, guideline promotion, and structured assessment tools (e.g., ABC charts). Baseline data (two 15-day periods) were compared against four PDSA cycles (15 days each)measuring BPSD incidence, use of pharmacological and non-pharmacological interventions, and falls.

Pharmacological interventions decreased from 44.3% (baseline) to 23.5% (Cycle 4), exceeding the target (average reduction: 42.5%). Non-pharmacological interventions rose from 55.7% to 76.5%. BPSD incidents dropped by 56% (Cycle 4), and falls reduced by 76% (Cycle 3). Variability in Cycle 3 highlighted situational challenges, but overall trends demonstrated sustained improvement.

The QIP successfully shifted practice towards non-pharmacological BPSD management, reducing medication use and improving patient safety; adhering to national guidelines. Key drivers included staff training, sensory resources, and iterative PDSA refinements. Recommendations include embedding these strategies into standard practice, ongoing staff development, and expanding monitoring to ensure sustainability. This project provides a replicable framework for dementia care settings aiming to minimise pharmacological reliance.

Life expectancy in serious mental illness (SMI) can be reduced by 15–20 years on average. This is in part due to lack of integration between physical and mental health services.

Prior to this project, there was no formal referral system for mental health inpatients in Central Northwest London (CNWL) to seek advice or refer to physical health services. In the community, GPs use Electronic Referral System (eRS) for accessing secondary services. eRS provides an entirely paperless system for contacting other health professionals, using a secure system. This system also improves access and reduces the admin time required to make and chase appointments and advice requests. It is widely used by GPs.

The aim of our project was to introduce eRS onto all the wards within St Charles Hospital Mental Health Unit (MHU). This was intended to reduce the time between a referral being planned, and a response being received from physical health services, by 50% within a year.

The initial stage was to collect a baseline measurement of the number of days it took between a plan being made for physical health input and receipt of a response.

We engaged stakeholders including Information technology services, General Practitioners and physical health colleagues to implement eRS in the MHU.

We collected data of the number of days it took from a plan for a physical health referral being made to response prior to eRS. We then re-audited the number of days it took once eRS was in place. The first cycle involved one ward, Redwood ward, for older adults. Following each cycle we scaled the project up, and introduced eRS to all wards at St Charles MHU.

Once eRS was integrated the number of days between a plan being made for a physical health referral and a response being received reduced on average by 94% from 53.95 days to 3.2 days on Redwood ward. The ward doctors provided feedback, saying “the system is much better and easier to follow”.

Data collected in St Charles MHU showed the number of days between a plan being made for a physical health referral and a response received reduced on average by 79% from 20 days to 4.4 days.

eRS has shown itself to be helpful for improving access to physical health. There is now widespread awareness of the system among doctors at St Charles and eRS will improve integration between physical and mental health.

Child and adolescent mental health services (CAMHS) and child development clinics (CDCs) in the UK are facing unprecedented demand, resulting in prolonged waiting times for assessment of neurodevelopmental conditions, including autism spectrum disorder andattention deficit hyperactivity disorder. Delayed diagnosis and intervention are associated with poorer outcomes, with administrative burden being a key contributor to limited assessment capacity. Emerging digital health technologies like ambient voice technology (AVT) can reduce this burden and improve service efficiency. This second-phase study builds upon the authors’ previous AVT proof-of-concept pilot.

The objectives were to:

1. Assess the performance of AVT across a broad range of use cases in CAMHS outpatient clinics and a CDC.

2. Assess the impact of AVT on quantitative and qualitative clinical outcomes, including administrative burden.

3. Explore clinician, patient and carer perceptions towards AVT in clinical settings.

We conducted a mixed-methods pre-post service development pilot from January to July 2025. The study was conducted across three outpatient sites: two CAMHS outpatient clinics and one CDC. Clinicians spanning CAMHS and neurodevelopmental roles were invited to participate, testing 13 use cases, mostly diagnostic assessment components for neurodevelopmental conditions. Clinician participants completed both baseline (manual documentation) and intervention (AVT-assisted documentation) phases. The primary outcome measure was self-reported time taken to complete administrative tasks per clinical encounter. Secondary outcome measures included qualitative clinician experience and patient/carer perception and acceptability of AVT. Data was analysed using descriptive statistics and mixed linear regression.

37 clinician participants provided baseline and intervention timesheet data. Mostwere full-time working mental health nurses, aged 25–34 and female. A total of 1,085 clinical appointments were recorded, with 50% (n=543) using AVT. Across all use cases, the mean time taken for administrative tasks was 28% less in the AVT group compared to manual documentation (p<0.001). However, satisfaction with documentation accuracy and confidence in documentation quality were significantly higher with manual documentation (93% and 100%, respectively) compared with AVT (60% and 56%). No significant differences were found in perceived efficiency of seeing patients or completing administrative work. Data from patient/carer surveys revealed no significant differences between AVT and manual documentation across any measures.

AVT significantly reduces documentation burden in neurodevelopmental assessments and is acceptable for patients and carers. However challenges including documentation accuracy and quality must be addressed. Further evaluation across other mental health and neurodevelopmental settings is necessary to validate these findings.

Tees, Esk and Wear Valley’s Eating Disorder teams recognised a lack of guidance to inform the introduction of exercise in young people with eating disorders. An MDT group reviewed evidence and international guidelines to inform the drafting of a decision-making tool in line with national risk assessment frameworks.

1) A multidisciplinary team assembled monthly, including physical and mental health clinicians and dieticians, to develop and refine guidelines.

2) A literature search was conducted to seek up to date best practice globally.

3) The impact and utility of the framework was assessed through pre-and post-guideline questionnaires distributed to the Eating Disorder Team.

4) Artificial Intelligence assisted Thematic Analysis explored pre-and post-guideline responses.

Thematic Analysis highlighted:

1. Guidance and decision tree were seen as helpful and providing more structure. There were still some requests for improved communication and shared application.

2. Some variation in decision making exists post guidelines, but several team members noted improved consistency with guidance/decision tools. Some pockets of inconsistency remain.

3. Greater reflection on balance of risk. Some felt the team were still overly cautious in the reintroduction of exercise, but others noted guidance enabled positive risk-taking for young people.

4. Confidence generally higher in this area within the team. Respondents highlighted MDT strength and guidance as supportive tools. Some newer staff still unsure around advice in this area.

Themes emergent from pre-and post-draft guideline questionnaires reflected those identified in wider clinical studies around the management of exercise in Eating Disorder interventions. Teams believed exercise was crucial to recovery, bringing benefits to mental and physical health, providing connection with past activities that previously brought enjoyment. The introduction of new clinical guidelines were felt to enable positive risk taking whilst improving consistency and confidence within the MDT.

The training scheme prospectus is usually the initial reference for prospective Higher Trainees (HT) in ranking training programmes. An outdated prospectus fails to showcase the strength of individual training schemes, resulting in failure to attract prospective trainees. The North Central and East London (NEL) Prospectus for Child and Adolescent Psychiatry (CAP) on the Health Education England (HEE) website had not been updated since2021 and recruitment into the scheme had declined resulting in up to 40% vacancies for the February 2025 recruitment cycle.

The aim of this QIP is to revise and update the NEL CAP training scheme prospectus to improve recruitment and retention of HTs by enhancing trainee confidence.

A PDSA cycle using surveys and focus groups including trainees and trainers at each placement across 4 Trusts, was used to gather feedback to identify gaps in the Prospectus. The key areas identified for revision included providing detailed placement descriptions and job-specific teaching, research, psychotherapy, special interest and leadership opportunities.

An initial survey of the trainees in the last 3 years indicated that more than half of the trainees (53%) never referred to the outdated Prospectus to guide their scheme selection to inform placement ranking, or to explore training opportunities. Of the 47% who referred to the prospectus, only 31% felt that their scheme selection was guided by the prospectus. Only 33% of the trainees used the outdated prospectus to rank their placements and to explore job-specific special interest opportunities.

Following the initial survey, the updated prospectus was distributed to all the trainees in February 2026. Formal qualitative feedback from trainees showed that the updated job descriptions of posts ‘reads well’, ‘pitched at a good level of detail’, shows ‘what to expect’,‘eases anxieties’,helped them ‘understand their roles’,and provides job-specific opportunities. Consultant feedback suggested that the updated prospectus was necessary in reflecting the strength of the training scheme and the broad range of opportunities available to the trainees.

The revised prospectus will be shared with HEE and the second cycle of PDSA will be completed in the next recruitment cycle in August 2026.

The revised prospectus has improved trainee confidence in the Scheme and in guiding their training progression. Further cycles will evaluate its impact on trainee recruitment and retention to the scheme.

The RCPsych Recruitment and Retention Charter identifies good quality inductions and creating a culture of belonging as strategies to improve workforce wellbeing.

The North Central and East London Child and Adolescent Psychiatry Higher Training (NEL CAP HT) scheme incorporates 19 placements across four different trusts. After thepandemic, inconsistent one-hour online inductions were provided by current trainees for new starters without formal protected time.

To address uncertainty towards placements, anxieties when starting on-call work and to prevent risk to patient safety, a quality improvement project was undertaken:

• • To improve NEL CAP trainee onboarding experienceby developing a standardised, mandatory, in-person induction.

• • To improve morale, build trustand cohesiveness amongst trainees and trainers.

Cycle 1 (August 2025) evaluated transition from fragmented online inductions to a structured half day, in-person session. Surveys measuring trainee confidence in onboarding andon-call experiences were completed by both previous trainees who had experience of online inductions and the new starters (n= 15).

Cycle 2 (January 2025) incorporated feedback from Cycle 1 to plan a full day in-person induction involving senior trainees and trainers, enriched with simulation case scenarios and a Microsoft Teams repository of relevant policies and protocols.

Quantitative data:

• • Confidence in managing out of hours on-calls increased by 16%.

• • Confidence in understanding the scheme structure and individual placements increased by 15%.

Qualitative themes:

Moving from an online to in-person induction led to a shift from trainees feeling isolated and anxious at the start of joining the scheme, to a sense of connectedness and reduced on-call anxieties.

Trainees frequently cited peer interaction and presence of trainers in the in-person induction as the most helpful part of their onboarding experience.

In-person induction improves the scheme onboarding experience for trainees by reducing their anxieties and ensures patient safety. Trainer presence in higher trainee induction boosts morale and improves psychological safety for new starters. A formal full day induction incorporating timely changes to the scheme and on-call workflows using simulation-based learning, is expected to further enrich content delivery.

Psychological safety and commitment to excellence are both critical in effective problem solving within healthcare. In the MMSPS MDTs were conducted virtually and there was a lack of consistency in chairing. We noticed tension in discussions and an avoidance of bringing cases to MDT. We explored the reasons for this with the aim of improving the quality of our MDTs leading to better patient care.

We formed a small working group of the Team Manager, Lead Psychologist and aConsultant Psychiatrist. We conducted a brief ten question survey of all staff in the MMSPS, gathering their views on their experience of and the effectiveness of MDTs. This included yes/no and free text responses. Responses were anonymous and reviewed by the working group only.

We had a high response rate of 69% across a range of professions indicating staff were engaged in this project. 38% of respondents did not feel MDTs were effective in their current format. 54% preferred face to face meetings over virtual. A third did not feel confident speaking during MDTs. Qualitative themes included feelings of conflict, feeling unsupported, contributions not feeling valued, ineffective use of MDT time and unstructured presentations.

We identified that key areas for improvement were psychological safety and MDT structure and implemented multiple strategies to improve these areas. We designed an MDT document including 8 points of “shared understanding” (ground rules) agreed on by the whole team, guidance on which cases to bring to MDT and on the role of the chair. We designed a tool for structuring presentations. We implemented a hybrid model giving the choice of face to face or virtual attendance and agreed the leadership team would chair meetings. We held a launch presentation to introduce the new concept to the team, including sharing a video on psychological safety, and we set a date for re-launch of the MDT.

Feedback from staff members has been overwhelmingly positive. The majority of staff prefer to attend face to face. There has been a notable reduction in conflict within meetings, an improved feeling of safety and improved structure and timekeeping. We are repeating the survey shortly to gather formal feedback on the new process. These strategiescould be replicated by other mental health teams hoping to implement a more psychologically safe approach to MDTs.

National standards require that adults start to receive help within four weeks of referral, which may include advice, support, or an initial assessment. Nevertheless, meeting this standard has been increasingly challenging for the Barnet West Community Mental Health Team due to rising referral volumes and clinical complexity. This project initially aimed to increase the proportion of referrals receiving first contact within 28 days by ≥10% over 1 year. As cycle 1 surpassed this target, cycle 2 aimed for a further ≥20% over 6 months.

Stakeholder consultation suggested that establishing a non-clinical Referral Coordination team could improve access without increasing clinician workload. The team would provide proactive early telephone contact to gather information, assess risk, and escalate or relay clinician advice where required.

In cycle 1, Foundation Year doctors piloted the Referral Coordination role. To minimise impact on their training, they contacted only incomplete or high-risk referrals.

Following demonstrated safety and benefit, cycle 2 employed 2 non-clinical workers to form a dedicated Referral Coordination team. They contacted all new referrals and reviewed outcomes at weekly multidisciplinary meetings.

The primary outcome measure was the proportion of referrals receiving first contact within 28 days of referral. Patient satisfaction with waiting times was measured as a secondary outcome via telephone survey. Due to high referral volumes, outcome measures were collected for a random sample of 50 patients per cycle.

Baseline data showed that only 24% of referrals were contacted within 28 days. Median time to initial contact was 51.5 days (range 307, IQR 53), and 34% of referrals reported satisfaction with waiting times.

In cycle 1, 44% of referrals were contacted within 28 days, with a reduced median wait of 31.5 days (range 284, IQR 73); satisfaction increased to 48%. In cycle 2, 96% were contacted within 28 days, with a median wait of 5 days (range 41, IQR 4); satisfaction was reported by 44%. Notably, only 21% reported dissatisfaction whilst 15% abstained, stating they had not wished to be referred.

The Referral Coordination team was successful in achieving near-universal timely contact. It also acted as an early warning system for clinical risk and reduced competing demands on doctors. Patient satisfaction did not correspond directly with access, suggesting influence from contextual factors such as patient expectations. Future work mayexplore additional drivers of patient experience to ensure service changes deliver meaningful benefit for patients and carers.

To evaluate the Institute of Mental Health's (IMH) clinical governance and quality processes following an independent review of systems related to care lapses, and to implement standardised root cause analysis (RCA) processes to improve patient safety outcomes.

An independent review of IMH's clinical service delivery model and governance processes was conducted, examining Serious Reportable Events (SRE) and Sentinel Events (SE) from January 2017 to October 2023. A two-pronged approach was employed: an independent-led review by the National Healthcare Group and an internal self-review. Further in-depth analyses of selected incidents were conducted by subject matter experts using selection criteria based on recency, incident type, severity of harm, and findings. Root causes and recommendations were assessed using the New South Wales Root Cause AnalysisReview Committee's Classification of Recommendations. Following identification of governance deficiencies, a comprehensive change management process was implemented incorporating six key strategies: educate, engage, empower, evaluate, encourage, and escalate. A standardised RCA process utilising the Human Factors Analysis and Classification System (HFACS) framework was adopted, with establishment of the SRE-SE Oversight Panel in October 2024 to ensure oversight and consistent quality of the RCAs.

The review identified inadequately robust clinical and quality governance processes. Previous RCA investigations were sub-optimal, resulting in weak recommendations and reactive responses that missed opportunities for systems-level improvement. Prior to HFACS implementation, majority of recommendations in 2022 and 2023 were classified as 'weak', relying heavily on memory and vigilance. Post-implementation, there was an increase in robust, system-level recommendations requiring greater senior management involvement. However, approval processes initially extended to 373 days, failing to meet the 60-day requirement stipulated by the Ministry of Health. Following establishment of the SRE-SE Oversight Panel, approval times reduced from an average of 145 days to 50 days by April 2025. Despite improved recommendation quality, there was a decrease in the percentage of recommendations implemented within stipulated timeframes, attributed to the increased complexity of system-level interventions.

The implementation of standardised RCA processes using HFACS successfully improved the quality and robustness of safety recommendations at IMH. However, stronger system-level recommendations require greater resources and extended implementation timelines. Continuous improvement through iterative Plan–Do–Study–Act cycles, stakeholder engagement, and appropriate escalation processes are essential for drivingsustainable change in psychiatric healthcare quality and safety initiatives.

Multiple projects across the country are fortunately looking closely at violence and aggression happening to health and social care workers. This is a piece of work around experience of support made available to resident doctors in psychiatry following violence and aggression incidents.

This QI project aims to improve the quality of support and spread awareness about available channels to resident doctors following abuse incidents. A baseline survey was conducted to explore awareness of available channels, rate satisfaction with them, improve them as well as suggest new possible ways of providing support.

As a part of the QI project, we did a baseline survey to explore whether resident doctors had access to support after a violence and aggression incident and how satisfied they were with it. We then did a root cause analysis (RCA) workshop where resident doctors identified reasons for not accessing these channels.

41 resident doctors participated in the survey. 12 residents reported experiencing anincident of violence and aggression (1–2) times and 8 of these residents were in a junior entry level (CT1–CT3). 22 of these incidents were identified as verbal. 85.71% of residents were not aware of available channels of support in the trust. This coincided with 75% of residents not seeking support. Of the participants that did seek support, 2.44% graded the level of satisfaction with the type of support as 1 (very unsatisfied) and the follow-up answer was (due to lack of communication following the report and not knowing what the outcome of the report was). We then carried out an RCA and the resident doctors identified multiple causes to not seeking support including (not knowing how to access support, feeling speaking up is a burden, feeling the process is not followed through, feeling like they don’t belong due to rotating every 6 months) etc.

The residents have overall agreed there is room for improvement on the level of support available. We used the suggested themes in the RCA to come up with an action plan. Measures we have come up with are including all information around support channels in the induction file given to all new starting resident doctors, spreading awareness about available support on the trust intranet, liaising with the incident reporting system representatives in the trust to improve reporting process and include proper follow up. We are also still meeting regularly to discuss and improve our action plan.

The aim of the project is to explore resident doctors’ experience of workplace-based violence within Central and Northwest London NHS Foundation Trust. These findings will help:

1) To identify barriers to reporting incidents.

2) To improve access to wellbeing support provided to resident doctors.

3) To update serious incident policy for resident doctors.

Both qualitative and quantitative surveys were conducted among all the resident doctors in Central and Northwest London NHS Foundation Trust.

Quantitative Survey: Between January and February 2025, Resident Doctors within Central and Northwest London NHS Trust were invited to complete a 13-item quantitative survey. 34 responses were received.

Qualitative Interviews: Following responses from quantitative surveys, seven resident doctors who reported workplace-based violence through Datix agreed to participate in semi-structured qualitative interviews, consisting of 13 questions. All the interviews were conducted through Microsoft teams and transcribed. Interview responses were analysed through thematic analysis to identify common themes and subthemes of individual perception and reflection on their experience of violence.

Quantitative Survey:

34 resident doctors from different grades (foundation year doctors, GP trainees, core trainees, and higher trainees) across five different boroughs responded to quantitative surveys. Of these, five core trainees, three higher trainees, two foundation year trainees and two GP trainees reported the violence.

These resident doctors who experience violence are 40% from inpatient units and 60% from community clinics. Physical and non-physical violence are most common types of violence that resident doctors experienced. Only 7 out of 20 resident doctors who experienced workplace violence reported the incident through the incident reporting system called Datix.

Qualitative Survey:

Seven resident doctors participated in interviews exploring their experience of workplace-based violence. Participants include one higher trainee, one GP trainee and five core trainees. Participants highlighted there were significant impacts of violence or aggression on emotional wellbeing as well as professionally on career commitment. A common theme emerging from the semi-structured interviews was that resident doctors who experienced physical violence were preceded by non-physical or verbal violence.

Resident doctors experiencing workplace violence and aggression in the NHS is common across different specialities, among which unfortunately psychiatry resident doctors experience the most.

In addition, resident doctors in training do not have always access to the help and support that they need following these incidents. Quantitative survey and Qualitative thematic analysis of this project call for Improved access to various wellbeing resources and Individual support for all resident doctors who experience workplace-based violence.

Repeat FP10 prescribing from secondary care increases administrative burden, risks medication gaps for patients, and may delay timely access to treatment. The South Hub (Yewcroft) team initiated a QI project to streamline repeat prescribing processes and increase timely initiation of Enhanced Shared Care Agreements (ESCAs) so that stable patients could be managed by primary care.

By 31 January 2025, we aimed to reduce the weekly frequency of repeat FP10 issues for patients under Yewcroft CMHT by 20%.

A multidisciplinary project team used Plan–Do–Study–Act(PDSA) cycles to test multiple change ideas across four domains: (1) facilitate use of the electronic prescribing and medicines administration system (EPMA) for FP10 generation; (2) improve accuracy and accessibility of repeat-prescription tracking; (3) strengthen liaison with GPs through timely ESCA initiation and repatriation letters; and (4) introduce a duty doctor rota to improve prescribing responsiveness. Process measures included weekly counts of repeat FP10s, reception calls about FP10s, and weekly antipsychotic FP10s. Baseline data were collected over eight weeks (median 6 repeat FP10s/week).

Multiple interventions were implemented, including EPMA prompts, printer-use guidance, an edited shared spreadsheet for tracking, repatriation letter templates, and a duty rota. Data collection revealed intermittent peaks and troughs without a sustained shift in the primary outcome during the project period. Operational challenges limited impact: variable staff access to systems, frequent staff rotation, printer failures, and constrained administrative capacity impeded consistent implementation and reliable data capture. Despite not meeting the 20% reduction target, the project improved local prescribing processes, increased awareness of ESCA pathways, and produced practical tools (templates, tracking spreadsheet) that the team judged beneficial.

Rapid introduction of multiple changes in a resource-limited context made it difficult to demonstrate measurable improvement within the project timeframe. Future work should adopt a phased approach, secure protected data-collection capacity, prioritise system access for prescribers, and include ESCA-signed rates as an additional outcome. With these adjustments, the interventions piloted here have potential to reduce repeat FP10 burden and improve continuity of care.

To improve access to the young person psychotherapy service by adapting intake requirements. National data indicates that there is an impact of ethnicity on accessing therapies. Our aims are to improve attendance of the initial pre-assessment consultation (PAC) appointments, but also to see if there is an improvement to PCREF diversity. To support the AYAS team in achieving the existing 4-week KPI target between referral and appointment by reducing DNAs and cancellations.

1) Data was collected during the period between April 2024–June 2025 on patients who either did not attend (DNA) or cancelled their initial pre-assessment consultation (PAC) appointments. Patient records were reviewed to understand the most common reasons why patients were unable to attend their appointments.

2) Stakeholder engagement was also sought by collecting opinions from staff members involved in the opt-in process.

3) Using the above data and feedback, a new opt-in template was developed that was user friendly, age appropriate, and helpful for booking appointments, thus improving the experience for patients and staff.

4) Following its implementation, data was collected on whether the new process was effective in achieving our initial aims and objectives. Continued feedback will be sought from patients and staff members to inform a new cycle of quality improvement in the future.

Data collected in the 14 months between April 2024–June 2025 found 21 DNAs and cancellations. The most common reason given for cancellations and DNAs was because their appointment clashed with college, work or other commitments (10). This was followed by being given too short notice (5) and sickness (4). Of the 304 appointments offered in 2024–2025, there were 42 first-appointment DNAs. Of these, the most common ethnicities were White British (10), White Other (6) and Black African (6). There was an improvement in the time it took for patients to respond once an opt-in was offered, which was supported by feedback from staff members involved in the opt-in process.

The new opt-in process for the Adolescent and Young Adult Service (AYAS) has demonstrated promising results in improving the rates of response for patients offered an opt-in to attend the pre-assessment consultation (PAC). Previous data suggests that there is no impact of diversity on attendance. Ongoing data collection is required to assess its longer-term impact on the service.

The Barnet Enhanced Support Team (BEST) are a multidisciplinary CAMHS service. BEST is a specialist Tier 3 CAMHS service to provide higher intensity support for children and young people (CYP) with complex mental health needs and their families. The aim is to improve the understanding of clinicians belonging to the Barnet CAMHS team of the BEST'sreferral criteria and what the service offers.

1) A pre-intervention questionnaire was given to members of the Barnet CAMHS team. Questions included: whether they have heard of the BEST service, if they have referred to the BEST service in the past, if they know how to refer, how familiar they were with the referral criteria, how confident they were in knowing what services BEST offers, how easy they found the process, how it can be improved, what service they work with and their role.

2) An information poster was made outlining who the BEST service are, what the service does, and how to refer to the service. This poster was presented to members of the Barnet CAMHS team during the weekly multidisciplinary team (MDT) meeting.

3) A post-intervention questionnaire was given to members of the Barnet CAMHS team. Questions asked were the same as in the pre-intervention questionnaire in order to observe a change in response.

4) Data from the pre- and post-intervention questionnaires were analysed to identify changes and what further improvements can be made, thus providing insight for further quality improvement cycles in the future.

31 pre-intervention and 13 post-intervention questionnaires were collected. The number of people who know how to refer to the BEST service increased by 53.60%. The familiarity of people with the referral criteria (rated out of 10) increased by 54.97%. Confidence in knowing what the BEST service offers increased by 35.33%. Ease of the referral process (rated out of 10) increased by 48.57%. Respondents suggested that the referral process can be improved by attending the BEST MDT meetings in order to hear the outcome of the referral.

The completion and presentation of the Barnet Enhanced Support Team (BEST) information poster produced an improvement in members of the Barnet CAMHS team's awareness of the service, including what the service offers and how to refer. Further improvements can be made through a collaborative approach with the respective teams, including by attending the BEST MDT meetings.

Under the Mental Health Act (MHA) 1983, patients detained under Section 3 must have their capacity to consent to treatment assessed on admission and reassessed at the three-month point. Failure to complete these assessments risks breaching patient rights, including those protected under the Human Rights Act, and undermines lawful and person-centred clinical practice.

Aims were (1) To determine compliance with documentation of capacity assessment at admission and at the three-month point for Section 3 inpatients; (2) to identify practical improvements to enhance compliance.

A retrospective audit was conducted on 13 inpatients detained under Section 3 on Vales Ward, Discovery House (LPFT). Admission dates and capacity-assessment records were extracted from the RiO electronic patient record for the period December2019–November 2022. The primary outcomes were the presence or absence of documented capacity assessment at admission and at the three-month review.

Capacity assessment at admission was documented in 46.2%(6/13) and not documented in 53.8%(7/13).

Three-month reassessment was documented in 7.7%(1/13) and not documented in 92.3%(12/13).

Compliance with MHA Section 3 statutory requirements for capacity assessment was poor, particularly at the three-month review. We recommend: (1) implementing automated RiO reminders to clinical and MHA administration teams at −1 month, −1 week, and −1 day before the three-month point; (2) delivering targeted staff education on the legal and clinical significance of capacity reassessment; and (3) providing patient information leaflets regarding consent and MHA rights. A reauditis planned to evaluate the impact of these interventions.

The Alcohol Dependence Guidelines provide the standard for assessment and management of alcohol withdrawal for inpatient units in Nottinghamshire Healthcare NHS Foundation Trust. Compliance with this guideline on the Cedar ward has been inconsistent. This could potentially impact patient safety. Using a problem-focused, collaborative approach, this project aimed to initially measure baseline compliance, identify barriers, and implement changes to improve compliance with the guideline by the end of March 2026.

A retrospective analysis of admissions from August 2025 to March 2026 was used to establish baseline compliance across the various guideline domains (documentation, monitoring, prescribing, and clinical interventions). Data has been collected prospectively to evaluate the impact of implemented change ideas. Multidisciplinary team meetings, survey questionnaires and one to one staff conversations were used to identify barriers for guideline compliance. Changeideas collaboratively identified using a driver diagram included structured teaching sessions for nursing staff and resident doctors, incorporation of alcohol-withdrawal guidance into nursing induction, electronic prescribing notifications prompting CIWA-Ar completion, integration of CIWA-Ar and SADQ tools into the Trust electronic record, and liaison with the Nottinghamshire Area Prescribing Committee to review andupdate existing guidance. Agreed changes were introduced using Plan–Do–Study–Act(PDSA) cycles, with ongoing communication with clinical teams.

Baseline audit findings showed low compliance with several core components of the guideline. Weekly alcohol intake (SADQ score) was documented in 44.4% of cases. Regular chlordiazepoxide prescribing in accordance with guidelines was noted in 55.6% cases, with much lower compliance for as required chlordiazepoxide prescriptions. Escalation of appropriate concerns for clinical review was documented in only 25% of cases. CIWA-Ar was completed in 23.97% of cases. A questionnaire survey of resident doctors identified gaps in awareness and challenges related to processes on the inpatient ward. This suggested that both knowledge gaps and systemic barriers contributed to the problem.

The initial audit confirmed poor compliance with alcohol withdrawal guidelines on Cedar ward, with gaps in documentation, clinical knowledge and awareness identified as key root causes. Implemented changes, such as multidisciplinary teaching on the ward, inclusion of teaching in nursing induction, and prompts in electronic records have improved clinician confidence, recognition, and documentation of withdrawal symptoms. Several process changes being implemented including updating the current guidelines. This is expected to address the root causes of poor compliance with a potential for wider Trust-wide adoption.

To improve mental health staff confidence in recognising and assessing common physical health conditions (hyponatraemia, deep vein thrombosis (DVT)/pulmonary embolism (PE), cellulitis/sepsis, neuroleptic malignant syndrome (NMS), serotonin syndrome, and extrapyramidal side effects (EPSEs)) through a structured teaching programme on an acute psychiatric ward.

Mental health inpatients have significant physical health comorbidities and face increased risk of acute physical deterioration. Nursing and allied health staff on psychiatric wards are often the first to notice clinical changes but informally reported low confidence in recognising and initially assessing physical health emergencies. Early identification by ward staff is crucial for timely escalation to medics and improved patient outcomes.

This quality improvement project was conducted on an acute adult mental health ward within Merseycare. A three-month teaching programme was implemented, consisting of six short (<15 minutes) educational sessions covering the above conditions. Sessions were designed for busy ward staff, adapted to areas of weakness identified on the ward, and each session was paired with a summary poster that was displayed in the clinic room to enable access across all shifts. Staff on the ward were sent a pre-teaching questionnaire and a post-teaching questionnaire to identify improvement in self-reported confidence levels.

10 staff members completed post-intervention questionnaire, representing a response rate of 66.7%.

Mean confidence scores across all six clinical conditions improved from 2.6 pre-intervention to 4.3 post-intervention, representing a 65.4% increase.

Individual condition improvements:

• • Hyponatraemia: [2.5] to [4.2].

• • DVT/PE: [3.1] to [4.3].

• • Cellulitis/sepsis [2.6] to [4.4].

• • NMS: [2.6] to [4.3].

• • Serotonin syndrome: [2.3] to [4.4].

• • EPSEs: [2.1] to [3.8].

• • Confidence in escalating physical health concerns [3.9] to [4.4].

• • Confidence in advocating for physical health investigations [3.7] to [4.4].

Brief, accessible teaching sessions combined with visual reference materials significantly improved mental health staff confidence in recognising and assessing common physical health problems and emergencies within psychiatry. This low-cost, sustainable intervention addresses an important training gap in psychiatric settings and may facilitate earlier detection and escalation of physical deterioration, improving patient outcomes.

Dementia affects approximately 850,000 people in the United Kingdom, and early diagnosis is a key priority outlined in National Institute for Health and Care Excellence (NICE) guidelines (1, 2). Increasing referral rates and service capacity pressures have resulted in prolonged waiting times for memory services, adversely affecting patient safety, clinical outcomes, and carer distress.

The Kensington & Chelsea and Westminster (KCW) Memory Service receives approximately 30–40 referrals per week. This Quality Improvement Project (QIP) aimed to improve quality and patient safety by reducing the time from referral to initial memory assessment within the KCW Memory Service.

A multidisciplinary team undertook a QIP using iterative Plan–Do–Study–Act (PDSA) cycles. Primary drivers were identified,including: (I) number of assessments completed per week, (II) delays awaiting brain imaging, (III) reporting times, (IV) multidisciplinary team meeting processes, and (V) triage. Baseline measures included waiting time from referral to assessment and monthly dementia diagnosis rates. Outcome measures were reviewed monthly, impact of changes over time, care quality and patient safety were maintained. Service user involvement by feedback and questionnaire was incorporated to support evaluation and inform ongoing improvement.

The average time from referral to assessment was reduced by more than one third, from over 120 days in March 2025 to 72 days by January 2026. Over the same period,monthly dementia diagnosis rates increased from 4 diagnoses in February 2025 to approximately 50 diagnoses per month following implementation of the interventions. The number of individuals waiting longer than 18 weeks for assessment decreased from 180 in March 2025 to 55, while the number of referrals awaiting triage reduced from 199 in April 2025 to fewer than 10 currently.

During this period, the service also received positive feedback from service users, reflecting improved experiences related to timeliness and communication.

This QIP demonstrates that structured, data-driven service redesign can significantly reduce waiting times and improve diagnostic capacity without compromising care quality. These findings indicate a meaningful and sustained improvement in service performance. Reduced waiting times has important secondary benefits for patient safety, including earlier identification of clinical risk and reduced distress for patients and carers. Ongoing incorporation of service user involvement supports the acceptability and sustainability of the improvements. The approach may be transferable to other memory services facing similar demand and capacity challenges.

References:

1. NHS England. (n.d.). Dementia. NHS England. https://www.england.nhs.uk/north-west/north-west-coast-strategic-clinical-networks/our-networks/adult-children-and-young-peoples-mental-health-and-dementia/dementia/

2. Dementia: assessment, management and support for people living with dementia and their carers, NICE guideline, Published: 20 June 2018