Every fifth pregnant person experiences mental health problems during pregnancy and the puerperium. The Joint Perinatal Mental Health Clinic (JPMHC) at Milton Keynes University Hospital was established to offer multidisciplinary team (MDT) support to patients with a complex mental health background during this time. Here, patients are supported by a team, including a psychiatrist, an obstetrician and a specialised midwife. Plans are made for pregnancy, delivery and follow-up. We aimed to audit the outcomes of this clinic between July 2023 – July 2024.

Data were extracted from electronic patient records, for all patients booked into the JPMHC in July 2023 – July 2024. Data were analysed and figures were generated using Microsoft Excel.

35 patients were given an appointment with 83% attending all their appointments. Patients booked into clinic were 29.5 years old on average (19-39). 17% patients were from ethnic minority backgrounds, 74% were from a white background and 9% from other backgrounds.

Of the 32 patients that attended at least one appointment, 94% were seen by at least 3 MDT members. 74% of these patients had a perinatal mental health plan recorded. 28% were seen with at least one relative present.

82% of all patients had two or more psychiatric diagnoses recorded. The most common mental health backgrounds were affective disorders (31 diagnoses), anxiety disorders (29 diagnoses) and history of trauma or adverse life experiences (31 diagnoses). 69% of patients were on at least one psychotropic medication. 26% were on 2 or more psychotropic medications. The most used medications were SSRIs (16 prescribed), and antipsychotics (11 prescribed).

This audit highlights the value of MDT input to address the needs of pregnant patients with complex mental health backgrounds. Being seen in a joint clinic allowed for clear communication with patients, their relatives and between relevant healthcare teams. This allowed for detailed perinatal mental health plans to be made. Close collaboration in the MDT promotes safety, for example when considering teratogenicity risks or adverse effects on neonates with the use of psychotropic medication. MDT members provide expert guidance on patients in their care, which is essential in the context of psychotropic polypharmacy and a multitude of psychiatric diagnoses.

The JPMHC helps pregnant people look after their physical and mental health as well as their growing child’s wellbeing in a vulnerable time in life. Going forward, we aim to design a standardised template and create a clinic model for other sites to implement.

Effective communication between secondary and primary care is fundamental to patient safety and continuity of care. While the GMC and RCPsych emphasize high-quality correspondence, there is a lack of strictly mandated national timeframes for non-urgent outpatient letters. In line with the NHS Standard Contract, our Trust (NHFT) utilizes a 24-hour benchmark for clinic entry completion and a 7-day standard for issuing GP letters. This audit aimed to evaluate compliance with these standards across the North and South Community Mental Health Teams (CMHTs). The Set standard was that 100% of clinic outcomes and clinic letters should be completed within Trust’s time standards of 24 hours and 7 days, respectively.

A retrospective audit was conducted over a six-week period (24 March–2 May 2025). Data was collected from SystmOne (Trust’s Electronic record system) for 176 clinics across various localities.

Primarily, the timeframe within which clinic outcomes were completed was evaluated against standards. Secondarily, the same was done for Clinic letter completion timeframe. The final compliance rates were compared between the North and South teams, to assess for any variability.

Of the 176 clinics audited (North: 62; South: 114), overall compliance was high, although it was below the target of 100%.

• • Clinic Entries (<24 hours): South CMHTs achieved 99% compliance, while North CMHTs achieved 94%.

• • Clinic Letters (<7 days): South CMHTs demonstrated excellent timeliness at 99%. However, North, 92% of letters met the 7-day target. In the North locality, 8% of letters were overdue or missing, with some delays extending up to 31 days. Conversely, the South locality had only one missing letter and one overdue letter, representing less than 1% of the sample.

The overall compliance was below set standards. Identified factors included missing letters and significant delays (>30 days). The clinicians involved were not aware of the undergoing audit.

In addition to the short duration, the audit didn’t account for the total number of appointments, patient non-attendance and administrative capacity.

We recommend that the findings are presented to regional academic teaching program, a survey to identify administrative capacity issues, a longer re-audit duration of 12 weeks, inclusion of the newly implemented Local Area Partnership (LAP) transformation model, as well as addressing the identified limitations. Going a further step, we recommend the addition of consenting patients as recipients according to the new clinic-letter standard.

PRN (pro re nata, or ‘as required’) psychotropic medications are commonly given by nurses based on patients’ needs to manage sudden psychiatric symptoms effectively. While these medications are essential in quickly relieving acute distress, inappropriate usage can cause issues such as excessive medication, unnecessary multiple drug prescriptions, and potential patient dependency. Therefore, strict compliance with prescribing guidelines is crucial.

This audit was conducted to check whether PRN psychotropic medication prescriptions on an adult psychiatric inpatient ward met the Trust’s guidelines (PHARM-0041-v4.2) and were prescribed safely.

Retrospective audit of all PRN psychotropic prescriptions on Danby Ward, Cross Lane Hospital (TEWV NHS Trust) in the Electronic Prescribing and Medicines Administration (EPMA) system between 13 March and 5 April 2024 (registration 7482AMH23). Fifteen prescriptions comprising 32 PRN medicines were assessed against protocol-derived criteria (standard=100%): indication; dose/formulation/frequency; minimum dosing interval; maximum 24-hour dose; documented review date; first-/second-line guidance when more than one PRN option was prescribed for the same indication; and review/discontinuation if not administered for four weeks.

Indication and dosing parameters met the standard in all cases (32/32, 100%). No PRN medicine had a documented review date (0/32). Where more than one PRN option was prescribed for the same indication (18/32 medicines), first-/second-line guidance was absent in all applicable prescriptions (0/18; not applicable 14/32). Among medicines prescribed for four weeks or more without administration (8/32), none were reviewed or discontinued (0/8; not applicable 24/32).

Non-compliance with PRN review standards is a medication-safety risk, with potential for delayed optimisation, avoidable polypharmacy/adverse interactions, and prolonged PRN use without a clear ongoing rationale. Improvements should focus on EPMA-enabled review prompts, routine pharmacy-led checks, targeted prescriber education, and clearer documentation to support consistent review and rationalisation.

Post-audit actions are largely completed Trust-wide: PRN oral and IM regimens now include an automatic 14-day review date; PRN guidance has been updated to clarify first-/second-line options and implemented across inpatient settings with updated EPMA content and training materials; EPMA has been upgraded to v3.3 to support Mental Health Act consent requirements; and EPMA e-learning plus a Quick Reference Handbook for medicines review/discontinuation have been produced. One action remains in progress: customisation of regimen dose screens, with change requests under discussion with Civica. The re-audit will assess compliance after full implementation.

The aims of this audit are to assess compliance with local audit standards for: (1) documentation of driving status at initial assessment; (2) documentation of DVLA notification advice; and (3) documentation and follow-up of driving safety advice aligned with DVLA/regional guidance because young people with eating disorders (EDs) may experience physical and cognitive impairment (e.g., blackouts, hypotension, hypoglycaemia) that can compromise driving safety. UK Driver and Vehicle Licensing Agency (DVLA) guidance requires individuals to notify DVLA if an ED affects fitness to drive. Yet, no CAMHS-specific local process existed to guide systematic assessment and documentation of the risk that young people pose from driving, to ultimately maintain patient and public safety.

A retrospective electronic case-note review was undertaken within the North Yorkshire & York CAMHS ED Service. All patients aged ≥15 years 9 months up to October 2024 were screened (n=65); 48 met the inclusion criteria. An agreed proforma captured driving status documentation; presence and content of driving safety advice; how this aligned with DVLA/ NHS guidance; follow-up advice at specified intervals; and explicit documentation of DVLA notification advice.

No cases documented driving status at initial assessment (0/48). Any documented driving safety advice was present in 33.3% (16/48) of cases. Among those with documented advice (n=16), follow-up driving advice was recorded in 93.8% (15/16), and 100% had documented advice aligned with DVLA/NHS guidance (16/16). Explicit documentation that the patient should notify DVLA was present in 43.8% (7/16). The key areas for improvement were the lack of risk assessment regarding driving; documentation at initial assessment; and inconsistent DVLA notification advice.

This audit identified that the ED service was not adequately assessing the driving status of young people with ED and/or providing the necessary advice, which could have implications for patient safety. Where advice was documented, quality and follow-up were high, suggesting that introducing structured prompts would be beneficial.

A revised initial assessment pro forma incorporating a structured “Driving Status & Advice” section and visual reminders (a clinic poster) has been implemented; a co-produced CAMHS-specific ED and Driving patient leaflet and an updated follow-up review template are in progress. The second cycle will evaluate the impact of the changes and the standardisation of DVLA-related documentation across the pathway.

Personality disorder (borderline type), previously known as Emotionally Unstable Personality Disorder (EUPD), is a complex psychiatric condition associated with unstable relationships, emotional lability and transient psychotic-like features. National Institute for Health and Care Excellence (NICE) guidelines for EUPD (CG78) advise against routine use of psychiatric medication for personality disorder symptoms, recommending pharmacological treatment only for comorbid mental illness in accordance with relevant guidance. Antipsychotics are not licensed for EUPD. Where used, prescribing should be short-term, crisis-focused, and accompanied by clear documentation and informed consent. However, national data from the Prescribing Observatory for Mental Health indicate that antipsychotic prescribing in EUPD often occurs off-licence and may continue long-term by default, with variable documentation and review. This audit evaluated antipsychotic prescribing practices for inpatients with EUPD within Sussex Partnership NHS Foundation Trust, focusing on documentation of prescribing rationale, communication with patients regarding above license and physical health monitoring.

A retrospective review of clinical records was conducted across all working-age adult inpatient wards within the Trust. Data were collected as cross-sectional snapshots at three time points, each one month apart. Inpatients aged 18-65 years with a documented diagnosis of EUPD were included. Patients with primary psychotic disorder and out-of-area admissions were excluded. Where diagnostic ambiguity existed, a senior psychiatrist reviewed clinical notes to determine eligibility on a case-by-case basis. Outcomes were assessed against NICE and local Trust guidelines using descriptive statistics.

Of 508 records reviewed, 52 patients met the inclusion criteria. Antipsychotics were prescribed in 86.5% (45/52) of patients, with 20% (9/45) initiated during admission and 8.9% (4/45) receiving polypharmacy. None of the antipsychotics initiated were documented as time-limited. Documentation of communication regarding off-licence prescribing was present in only 6.6% (3/45) of cases. Physical health monitoring was inconsistently completed: body mass index was tracked in 80.7% (42/52) patients, HbA1c in 21.1% (11/52), electrocardiogram in 48.1% (25/52), blood pressure in 98.1% (51/52), prolactin in 42.3% (25/52), and cholesterol in 53.8% (28/52). Random glucose was requested instead of HbA1c in 42.3% (22/52) of cases, contrary to Trust guidelines.

Antipsychotic prescribing for EUPD inpatients frequently deviated from guideline recommendations, with significant gaps in documentation, consent recording, and physical health monitoring. These findings highlight the need for improved adherence to guidance, clearer documentation standards, and structured monitoring pathways to enhance patient safety and quality of care.

Antipsychotic medicines can cause QT prolongation, are pro-arrhythmogenic (specifically, they can increase the risk of torsade de pointes) and are linked to sudden cardiac death. The Maudsley prescribing guidelines advise patients being treated with antipsychotic medications should have an ECG both on admission and before discharge if their medication regime has changed. The aim of this audit was to establish current adherence to national guidance in the Acute Mental Health Inpatient Centre (AMHIC) in the Belfast Health and Social Care Trust (BHSCT).

The decision was made to collect data based on all the discharges from AMHIC. Data was retrospectively collected using the H&C numbers of the patients discharged in the entire month of December. The unit consists of 5 acute inpatient wards and in December there was a total of 42 discharges. Of these 42 patients, 8 were not on any antipsychotic medicines so they were discounted from the data set. A further 2 patients had no changes made to their antipsychotic during inpatient admission, so they were also not included. This left 34 patients on which to base the review. We collected information for 34 patients, including whether patients had an admission ECG, how long it took to get their admission ECG during admission and if this was being done in a ‘timely fashion’ (defined as within one week of admission for the purposes of this audit) and if patients got a discharge ECG.

100% of patients did not have a discharge ECG prior to them leaving hospital.

1. 20.59% (7/34) of the patients had no ECG completed during admission.

2. 50% (17/34) of patients did not have ECG completed within 7 days of admission to AMHIC.

Results suggest that recommended ECG monitoring for patients on antipsychotic medicines is not being completed consistently at ward level. This has helped to assess areas for improvement and to put together plans for future interventions for ensuring patient safety while on antipsychotic medications. Interventions are required to improve timely ECGs both at admission and discharge within the inpatient setting. We have arranged a teaching session during the monthly patient safety meeting to communicate our findings to our medical and nursing colleagues. We have made reminder posters for each ward nurses’ station and clinical room. We plan to address this issue by using the PDSA model for effective change management.

Antipsychotics may be prescribed for severe behavioural and psychological symptoms of dementia (BPSD) but carry significant risks. National and local guidance recommends structured assessment, documentation, regular review, and timely deprescribing.

This audit assessed compliance with Nottingham Area Prescribing Committee guidance EG019 and National Institute for Health and Care Excellence guidance NG97 within the Newark and Sherwood Older Adult Community Mental Health Team.

We hypothesised that initial clinical assessment would show high compliance, while structured monitoring documentation would be inconsistent.

A retrospective audit was conducted using the RiO electronic clinical record system. A Clinical Record Interactive Search identified patients with a diagnosis of dementia initiated on antipsychotic medication by the Newark and Sherwood Older Adult Community Mental Health Team between 1 October 2023 and 1 October 2024. Diagnoses included International Classification of Diseases, Tenth Revision (ICD-10) codes F00–F04 and G31.8.

The audit tool was a locally developed audit proforma derived from the standards from the two guidances (EG019 and NG97), and it assessed documentation of symptom assessment, risk evaluation, discussion of risks and benefits, use of the Antipsychotics in Dementia Assessment and Monitoring Form, review intervals, and consideration of deprescribing. Compliance was reported descriptively as percentages.

Of 114 records screened, six met inclusion criteria.

• • Target symptoms were identified and quantified in 100% of cases, and contributing factors for distress were explored in all patients.

• • Delirium was considered in 83%, and modifiable factors were addressed in 83%.

• • Lewy body or Parkinson’s disease dementia was considered in all cases.

• • Risk of harm to self or others was documented in 67%

• • Discussion of risks and benefits with patients or carers was documented in 83%.

• • Medication review occurred in 100%, with dose reduction or discontinuation in 17%.

• • Review at or before six weeks occurred in 80% of eligible cases, with a documented rationale for continuation in 60%.

• • Regular six-weekly review and consideration of deprescribing were each evident in 60%.

• • Notably, the completion of the Trust Antipsychotics in Dementia Assessment and Monitoring Form occurred in 0%.

This audit demonstrates good compliance with recommended clinical assessment and cautious prescribing for BPSD but identifies a critical gap in structured monitoring, with no use of the Trust-mandated monitoring form. Documentation of ongoing review and rationale for continuation was also inconsistent. These findings support targeted education, improved induction processes, and system-level changes to embed structured monitoring. A re-audit, including baseline physical health monitoring, is planned.

To evaluate compliance of lithium monitoring practices at Kilbarrack East CMHT with NICE guidelines and identify areas for improvement to enhance patient safety.

This quantitative audit comprised a retrospective initial audit, where data was collected from August 2024 to February 2025 from patients on lithium therapy. Following the initial audit results, which highlighted significant gaps, a multidisciplinary team (MDT) meeting was held to discuss the findings with all clinical stakeholders. Interventions were implemented in March 2025, including a green sticker system for patient identification, a lithium monitoring sheet for tracking assessments, patient monitoring lists to define responsibilities, a lithium blood clinic, and a new Clinical Nurse Specialist reporting system. A prospective follow-up audit was conducted from May to October 2025, with the overall audit concluding in November 2025. Compliance with NICE guidelines was assessed through indicators such as the frequency of lithium level testing as well as renal and thyroid function tests. Statistical analysis was performed to compare compliance rates between the initial and follow-up audits.

The first audit (Cycle 1) revealed that only 12% (3 out of 25) of patients were compliant with all relevant lithium monitoring guidelines. Although all compliant patients had urea and electrolyte (U&E) levels and thyroid function tests conducted, none had calcium levels tested or BMI measured. In the follow-up audit (Cycle 2) in October 2025, the overall compliance improved, with 68% (17 out of 25) compliant, but significant gaps remained; 32% (8 out of 25) did not have their lithium levels tested, and 44% did not undergo U&E or thyroid function tests. Only 8% had calcium levels tested, and no patients had their BMI recorded. These findings indicate that while there was some progress, critical areas still need attention.

The audit cycle demonstrated substantial deficiencies in compliance with NICE guidelines for lithium monitoring at Kilbarrack East CMHT. While some changes led to improvements, significant gaps remain, underscoring the necessity for continuous quality improvement initiatives. A patient education leaflet was introduced after the second audit to enhance adherence to lithium monitoring protocols. Implementing the recommended action plan aims to enhance adherence to monitoring protocols and improve patient safety in lithium therapy management. Regular audits will continue to check progress and make sure guidelines are followed.

Atypical antipsychotics are a class of medication used to treat psychiatric disorders involving psychosis. Alongside other side effects, they are strongly associated with increase the risk of adverse cardiovascular outcomes e.g. hyperlipidaemia and weight gain. As such, the BNF states that patients should be monitored annually for these risk factors, including weight, glucose/Hbs-648c, blood lipids and blood pressure.

To assess the monitoring of cardiovascular risk factors for vulnerable patients on atypical antipsychotics at a general practice in the West Midlands to allow interventions and modifications to be put in place. In the second cycle, the aim was to assess whether interventions and recommendations made from the first audit made a significant difference to levels of monitoring.

Searches on EMIS were conducted from a list of registered patients currently on atypical antipsychotics to assess whether weight, glucose/HbA1c, blood lipids and BP had been checked in the previous year, in accordance with BNF recommendations for monitoring. Standards set were:

• • 100% of patients will have three or more of the four CVD risk factors monitored within the past year.

• • 80% of patients in the practice monitored for each measure within the past year.

• • A statistically significant increase in overall rates of monitoring from 2024 to 2025 using Fisher’s Exact Test.

For standard 1, there was an increase from 48% to 60% of patients who met this standard from 2024 to 2025. For standard 2, none of the four measures met the criteria in either year, however three measures had increased from 2024. Standard 3 was met as the overall monitoring rate had increased from 58% in 2024 to 65% in 2025, which was a statistically significant increase using Fisher’s Exact test with a p value of 0.04.

NICE guidelines state that patients taking antipsychotics should have annual monitoring of cardiovascular risk factors due to their potential side effects. Although results show that neither of the first two standards were met in both cycles, standard 3 was met, showing a statistically significant improvement in rates of monitoring. This suggested that recommendations made from the 2024 cycle had a positive effect on rates of cardiovascular monitoring of patients on antipsychotics but that further improvements could be made. Further recommendations were made, including implementing manual monitoring reminders for patients not under the SMI checks and long-term solutions for phlebotomy access. Another re-audit will be conducted to assess the impact of these recommendations.

• • To ensure the Southwest Crisis Function Team (in HPFT) manages non-cognitive symptoms of dementia as per NICE guidelines, and provides appropriate non-pharmacological and pharmacological management options.

• • If not possible, identify reasons and challenges, and suggest methods for improvement, which could be implemented and re-audited.

1. All referrals received by CFT in a 12-month period were obtained through the SPIKE database.

2. 48-hour referrals and wrong referrals were excluded.

3. Only service users with a diagnosis of dementia AND were presenting with agitation, aggression, distress or psychosis were included. This information was obtained through PARIS.

4. Service users’ case notes were reviewed to ascertain whether they or their carers:

○ Had a structural assessment and had been offered psychosocial and environmental interventions as initial and ongoing management to reduce distress for service users.

• Had been offered antipsychotics and:

• If they were at the time at risk of harming themselves or others, or were experiencing agitation, hallucinations or delusions that are causing them severe distress.

• If they had discussions about risks and benefits of antipsychotics.

• Had been started on the lowest effective dose possible and were recommended to be reassessed by the prescriber.

1. In 2023, a total of 247 new Service Users (SU) were referred to CFT. After excluding 48-hour follow up referrals and inappropriate referrals, A total of 55 referrals were for SUs who were diagnosed with dementia and were presenting with agitation, aggression, distress, or psychosis. 12 out of the 55 referrals were for 6 SUs who were referred twice at different times during the year.

2. 100% (55/55) of the included referrals received a structural assessment to 1- explore possible reasons for their distress, and 2- check for and address clinical or environmental causes. 100% (55/55) were also offered psychosocial and environmental interventions as initial and ongoing management to reduce distress for SUs.

3. In 12/55 referrals, SUs were already on antipsychotics. In 7/55 referrals, SUs could not be managed without a new prescription of antipsychotics.

4. In these 7 referrals (12.7% of total eligible SUs), SUs received new prescriptions of antipsychotics as a pharmacological intervention and in all 7 referrals, the SUs were at risk of harming self or othersorwere experiencing agitation, hallucinations or delusions that are causing them severe distress.

5. 100% of the 7 referrals showed that SUs were started on the lowest effective dose of the prescribed antipsychotic.

6. However, out of the 7 referrals that received new prescriptions of antipsychotics, none of them (0%) had documentation on PARIS about discussions of risk and benefits of antipsychotics.

7. Finally, when looking at all the referrals where antipsychotics were used (19 referrals in total), there was clear documentation on PARIS about reassessment or a recommendation for reassessment of antipsychotic after 6 weeks in 4/19 referrals (21%).

• • 100% of referred SUs received a comprehensive, structural assessment.

• • The team offered psychosocial and environmental interventions to all SUs who were eligible.

• • The team offered antipsychotics only when necessary, in a small percentage of cases(12.7%), and followed NICE guidelines for initial doses and service user eligibility.

• • However, no documentation in any of the service user’s case notes mentioned discussions about risk and benefits of antipsychotics and only 21% had recommendations for reassessment of the antipsychotics within 6 weeks.

This audit compares the old and new referral forms to determine whether the redesigned version captures the required data more effectively, whether certain fields are unnecessary, and whether further improvements are needed. It also explores whether the older form encouraged more information or whether both forms still fall short in key areas.

Data were obtained from stored copies of liaison psychiatry referrals submitted to University hospital of Limerick. A total of 100 referrals were reviewed. Two samples were created:

Baseline audit included 50 referrals randomly selected from January to April 2024 (using the old referral form)

Re Audit 50 included referrals randomly selected from January to April 2025 (using the redesigned referral form)

Data were collected and analysed. Each referral was reviewed against the predefined checklist of required data items derived from the 2025 redesigned referral form.

A structured Excel spreadsheet was used to record the presence or absence of each criterion for all referrals. Analysis was performed to compare completion rates between the old and new forms, assess compliance with the working standard, and identify areas requiring further refinement.

Overall, the redesigned referral form demonstrated significant improvement in the completeness and consistency of information provided across nearly all domains.

The new referral form showed compliance for patient identifiers and referrer details. In contrast, the old form showed inconsistent completion rates for key administrative data, particularly GP details, referring doctor, referrer contact number, and email.

Medical status, suspected psychiatric symptoms, duration, and pattern of symptoms were better captured in the new form compared to the old form.

Cognitive screening items such as alertness, AMT4 score, and counting months backwards were rarely recorded in the old referrals but were captured with much higher consistency in 2025.

The reason for admission was well documented in both forms, though more consistently in the new version.

Documentation of previous psychiatric diagnoses, current psychiatric medications, and attempts to treat prior to referral improved markedly with the new form. These elements were commonly missing or incompletely described in the old referrals.

Risk documentation was among the most significant improvements

The redesigned 2025 referral form clearly improved the completeness of information submitted to liaison psychiatry, as demonstrated by the higher documentation rates across nearly all criteria. However, despite these improvements, several challenges remain that impact the practical usability and clinical value of the referral information received. This audit will inform a new service and quality development project.

To evaluate the quality of suicide risk assessment documentation in outpatient consultations against NICE NG225 and Local Trust standards, and to assess whether a focused feedback intervention improved documentation quality.

A retrospective baseline audit reviewed the first 50 consecutive outpatient consultations from 1 December 2025. Findings were summarised and fed back to clinicians. A re-audit examined 50 subsequent consultations from 23 January using the same structured assessment criteria. Core criteria included documentation of suicidal ideation, plan, intent,access to means, history of self-harm, risk formulation, and safety planning. Additional criteria assessed shared decision-making and communication with the General Practitioner.

Substantial improvement followed the feedback intervention. Documentation of consent and confidentiality increased markedly (from 4% to 76%), reflecting greater attention to patient involvement and transparency. Recording of history of self-harm, a key predictor of future risk, improved significantly (from 28% to 76%). Protective factors, often under-recorded locally, increased from 52% to 78%, strengthening overall risk formulation. General risk formulation itself showed a notable improvement (62% to 82%), showing a clearer integration of dynamic and historical factors.

Among patients expressing suicidal ideation (baseline 28%, re-audit 50%), documentation of suicidal plan and intent improved from 0% at baseline to 84% post-intervention–representing one of the most clinically meaningful changes observed. Despite improvement in several domains, access-to-means exploration remained low (6% to 14%), identifying an important area requiring further attention. Documentation of shared decision-making showed some decline (98% to 84%), suggesting that emphasis on risk-specific domains may have inadvertently reduced focus on collaborative discussions.

Targeted feedback led to clear and meaningful improvements in several domains central to high quality suicide risk assessment, particularly self-harm history, protective factors, overall risk formulation, and documentation of plan and intent among patients with suicidal ideation. Persistent gaps in assessing access to means highlight a priority area for additional intervention. Future work would focus on embedding structured reminders within clinical templates, reinforcing collaborative practice, and conducting further re-audits to sustain improvement.

1. To evaluate the completeness and quality of admission clerking documentation for psychiatric inpatients on Ward F, Neath Port Talbot Hospital.

2. To identify areas for improvement to ensure compliance with national psychiatry standards.

A retrospective audit was conducted on 13 December 2024, reviewing admission clerking proformas for all 23 inpatients on Ward F. Documentation was assessed across key domains including patient identification, presenting complaint, psychiatric and medical history, forensic and substance misuse history, risk assessment, mental state and physical examinations, medication history, investigations, impression, and management plan. Audit standards were derived from the Oxford Textbook of Psychiatry, Core Competencies for a Trainee in Psychiatry, and the Royal College of Psychiatrists (CCQI) Standards for Inpatient Mental Health Services: Admission–First 12 Hours (2022).

Core components of admission clerking were well documented. All patients had recorded identification, history of presenting complaint, psychiatric history, impression, and management plan. Mental state examinations and risk assessments were completed in 22/23 cases; however, documentation predominantly focused on current risk, with limited recording of past risk (4/23) and previous admissions (8/23). Physical examinations were completed in 18/23 cases, with frequent omissions in neurological, cardiovascular, and anthropometric assessments. Substance misuse history was inconsistently documented, particularly with respect to alcohol intake and illicit drug use. Medication history was recorded in 16/23 cases, with variable documentation of dates, signatures, and electronic prescribing status. Investigations were documented in only 4/23 cases.

Although core elements of psychiatric admission clerking were generally completed, significant gaps were identified in documentation of physical health assessments, substance misuse history, past risk, investigations, and medication history. A revised admission clerking proforma has been introduced incorporating a structured clerking checklist, detailed substance misuse history (including alcohol units, smoking pack-years, and illicit drug use), and comprehensive physical examination with emphasis on neurological assessment. Re-audit following implementation is recommended to evaluate improvements in documentation quality, compliance with national standards, and patient safety.

The objective of this audit is to establish the baseline of how much physical health monitoring is being completed in a general adult outpatient mental health team for patients with severe mental health illnesses (SMI) in accordance with NICE Guidelines.

Data were collected from CMHT records and the Welsh Clinical Portal for patients who attended outpatient appointments in a CMHT in North Wales over a two-week period in September 2025.

Inclusion criteria:

Patients with a diagnosis that falls under SMI.

Patients prescribed antipsychotics or Lithium.

The Welsh Clinical Portal will be accessed to identify patients who have received a full or partial physical health check from primary care

Out of the 29 patients studied, the following parameters were monitored:

Pulse in 30.4%, Blood Pressure in 56.5%, Weight in 20.7%, Hbs-653C/Glucose in 41.4%, Liver Function in 58.6%, Renal Function in 65.5% and Lipids in 58.6%.

Of the 4 patients who required prolactin testing, 75% had their prolactin monitored.

Comparing patients on Lithium or Clozapine (11 patients) (as they were monitored in dedicated clinics) vs those on other antipsychotics (18 patients), weight was monitored in 45.5% vs 5.6%, Renal Function in 45.5% vs 77.8%, Liver Functions in 36.4% vs 72.2% HbA1c/Glucose in 27.3% vs 50.0% and Lipid Profile 45.5% vs 66.7%.

Comparing High Metabolic Risk Patients (on Olanzapine=5, Quetiapine=7 and Clozapine=3) vs those not on those (14), the monitoring of the parameters was -Weight: 18.8% vs 23.1%, Hbs-653c/Glucose: 50.0% vs 30.8%, Renal function: 75.0% vs 53.8%, Liver Functions: 68.8% vs 46.2% and Lipid Profile: 62.5% vs 53.8%.

Of the patients prescribed Lithium (9/29), Lithium levels were measured ≥4/year in 1/9 (11.1%), Urea and Electrolytes ≥2/year in 6/9 (66.7%), and Thyroid Function ≥2/year in 4/9 (44.4%).

Monitoring of physical health parameters has considerable scope for improvement among patients with SMI in CMHT. Compared with patients prescribed Clozapine or Lithium, those not receiving these medications had their weight monitored more frequently. Interestingly, Renal function, Liver Function, Hbs-653c/Glucose, and Lipids were monitored more closely in the latter group, even though patients receiving lithium and clozapine had dedicated clinics.

The CMHT is planning to allocate a dedicated health worker to monitor all patients with SMI being prescribed antipsychotics. Concordance with the monitoring protocol will be reassessed after this intervention.

Harmful and dependent alcohol use frequently co-occurs with psychiatric disorders and is more prevalent amongst psychiatric inpatients than in the general population. Patients admitted to general adult psychiatric wards are at increased risk of alcohol withdrawal.Early identification of alcohol misuse at admission is essential to guide appropriate investigation, monitoring, pharmacological management, and referral to specialist alcohol services.

This re-audit of assessment and management of alcohol misuse in a general adult psychiatric inpatient setting in Mersey Care NHS Foundation Trust follows the original audit conducted in 2021 and re-audit in 2022 and evaluated whether assessment and management of harmful or dependent alcohol use, as defined by ICD-11 criteria, had improved since previous audits and assess effectiveness of previous recommendations implemented.Key areas reviewed were documentation of alcohol history, identification of alcohol misuse, monitoring for withdrawal, prescription of evidence-based treatments, appropriate investigations, and referral to community alcohol services.

A retrospective audit of all patients on eight general adult inpatient wards in the Trust was conducted on 22ndof April 2025. The electronic patient record and prescription chart for each patient were reviewed. Patients with no documented history of alcohol misuse were excluded from monitoring for and management of withdrawal. Audit standards were based on the Trust’s alcohol detoxification policy and NICE guidance.

The total sample was 130 inpatients - 52% male, 48% female.55% of patients had an alcohol history documented on admission.28% of patients had a prior history of alcohol misuse but only 28% of these had their average weekly alcohol intake recorded.Among patients with identified alcohol misuse, a CIWA score was documented within 24 hours in 17% - an improvement from 1% in 2021 and 4% in 2022. Prescribing of withdrawal-related medications remained inconsistent - 14% were initiated on Chlordiazepoxide, 25% on Thiamine, and 3% on Vitamin B Compound Strong within 24 hours of admission.Relevantblood tests - gamma GT level - 31% and Mg2+ - 25% were incompletely performed. No patients were offered referral to community alcohol services, a deterioration compared with previous audits.

Despite modest improvements in CIWA documentation, significant gaps remain in assessment and management of alcohol misuse in general adult inpatients.Inconsistent clerking practices, limited use of structured proformas, and poor referral rates to community alcohol services represent missed opportunities to reduce withdrawal-related morbidity and support long-term recovery.Increased use of clerking proformas and targeted education on alcohol withdrawal management were recommended.

Individuals with severe and enduring mental illness (SMI) are at greater risk of poor physical health than the general population and have a higher premature mortality rate. Average life expectancy of individuals with SMI is ~15 - 20 years shorter than the general population, often due to physical disease, most commonly of metabolic or cardiovascular origin. A significant contributor is underperformance of physical examination, assessment and intervention.NICE Clinical Guidelines and Mersey Care NHS Foundation Trust guidelines state that, following admission to a mental health inpatient unit, a patient should have a physical examination and assessment completed within 24 hours.

This audit assessed if the following were completed within 24 hours of admission to the Trust’s general adult inpatient wards: physical examination; set of physical observations; Body Mass Index (BMI); Malnutrition Universal Screening Tool (MUST); smoking status; alcohol consumption status; and physical health comorbidity (cardiac disease, respiratory disease, diabetes mellitus) status documented.

A retrospective audit was conducted, with the sample comprising all patients on 12 of the Trust’s general adult inpatient wards on a specific date in December 2025.An audit tool was designed with standards based on NICE Clinical Guidelines and the Trust’s physical health policy and completed for each patient using the patient’s electronic patient record.

129 of the 200 patients were male, 71 were female (3 patients were born biologically male but transitioned to female).Age of patients ranged from 18 to 73 years.Within 24 hours of admission to the ward, 60% of patients had a physical examination completed; 86% had a set of physical observations completed; 62% had a BMI done; 62% had a MUST score done; 54% had a smoking status recorded; 65% had their alcohol consumption recorded; and 67% of patients had their physical health comorbidity status checked.

Improvement is required to ensure patients have a complete physical examination done within 24 hours of admission, and, or those declining one, this should be documented and re-attempted at the earliest opportunity. Timely completion of a physical examination ensures rapid identification of any patient that is acutely physically unwell at the time of admission. Ensuring the alcohol consumption status is checked will reduce risk of acute alcohol withdrawal and smoking status should be checked to enable prompt consideration of nicotine replacement therapy. There is a need for greater awareness from both medical and nursing staff on the ward of the importance of physical health assessment.

Individuals with severe and enduring mental illness (SMI) are at greater risk of poor physical health than the general population and have a higher premature mortality rate.Average life expectancy of individuals with SMI is ~15 - 20 years shorter than the general population, often due to physical disease.A significant contributor is underperformance of physical examination, assessment and intervention.NICE Clinical Guidelines and Mersey Care NHS Foundation Trust guidelines state that, following admission to a mental health inpatient unit, a patient should have a physical examination and assessment completed within 24 hours.

This audit assessed if the following were completed within 24 hours of admission to the Trust’s general adult inpatient wards: FBC; U and Es; LFTs; TFTs; bone profile; Vitamin B12 level, serum folate level; serum prolactin level; Hbs-656c level; random serum total cholesterol level; ECG; urine dipstick, urine pregnancy test in females of childbearing potential; and QRISK score in relevant patients.

A retrospective audit was conducted, with the sample comprising all patients on 12 of the Trust’s general adult inpatient wards on a specific date in December 2025.An audit tool was designed with standards based on NICE Clinical Guidelines and the Trust’s physical health policy and completed for each patient using the patient’s electronic patient record.

129 of the 200 patients were male, 71 female (3 patients were born biologically male but transitioned to female).Age of patients ranged from 18 to 73 years.Within 24 hours of admission the following were completed: FBC - 46%; U and Es - 45%;LFTs - 44%; TFTs - 40%; bone profile - 44%; Vitamin B12 level - 38%; serum folate level - 37%; serum prolactin level - 33%; Hbs-656c level - 39%; and random serum total cholesterol level - 43%.47% of patients had an ECG done.28% had a urine dipstick; 23% of female patients of childbearing potential had a urine pregnancy test.2% of applicable patients had a QRISK score.

Admission to the ward presents an opportunity to “screen and intervene” in a patient population with poorer physical health than the general population and who are less likely to engage in physical health monitoring in the community.An ECG is required if psychotropic medication is initiated or changed. There is a need for greater awareness from both medical and nursing staff on the importance of relevant physical health investigations being completed following admission to the ward.

To illustrate the heterogeneity of drivers underlying wishes to die and to consider the implications for psychiatric practice, particularly in relation to transparency, ethical formulation, and end-of-life decision-making.

Four anonymised cases assessed within UK mental health services were selected for qualitative analysis. Each case involved a formal psychiatric assessment including mental state examination, capacity assessment, risk formulation, and evaluation of psychosocial context. Cases were examined thematically, with reference to the ethical principles of autonomy, beneficence, non-maleficence, and justice.

Case one involved a 93-year-old widower who attempted suicide following profound loneliness and bereavement. He was cognitively intact and denied depression. His distress was primarily social and existential and improved significantly with psychosocial intervention, antidepressant treatment, and relocation closer to family.

Case two described a 62-year-old woman with terminal breast cancer who retained capacity and engaged with services but concealed ongoing suicidality, later dying by suicide. Loss of autonomy and fear of dependency were prominent drivers.

Case three involved a 72-year-old woman with severe depression and Parkinson’s disease who deteriorated following her husband’s terminal diagnosis. Despite compulsory admission and maximal treatment, including electroconvulsive therapy, she showed no meaningful recovery and died shortly after discharge, raising concerns regarding proportionality and dignity.

Case four described a 67-year-old man with mild cognitive impairment whose fear of future dementia drove concealed suicidality, culminating in suicide despite minimal overt psychiatric symptoms.

Across cases, wishes to die arose from heterogeneous and often non-psychiatric drivers. In several cases, concealment of intent appeared linked to fear of coercive intervention.

Wishes to die cannot be understood solely through diagnostic frameworks. These cases demonstrate the importance of distinguishing treatable distress from enduring suffering and recognising how legal and clinical contexts shape disclosure. Psychiatry has a central role in ethical formulation, safeguarding, and facilitating honest dialogue as end-of-life debates evolve.

Sexual dysfunction (SD) is a common side effect of antipsychotic treatment, affecting desire, arousal, orgasm, and sexual pain, and may reduce quality of life and medication adherence. Despite this, it is often overlooked in clinical settings. NICE CG178 recommends annual review of antipsychotic side effects, including sexual side effects. Improving the management of sexual side effects has the potential to enhance both quality of life and medication adherence. This audit aimed to establish a baseline understanding of the documentation of sexual side effects in patients receiving antipsychotics in Meadowbank Ward (a 12-bed inpatient specialist adult male rehabilitation ward in Berrywood Hospital), assess adherence to NICE CG178 guidelines and identify areas for improvement.

A retrospective case notes review of all the patients admitted to Meadowbank Ward between 1st of January 2023 and 1st of January 2026. The collected data included age at discharge, length of admission to the ward, ethnicity, primary diagnosis, documentation of sexual side effects within the last 12 months of their admission, and subsequent actions.

Twenty-two male patients met the inclusion criteria. Age at discharged ranged between 21-47 years-old. Primary diagnoses were schizophrenia (n=18, 82%), schizoaffective disorder (n=3, 14%) and delusional disorder (n=1=5%). Three patients (14%)had neurodevelopmental comorbidity (ASD or ADHD). Documentation of sexual side-effect discussion within 12 months was identified for 18 patients (82%). No patients declined discussion. Nursing staff authored for 14/18 patients in the trust’s physical health monitoring and intervention template and medical staff documented entries for 4/18 patients in ward round notes. Four patients (22%) of those with documented discussions reported sexual side effects. Actions included physical health check with blood tests (n=1), reduction of antipsychotic dose (n=1), use of a herbal remedy (n=1), and no documented action (n=1).

This audit demonstrates that most patients (82%) had documented discussion regarding sexual side effects of antipsychotic medication, with nursing staff effectively utilising the Trust’s monitoring template. However, the audit identified incomplete adherence to NICE CG178 standard (target of 100%) and inconsistent clinical responses when SD was reported. The plan includes conducting a staff survey to identify barriers to discussion and documentation of sexual side effects; developing a standardized pathway for the assessment and management of antipsychotic-related SD; providing targeted training for medical and nursing staff; presenting findings to the MDT and Trust’s audit committee; and conducting a re-audit.

Background

There is no safe level of alcohol consumption during pregnancy, and NICE guidelines recommend complete abstinence. Even low levels of alcohol intake are associated with increased risks of miscarriage, prematurity, low birth weight, and Foetal Alcohol Spectrum Disorder. Women with mental health difficulties are at higher risk of alcohol use during pregnancy, potentially due to social disadvantage, increased stress, limited support networks, and reduced awareness of alcohol-related risks. Routine enquiry about alcohol use, including level and pattern of consumption, is therefore essential in all pregnant women.

Aim

To determine whether alcohol use is routinely discussed and documented during initial assessments of pregnant women referred to the South West community Perinatal Mental Health Team (SW-PMHT).

A retrospective analysis of electronic records and assessment letters was conducted for all initial assessments of pregnant women referred to the SW-PMHT between April and June 2025. Of 48 identified patients, 13 were excluded due to discharge prior to assessment, non-attendance, or assessment by other services (e.g. CMHT or MBU). The final sample included 35 patients. Documentation was reviewed to determine whether alcohol use was explored during assessment.

Alcohol use was explored in 16 out of 35 patients (45.7%), with one patient disclosing alcohol consumption during pregnancy. Alcohol use was not explored in 19 patients (54.3%).

This results demonstrated that alcohol use was not routinely explored in over half of pregnant women assessed by the SW-PMHT, representing a significant gap in care given the known risks of alcohol exposure during pregnancy. This highlights a clear need for improved and consistent screening practices.

Actions and Re-audit

Findings were presented at the multidisciplinary team meeting in September 2025, with action agreed to ensure routine enquiry and documentation of alcohol use at all initial assessments, using the AUDIT screening tool where appropriate.

Completion of the cycle

A re-audit was conducted using the same methodology over a three-month period (October–December 2025). Of 22 pregnant women included, alcohol use was explored in 17 patients (77.3%), compared to 5 patients (22.7%) where it was not explored, demonstrating significant improvement from previous results.

Conclusion and future direction following completion of cycle

The re-audit demonstrated improved compliance with assessment for alcohol use in pregnancy. To further enhance awareness and prevention, an information leaflet was developed and introduced for service users, outlining the risks of alcohol use during pregnancy and breastfeeding, with relevant resources and support links.