This audit cycle evaluated adherence to recommended follow-up timeframes (NICE guidance/ RCPsych core standards) for patients discharged from a general adult psychiatry ward in Wales.

Cycle 1 assessed compliance with NICE guidance recommending review within 7 days for all patients and within 48 hours for those at risk of suicide.This included all patients discharged from Bryngofal ward between January to March 2024. Suicide risk was determined using the Wales Applied Risk Research Network (WAARN) formulation at discharge. The first scheduled post-discharge care contact was recorded.

Following staff education and clarification of local accepted standards, cycle 2 assessed compliance with the RCPsych core standards of review within 3 days for all patients. The audit was repeated for all discharges between November 2024 to January 2025 using the RCPsych standards.

Cycle 1: Of 44 patients, 42 (95%) received follow-up within NICE-recommended timeframes. Instances of non-compliance were related to transfer of care to another health board and incomplete discharge risk documentation. Interventions included reinforcement of discharge risk documentation and clarification of local follow-up standards. Based on evidence from the National Confidential Inquiry into Suicide and Safety in Mental Health (days 2–3 post-discharge is a high-risk period), our local health board aligned with the RCPsych core standards recommending review within 3 days.

Cycle 2: Of 19 patients, 18 (95%) received follow-up within 3 days. The single delayed review occurred due to a communication lapse between inpatient and community teams.Improved communication between ward and community teams was emphasised during ward round to support timely review.

Compliance with national standards for timely follow-up was high and sustained across both cycles. The findings highlight the critical role of effective communication and clear recording between inpatient teams, community mental health teams, and care coordinators to ensure timely follow-up and patient safety. Simple measures, including staff education, clear discharge risk documentation, enhanced multidisciplinary communication and clarification of local standards can support ongoing high quality follow-up care.

This audit aimed to review patterns of psychotropic prescribing within a community LD psychiatry service in Caerphilly, focusing on medication type, dosage, documented clinical indication, and trends in medication change over time.

Psychotropic medications play a central role in the management of mental health conditions among individuals with Learning Disability. However, their use in this population requires careful consideration due to increased vulnerability to adverse effects, polypharmacy, and challenges in monitoring efficacy and safety. National guidelines, including those from NICE and the Royal College of Psychiatrists, emphasize the importance of regular review, clear documentation of indications, and adherence to best practice standards to minimize inappropriate prescribing.

A retrospective review of clinic and home visit letters for all patients seen by the community LD psychiatry service during the audit period was undertaken. Data were collected by 3 doctors on level of LD, presence of autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD), psychiatric diagnoses, psychotropic medications prescribed, antipsychotic dose expressed as a percentage of the British National Formulary (BNF) maximum, and medication changes over the audit period.

A total of 117 patients were included. 114 (97.4%) were prescribed at least one psychotropic medication. 77 patients (65.8%) were prescribed antipsychotics, mostcommonly risperidone (n=37). Antipsychotic doses ranged from 1.5% to 100% of the BNF maximum, with 47 patients (61.0%) prescribed doses at or below 25% of the maximum.

A clear mental health diagnosis supporting antipsychotic use was documented in 23 of 77 patients (29.9%), while behaviours that challenge were documented in a further 15 patients (19.5%). No clear indication for antipsychotic prescribing was recorded in the remaining 39 patients (50.6%). Antidepressants were prescribed to 44 patients; anxiety or depressive disorders were documented in 16 patients (36.4%), while 8 patients (18.2%) had no documented indication.

Over the audit period, psychotropic medication remained unchanged in 57 patients (48.7%), increased in 27 patients (23.1%), reduced in 23 patients (19.7%), and switched or cross-titrated in 6 patients (5.1%).

This audit demonstrates high rates of psychotropic prescribing within a community LD caseload, with substantial gaps in documentation of clinical indication, particularly for antipsychotic and antidepressant use. Although some medication reduction occurred, increases were more common than reductions. Improved documentation, structured medication review processes, and multidisciplinary approaches are required to support safe prescribing and align practice with national guidance.

Performing a comprehensive physical health examination is crucial for individuals admitted to a neuropsychiatric inpatient unit as it helps identify potential underlying organic conditions that may contribute to a patient’s psychiatric presentation. To ensure optimal care, it is essential for the team to prioritize physical health assessments and maintain clear, timely communication to address all health aspects within the recommended time frame.

Aims

To improve the quality of physical health assessments performed by clinicians across the wards.

To assess whether physical health assessments being performed met the standards and were carried out within the time frames recommended by the Royal College of Psychiatrists and North Staffordshire Combined Healthcare Trust (NSCHT).

To assess whether physical health assessments were being recorded onto Lorenzo electronic patients record (EPR) as recommended by NSCHT.

As part of the admission clerking process, the clinician is advised to fill out the General Condition Examination form on Lorenzo (EPR) which ensures a complete examination to be carried out within the recommended time frame.

This was a retrospective study using records from patients admitted to Ward 5 of the NSCHT between March 2023 and March 2024, a total number of 44 patients were included in this study. A data collection form was used which included the following parameters:

Completion status of physical health assessments

• • Completed Physical Health Assessment

• • Incomplete Physical Health Assessment

• • Missing Physical Health Assessment

Completion status of General Condition Examination form on Lorenzo (EPR)

• • Completed physical health assessments and completed General Condition Examination form on Lorenzo

• • Completed physical health assessments but no form on Lorenzo

• • Data was analysed and graphically represented.

The analysis revealed that 70% of patients underwent complete physical health assessments within the designated timeframe, 14% of the examinations were incomplete/not up to standard and 16% were missing altogether. Reasons for missing assessments were recorded for only 2 patients. These figures fall below the recommended standards.

In relation to the General Condition Examination form on Loranzo EPR, only 18% of patients had the form completed, leaving 82% without the recommended documentation.

Figures from the data analyses were found to be below the standards set out by the NSCHT and the Royal College of Psychiatrists. This would suggest potential communication lapses between clinicians and ward staff.

Key Recommendations:

• • Emphasising the importance of physical health assessments and filling the General Condition examination form as a fundamental component in the resident doctor’s induction handbook and induction meetings.

• • Adding the procedure of filling out the General Condition Examination form on Lorenzo to the induction smartphone application (EOLAS).

Sub-optimal prescribing of anti-dementia medications may compromise the cognition of patients with dementia. The aim of this audit was to assess the prescribing of anti-dementia medications, including Donepezil, Rivastigmine and Memantine, for patients diagnosed with dementia against local and national guidelines in relation to three domains: appropriate indication for dementia subtype, optimal dosage titration and recommended physical health monitoring. The target was to achieve a minimum of 90% adherence to guidelines for each domain.

This retrospective clinical audit was based at the Forget Me Not Unit, a specialist dementia intensive care unit in Worthing. The first audit cycle collected data from twenty patients discharged between February and May 2025. Data obtained from electronic medical records included dementia subtype and severity, pre-admission and inpatient-initiated anti-dementia medications, titration regimes, pulse checks and renal function profiles. Results were compared against Trust and Maudsley prescribing guidelines which served as standards. An action plan was subsequently implemented which included raising staff awareness of the audit, disseminating its results and placing visible audit reminders on ward lists. A second cycle was commenced in November 2025 to February 2026 which examined the data of twenty discharged patients following implementation of the action plan.

In the first cycle, thirteen out of twenty patients were prescribed pre-admission anti-dementia medications (65%) whilst seven out of twenty patients were candidates for an inpatient-initiated anti-dementia medication given their dementia subtype (35%). Six of these patients were offered an anti-dementia prescription of which five were clearly indicated (83%). All prescriptions were titrated according to guidelines but recommended physical health monitoring was only completed for five patients (83%). Similar results were demonstrated in the second cycle. Eleven patients were prescribed an anti-dementia medication prior to their admission (55%), six patients were candidates for an anti-dementiamedication (30%) but only four patients were prescribed an indicated drug during their admission (67%). However, all inpatient-initiated anti-dementia medications were titrated and monitored according to standards.

Anti-dementia medications are licensed treatments for dementia but may be underutilised as evidenced by this audit. Although the target was achieved by the second cycle in two out of three domains, the indication of anti-dementia prescriptions was not fully adhered to against guidelines. Further audit cycles and tailored action plans could raise the standards of anti-dementia prescriptions and thereby improve patient safety and care.

Background

In April 2025, city-wide changes to General Practitioner (GP) prescribing increased prescribing activity within the Community Learning Disability Team (CLDT). This audit evaluated the quality and consistency of prescribing documentation to determine whether current practice met local standards and to identify areas requiring improvement.

Aims

1. Assess adherence to documentation standards for prescriptions recorded in the electronic health record (Care Director), clinic register, and clinical notes.

2. Describe prescribing patterns across the team.

3. Develop a Standard Operating Procedure (SOP) to address gaps identified through the audit.

Records of 297 service users receiving prescriptions between 01/04/2024 and 31/05/2025 were reviewed. Outcomes included whether prescriptions were uploaded to Care Director (scan or photograph), whether entries were completed in the clinic register, whether prescribing was documented elsewhere (case notes or letters), and the site of prescription issue. Prescribing patterns were summarised.

A total of 319 prescriptions were issued to 147 patients. Of these, 65% (208/319) were uploaded to Care Director–half scanned and half photographed. Only 19% (58/300; clozapine excluded) were entered into the clinic register. Prescribing was documented elsewhere in 98% (314/319). Documentation occurred frequently but was inconsistent in format, location, and completeness.

Conclusions

The audit identified frequent but inconsistent documentation. The SOP provides a structured framework to improve accuracy, consistency, and audit-ability, with re-audit recommended at 6–12 months.

Actions

Based on the identified gaps, a SOP was developed. Key components included a scanfirst requirement, defined legibility standards, mandatory casenote entry confirming medication and dose, creation of a centralised electronic tracking register, quarterly monitoring, and data protection guidance.

• • To collect a database of all patients with ADHD in the adult mental health community team.

• • Investigate current compliance with following NICE guidelines on physical health monitoring for patients with ADHD taking medication.

• • Ensure all patients on medications were under the care of the Physical Health Monitoring Team (PHMT) who undertake the monitoring.

• • Make recommendations for improvement in care where guidelines are not being adhered to.

A database was compiled with patients suffering from ADHD and those on medications were noted.

The following criteria from the NICE guidelines on ADHD management were included:

• • Baseline observations (heart rate (HR), blood pressure (BP), height, weight) – we reviewed this for those patients who had commenced ADHD medications less than one year ago.

• • 6 monthly weight

• • 6 monthly HR and BP

• • 6 monthly psychiatry review

• • Assessment for side effects at review – This includes cardiovascular issues, emerging tics / abnormal movements, sexual dysfunction, seizures, sleep, worsening behaviour

• • 21/31 patients with confirmed ADHD were being medicated for same.

• • 10/21 medicated patients were not under the care of the PHMT nor did they have a key worker.

• • Medications included forms of methylphenidate or lisdexamfetamine and/or both:9/21 (43%) Concerta XL, 5/21 (24%) Equasym XL, Lisdexamfetamine 6/21 (29%), methylphenidate 3/21 (14%).

• • 9/21 (43%) did not receive appropriate baseline observations.

• • 14/21 (67%) did not have a 6 monthly weight documented.

• • 15/21 (71%) did not have 6 monthly HR/BP checks

• • 8/21 (38%) did not have a 6-month psychiatry review.

• • Regarding assessment for side-effects, on reviewing clinical letters, 1/21 (5%) of letters did not document any discussion regarding side effects. Variation in side effects discussed was evident with 10/21 (48%) documenting general side effects such as sleep and 8/21 (38%) documenting more specific side effects such as tics or sexual dysfunction.

This audit highlighted that ADHD monitoring was being neglected in a large percentage of patients on our ADHD database and variation in documentation regarding side effects.

• • Review led to the following improvements being made:

• • We developed an identifiable case load of patients with ADHD which is helpful for future audit and monitoring.

• • Patients were referred to the PHMT for follow up of monitoring, helping to improve the likelihood that NICE guidelines will be adhered to.

• • A reflection on the need for more specific documentation regarding monitoring of side effects in clinical letters.

High Dose Antipsychotic Therapy (HDAT) is defined as prescribing a single antipsychotic above the British National Formulary (BNF) maximum or a combinedpercentage dose of two or more antipsychotics exceeding this limit.HDAT is off-label and associated with increased morbidity and mortality, requiring documented clinical justification and risk–benefit discussion.This audit evaluated HDAT prevalence, adherence to Trust monitoring standards and reported side effects among adults prescribed antipsychotics in inpatient and community settings.

A cross-sectional audit was conducted between May and August 2025 of adults aged 18–65 years receiving antipsychotic therapy.All patients in nine inpatient psychiatric wards and a random sample of patients from two Community Mental Health Teams and one Early Intervention in Psychosis service were audited.Prescription charts, clinic letters and medical records were reviewed to assess prescribing patterns, HDAT prevalence, compliance with Trust monitoring standards, patient demographics, psychiatric diagnosis, treatment duration, and medication side effects.

A total of 337 patients were audited (n=142 female, 42.1%; n=195 male, 57.9%), mean age 41 years. Most identified as White (76.9%), with 19.0% Black or Asian and 4.2% unknown ethnicity. The majority (72.7%) were prescribed at least one additional psychotropic medication and 18.1% reported side effects, predominantly extrapyramidal symptoms (52.5%), weight gain (24.6%), and sedation (23%).Thirteen patients (3.9%) met HDAT criteria, primarily in inpatient settings (n=11); mean age 43 years.Most were male (84.6%), White (92.3%) and diagnosed with schizophrenia (84.6%).Over half (69.2%) received two antipsychotics, whilst 30.7% were prescribed a single antipsychotic above BNF limits.HDAT monitoring was fully compliant in 38.5% of cases, partially in 23.0%, and incomplete in 30.8%.Fewer HDAT patients reported medication side effects (15.4%).In the overall, sample, 32.6% had received antipsychotic treatment for over 12 months, rising to 46.2%among those on HDAT.

HDAT was infrequent, largely confined to inpatient settings and typically associated with antipsychotic polypharmacy and co-administered psychotropics.White men were more likely to receive HDAT, despite a broadly balanced gender distribution overall. Frequent side effects, relatively young cohort and known risks of HDAT highlights the importance of adherence to Trust monitoring standards, which was achieved in fewer than half of cases. The low rate of side effects among patients receiving HDAT likely reflects under-recognition or under-reporting rather than true tolerability, particularly in the context of polypharmacy and long-term treatment.These findings support the need for targeted clinician education and improved systems to promote safer HDAT practice.

This audit aimed to determine the proportion of adults with Intellectual Disability (ID) residing at ‘Dar tal-Providenza’ residence, who had undergone genetic testing confirming a genetic diagnosis, assess documentation of genetic testing discussions or referrals, and evaluate alignment of current practice with national and international guidelines for genetic testing in neurodevelopmental disorders.

All adults under the care of the ID team with a documented diagnosis of ID and/or Autism Spectrum Disorder (ASD) were included. Electronic Patient Records were reviewed for demographic data, primary diagnoses, documentation of genetic testing or referral to genetics services, discussions with patients or carers, and documentation of results and follow-up actions in accordance with National Institute for Health and Care Excellence (NICE) and European Society of Human Genetics (ESHG) guidelines.

The cohort consisted of 80 adults aged ≥18 years, with a mean age of 50.4 years and a gender distribution of 49 males and 31 females. Most individuals had multiple co-existing neurodevelopmental, neurological, genetic, and mental health diagnoses. ID severity was mild–moderate in 23.75% (n=19), moderate–severe in 57.5% (n=46), and unspecified in 18.75% (n=15). An associated genetic syndrome was identified in 16.25% (n=13).

ASD was the second most common diagnosis (22.5%, n=18) and a frequent comorbidity with ID (16.25%, n=13). Other diagnoses included cerebral palsy (13.75%, n=11), trisomy 21 (11.25%, n=9), epilepsy (6.25%, n=5), Fragile X syndrome, Cri-du-Chat syndrome, and Peters-plus syndrome (each 1.25%, n=1). Challenging behaviour co-occurred in 8.75% (n=7). Mental health comorbidity was common, including bipolar affective disorder (6.25%, n=5), emotionally unstable personality disorder, post-traumatic stress disorder, schizoaffective disorder, anxiety disorder, and psychotic depression (each 1.25%, n=1).

Only 6 patients (7.5%) had a documented genetics referral, with genetic testing discussed in one case (1.25%). Among those referred, five had confirmed diagnoses, one was awaiting results, and no follow-up plans were documented.

This audit identified a highly complex cohort with extensive neurodevelopmental and mental health needs. Despite meeting NICE and ESHG criteria, genetics referral was low (7.5%) with minimal documented discussion or follow-up, highlighting the need for further training and collaboration between the Psychiatry and Genetics Department in Malta.

This audit assessed whether psychotropic prescribing practices for young people (YP) with Intellectual Disability (ID) and/or Autism Spectrum Disorder (ASD) under the care of the ID Team aligned with STAMP principles. It also examined the proportion of patients prescribed psychotropic medication, the class of psychotropic medication used, and the quality of documentation regarding multidisciplinary input, medication reviews, behavioural interventions, and involvement of YP and their carers in the decision-making process.

All YP under 18 years with a diagnosis of ID and/or ASD receiving care from the ID team, were included. Electronic Patient Records were reviewed with demographic data, comorbid mental and physical health conditions, psychotropic medications prescribed (antipsychotics, antidepressants, mood stabilisers, anxiolytics, and Attention Deficit Hyperactivity Disorder (ADHD) medication), and documentation against STAMP criteria included. The latter included evidence of a clear clinical indication for medication use, use of non-pharmacological interventions, timely medication reviews, patient and carer involvement, and plans for medication reduction or discontinuation.

The cohort comprised 120 patients with a mean age of 14.7 years; 86 were male and 34 female. Within the ID clinic, ASD was diagnosed in 91 patients (75.83%) and common comorbidities included ADHD (60%), anxiety disorders (14.17%), and epilepsy (10.83%).

113 patients (94.2%) were prescribed psychotropic medications. Antipsychotics were most commonly prescribed (n=70, 58.3%), followed by ADHD medications (n=56, 46.67%), antidepressants (n=54, 45%), anxiolytics (n=47, 39.17%), and mood stabilisers (n=18, 15%). A clear clinical indication was documented in 100% of cases.

Non-pharmacological interventions were widely used (n=115, 95.8%), with school-based support in 88 patients (76.5%), psychology assessments/referrals in 42 (36.5%), behavioural therapy in 35 (30.4%), occupational therapy in 28 (24.3%), and psychotherapy in 24 (20.9%). Multidisciplinary team (MDT) involvement was documented in 117 cases (97.5%), and parent or carer involvement in care planning was recorded in all patients (100%). Medication reviews within the previous 12 months were documented for 117 patients (97.5%), and reduction or tapering plans were present for 81 patients (67.5%).

This audit highlights a high proportion of psychotropic medication use, particularly antipsychotics. While multidisciplinary involvement was prominent, there was little mention of positive behavioural therapy and behavioural plans used to guide judicious prescribing. Further emphasis on the importance of behavioural strategies throughout the department would help improve awareness and responsible prescribing practices.

The period immediately following discharge from psychiatric inpatient mental health care is associated with heightened clinical vulnerability, including increased risk of relapse, crisis presentation and suicide. National standards from the National Confidential Inquiry into Suicide and Safety in Mental Health, NHS CQUIN targets and the Welsh Government Crisis Care Concordat recommend that all adult patients receive follow-up by a mental health professional within 72 hours of discharge and that discharge documentation comprehensively records risk, mental state, medication and care planning. A previous regional audit identified variable compliance and incomplete documentation across sites. This re-audit aimed to assess current adherence to these standards, evaluate whether implemented quality improvement measures had improved practice, and identify ongoing gaps to inform further service development.

A retrospective clinical re-audit was undertaken across three adult inpatient units (East, Central and West) within Betsi Cadwaladr University Health Board. All eligible discharges occurring during June–July 2025 were included. Electronic discharge summaries and 72-hour follow-up records were reviewed using predefined criteria. Standards assessed included completion of follow-up within 72 hours and documentation of risk assessment, mental state examination (MSE), medication information, and a comprehensive discharge plan, alongside the quality of follow-up notes. Cases recorded as not applicable or refused were excluded. Missing or undocumented items were classified as non-compliant. Compliance rates were calculated overall and by site and compared with baseline findings from the initial audit.

Thirty-eight discharges were reviewed. Overall compliance with 72-hour follow-up was 78.4% (29/37). Documentation of comprehensive discharge plans was highest (86.5%), followed by MSE (78.8%) and risk assessment (72.7%). Medication documentation remained comparatively low at 63.6%. Considerable inter-site variation was observed. The Central site achieved 100% follow-up compliance and consistently strong documentation across domains. In contrast, the East site demonstrated lower follow-up completion (57%) and particularly poor medication documentation (20%), while the West site showed moderate follow-up rates (66.7%) with weaker recording of risk (46.2%) and medication (53.8%). Compared with baseline data, overall follow-up and discharge planning showed modest improvement, but reliability of documentation remained inconsistent.

Although small gains were demonstrated following initial interventions, substantial variation persists between sites, indicating inconsistent processes and handover practices. Standardised electronic templates, discharge checklists, automated alerts and routine audit feedback have been introduced to improve reliability. Ongoing quality improvement and targeted site support are required to achieve consistent adherence to national standards and to enhance safety during the high-risk transition from inpatient to community care.

Other authors-Dr. Aanika Nawer Hoque,Dr Nur Efina Mokhtar,Dr Charlotte Hague-Roberts

Individuals with severe mental illness experience a disproportionate burden of oral disease. Contributory factors include medication-induced xerostomia, cognitive deficits, and impaired motivation for self-care. Studies found that they are significantly less likely to engage in preventative dental behaviours or utilize services. Inpatient admission provides an opportunity to engage our service users in promoting their oral hygiene. Hence, an audit can provide valuable insights into current practices and identify areas for improvement and highlight gaps in service provision.

The study was conducted between April to May 2025 across inpatient mental health units within Derbyshire Healthcare NHS Foundation Trust. Electronic patient records were reviewed to assess completion of the ‘Eating, Drinking and Oral Health’ questionnaire and the standardized oral health risk assessment during their admission. The audit also examined the prevalence of documented dental issues and access to dental services. A structured data collection tool was developed to capture sex, gender, ward type, documentation of oral health assessments, completion of dental screening questionnaires and risk assessments, identified oral health issues, and access to dental care during their admission. Trust inpatient policy requires all inpatients to receive a comprehensive physical health assessment including oral health examination on admission, and dental hygiene included in ongoing nursing care reviews.

A total of 114 patients were included in this study, from acute working age (n=40), older adult (n=34), low-secure forensic (n=20), and rehabilitation ward (n=19), with a mean age of 53.6 years. 72/114 were male. Although the “Eating, Drinking and Oral Health” questionnaire was partially completed for 61.4% (n=70/114), full compliance was not achieved for any patient. Formal oral health examinations were recorded for only 10.5% (n=12/114), with the lowest rates observed in the forensic unit (0%). Notably, no patients had a completed oral health risk assessment. Of the 30 patients who presented with acute dental issues during their admission, 18 successfully accessed professional dental care, though access rates varied significantly between ward types with the service users in the forensic ward among the highest.

The audit demonstrates that current monitoring and documentation practices of oral hygiene in our local trust requires improvement. Immediate interventions should focus on increasing awareness, optimizing the accessibility of relevant assessment tools, and implementing clinical prompts to improve documentation quality. Long-term strategies must prioritize the integration of oral health into multidisciplinary care planning and the establishment of formal referral pathways with community dental providers to ensure holistic patient management.

The demand for adult Attention Deficit Hyperactivity Disorder (ADHD) assessments has surged while NHS capacity remains constrained by limited budgets, workforce shortages, and uneven specialist provision. Lack of national standardisation in ADHD pathways has created regional disparities, with waiting times ranging from two to five years–often termed the “ADHD postcode lottery.” Many patients turn to private clinics offering faster assessments, either self-funded or via the NHS Right to Choose pathway, which allows eligible patients to access approved private providers at NHS expense.

NICE guidelines (2018) state that “after titration and dose stabilisation, prescribing and monitoring of ADHD medication should be carried out under shared care protocol arrangements with primary care.” However, shared care implementation is inconsistent, with reported concerns among clinicians about private assessment validity and medicolegal implications of prescribing medications initiated outside NHS services. Without shared care arrangements, patients must either continue costly private prescribing or re-join NHS waiting lists for reassessment and treatment, risking abrupt treatment discontinuation.

This audit aimed to identify the prevalence of private ADHD diagnoses within the North Peterborough Adult Locality Team (PALT) caseload, determine how prescribing responsibility is managed, and assess alignment with NICE shared care guidance to inform local policy development.

Patient records were reviewed retrospectively using clinic letters and keyword searches (e.g., “ADHD,” “private,” “Right to Choose,” “shared care”). Data collected included demographics, route of diagnosis, treatment status, prescribing arrangements, and shared care documentation.

Of the 325 patients reviewed, 2 (0.6%) had received private ADHD diagnoses, both in 2022. Both were female, aged 39 and 47, one British and one African-Asian. The first accessed diagnosis via NHS Right to Choose and was managed under shared care between her private psychiatrist and GP for two years until discontinuing medication. The second obtained a self-funded private diagnosis but reverted to the NHS ADHD clinic treatment waitlist due to costs; subsequent delays in accessing treatment led to her returning to private care.

We identified a low prevalence of private ADHD diagnoses within the caseload. While the smaller cohort precludes generalisation, Right to Choose facilitated successful shared care, whereas self-funded pathways resulted in treatment delays. No mechanism exists for privately diagnosed patients to access NHS treatment without joining standard waiting lists, undermining the rationale for expedited private diagnosis and perpetuating treatment gaps. Further audit in a larger cohort is recommended to inform local policy development.

Individuals with first-episode psychosis (FEP) have a high prevalence of obesity and cardiometabolic abnormalities, compounded by antipsychotic-related metabolic side effects and unhealthy lifestyle behaviours, including tobacco smoking, physical inactivity, poor dietary habits, and substance use, resulting in an elevated risk of premature mortality. Black and minority ethnic populations exhibit elevated cardiometabolic risk, with ethnicity influencing the onset, progression, and outcomes of cardiometabolic disease. To mitigate these risks, the National Clinical Audit of Psychosis (NCAP) – Early Intervention in Psychosis standards require routine monitoring of body mass index (BMI) and intervention when thresholds are exceeded: BMI ≥25 kg/m² for the general population, compared with the lower threshold of BMI ≥23 kg/m² for South Asian and Chinese populations.

This audit aimed to establish a baseline understanding of BMI distribution within the Northamptonshire Early Psychosis Service (NSTEP), with a focus on ethnic groups at increased cardiometabolic risk, to inform future quality improvement initiatives.

A retrospective audit was conducted on cross-sectional caseload data from NSTEP North and South as of 11th March 2025. BMI and ethnicity were recorded, with BMI categorized as <20 kg/m², 20–24.9 kg/m², 25–29.9 kg/m² (overweight), and ≥30 kg/m² (obese); for South Asian and Chinese patients, BMI ≥23 kg/m² was also noted. Antipsychotic prescribing patterns from a previous quality improvement project (September 2024) were included to contextualize metabolic risk.

Of 187 patients, 182 (97%) had BMI recorded; BMI was <20 kg/m² in 6%, 20–24.9 kg/m² in 28%, 25–29.9 kg/m² in 34%, and ≥30 kg/m² in 29%, with approximately two-thirds of the total caseload (64%) falling in the overweight or obese range, and a higher prevalence in NSTEP North than South (68% vs. 63%). Among South Asian/Asian patients, 68% (13/19) had BMI ≥23 kg/m² while Black Caribbean/African patients showed 68% (23/34) prevalence of overweight or obesity. Approximately half of patients across both services were either not prescribed antipsychotic medication or were treated with Aripiprazole, a relatively weight-neutral antipsychotic.

This audit demonstrates that two-thirds of NSTEP patients are overweight or obese, with particularly high prevalence among South Asian/Asian and Black Caribbean/African populations, despite weight-neutral antipsychotic prescribing. These findings highlight the need for targeted, culturally informed lifestyle and weight management interventions. The plan is to introduce resource packs containing diet and exercise guidance, promote local NHS exercise and weight management programmes, encourage NSTEPactivity groups to incorporate exercise, and collaborate with the NHS Diabetes Prevention Programme to improve patient access.

Prolonged inpatient psychiatric admissions are unlikely to benefit individuals with Emotionally Unstable Personality Disorder (EUPD)/Complex Emotional Needs (CEN) and may even be counterproductive, disrupting daily routines, weakening stabilizing relationships and social roles, reinforcing avoidance of psychosocial stressors, and increasing risk behaviours aimed at maintaining institutional attachments or eliciting care, ultimately impeding recovery.

The Northamptonshire Healthcare NHS Foundation Trust (NHFT) CEN guideline outlines an Inpatient Personality Disorder Pathway enabling ‘Goal Focused Admissions’, requiring pre-admission goals and recommendations, care planning and engagement contracts within 24 hours, consultant review within 72 hours, and brief admissions under 14 days. This audit studied adherence to the CEN guideline.

Patients with EUPD admitted between 1 January and 28 February 2025 wereincluded; those with comorbid diagnoses were also included if EUPD was the primary reason for admission and remained the primary discharge diagnosis. Referral letters were audited for legal status and short and long-term treatment goals while electronic records were audited for time from admission to documentation of admission goals, engagement contracts, discharge planning, first psychiatrist review, and total length of stay.

Twenty-one patients were included; 81% were informal admissions and the remainder were detained under Section 2 of the Mental Health Act. Crisis resolution was the most frequently cited admission goal (in 48% of cases with documented goals); however, around half of all patients lacked clearly documented admission goals. Admissions were primarily for risk and safety management (42%), followed by medication review (37%), psychological input (16%), multidisciplinary liaison and/or social support (17%), and diagnosis review (5%) were also suggested, with recommendations for referral to other services (CMHT, Personality Disorder Hub etc). Admission goals were documented within 24 hours for 57% of patients, though only 9.5% had engagement contracts completed and 48% had discharge dates recorded within this timeframe. First consultant reviews occurred within the 72-hour target for 48%; delays ranged from 4 to 10 days for the remainder. Only 21% remained inpatient for ≤2 weeks, while 26% of patients stayed 5 weeks or longer.

This audit demonstrated low adherence to the CEN management guideline. Referrals lacked clear admission goals, delaying care planning, engagement contracts, and consultant reviews while extending hospital stays and undermining the collaborative planning and clear therapeutic boundaries fundamental to working with individuals with EUPD. Recommendations include staff training in Structured Clinical Management, group supervision and case discussions with community PD services, and greater guideline awareness among clinicians. Re-audit is advised to monitor improvement.

The aim of this audit is to assess compliance with physical health monitoring for patients admitted in an acute inpatient setting including weight, height, BMI, waist circumference. Also to assess if metabolic risk factors have been identified and whether appropriate risk mitigation measures were taken.

This is a retrospective audit design where electronic patient records of patients admitted in an acute inpatient unit between November 2024 and August 2025 were reviewed. Information was extracted to determine whether physical health monitoring including weight, height, BMI, waist circumference was completed at baseline (on admission), at 4 weeks, 8 weeks, 12 weeks and subsequently every 3 months. Data was only collected for the duration of the inpatient stay.

Drug charts were reviewed to see whether any changes were made to the treatment regime while inpatient. Discharge summaries were also reviewed specifically the section titled “Plan and Requested Actions” to determine any advice and follow up recommendation were made.

100 patients were admitted in the ward between November 2024 and August 2025. Waist circumference was not measured during the whole length of stay for any patient.

Base line weight was not recorded in 12 patients, height was not recorded in 14 patients. BMI was not calculated for 15 patients.4 patients were not on any psychotropic. Unclear documentation about medication for 3 patients.

37 patients were discharged/transferred before 4 week review.Among the remaining 63 patients, weight was not recorded in 21 (33.33%) patients, height was not recorded in 22 (34.9%) patients. BMI was not calculated in 23 (36.5%) patients. 2 patients didn’t have any psychotropics prescribed.

By 8 weeks, 30 patients were discharged/ transferred. Among the remaining 33 patients,weight was not recorded in 13 (39.39%) patients, height and BMI was not recorded in 14 (42.42%)patients. No psychotropics were prescribed for 1 patient

By 12 weeks, 15 patients were discharged/transferred. Among the remaining 18 patients, weight, height and BMI were not measured in 7 (38.8%) patients.

Before 3 monthly monitoring review point, 13 patients were discharged. Among the remaining 5 patients, weight was not monitored for 1 (20%) patients. 2 (40%) patients didn’t have their height and weight measured.

35 patients had documentation regarding their metabolic risk factor. No patient had clear documentation regarding action taken to mitigate these risks.

This audit shows the need for consistent weight monitoring and implementing a structured traffic-light risk category system to enable early identification and management of antipsychotic-induced weight gain.

As per NHS Forth Valley Psychiatry Emergency plan 2023, any patient admitted to the mental health unit should have a senior review within 48 hours of admission, regardless of the day of the week. A senior review is defined as either a higher trainee, i.e. ST4-6, or a consultant psychiatrist. Previous audits have reviewed compliance of this in the years 2021 and 2022. The aim of this re-audit was to review the compliance of the 48-hour senior review policy between 2023 to 2025.

Electronic patient records of patients admitted to five mental health wards in Forth Valley Royal Hospital were reviewed to determine whether there was a clear documentation of senior review within 48 hours of admission, in line with the existing policy. This was done biannually for the duration between August 2022-- August 2025 in a retrospective manner.

In 2025, all wards achieved 100 percent compliance with 48 hour senior review policy. Overall average of compliance in duration from Aug 2022 - February 2023 was 97 percentage which increased to 100 percentage between August 2024 - August 2025. One ward which showed low compliance (78%) in the time period August 2022 - February 2023, demonstrated progressive improvement in the re-audit cycles in February 2024 (89%), August 2024 (90%) and further 100 % compliance in both audit cycles in 2025. Interestingly, the Intensive Psychiatric Care Unit, which has the most acutely unwell patients, had showed full compliance with the 48-hour policy in all audit cycles since 2021.

Sustained improvement in compliance to 48 hours senior review policy was demonstrated by this audit, with all wards achieving full compliance in2025. To improve quality of care, a new audit process is being planned for the introduction of a standardised senior review template. Additionally, discussions are ongoing within the trust to adopt a 24-hour senior review policy which is the standard practice in medical wards.

The South West Yorkshire Partnership NHS Foundation trust (SWYT) policy on seclusion and long term segregation refers to Seclusion as ‘supervised confinement and isolation of a service user, away from other service users, in an area from which the service user is prevented from leaving, where it is of immediate necessity for the purpose of the containment of severe behavioural disturbance which is likely to cause harm to others.’ It is essential that they are afforded the procedural safeguards of the Mental Health Act Code of Practice. The SWYT trust policy provides clear recommendations on medical seclusion reviews.

The aim of the audit is to check the adherence to SWYT trust policy on medical seclusion reviews in a Psychiatric Intensive care Unit (PICU).

The SWYT trust policy on medical seclusion reviews has a seclusion toolkit which outlines the following timeframes for assessment: Initial medical review within an hour of seclusion, 4-hourly medical reviews till first Multidisciplinary (MDT) meeting, first MDT, independent MDT within 8-18 hours of seclusion, regular reviews thereafter (included 1 medical (non-RC) review, 1 Responsible Clinician (RC) review and 1 MDT till the end of seclusion. The RC MDT and RC medical review may be combined). The policy needs to be followed for seclusions initiated during out of hours/ weekends/bank holidays.

The list of all new seclusions in PICU from January 2025 to April 2025 was obtained from the Trust Performance and Business Intelligence team. An audit tool was prepared using the seclusion toolkit in the trust policy. The audit tool comprised of questions checking if the medical, MDT and Independent reviews were completed in a timely manner as per the trust guidance.

Data collection was done by members of the audit team. All the data was collected from electronic records.

Key successes:

1. In 92.7% cases, first MDT was completed within 08:00 to 22:00 the next day.

2. 95% seclusion reviews on bank holidays/ weekend and out of hours were adherent to the trust policy.

3. Non-RC medical reviews were completed daily for the duration of the seclusion in 87.2% cases.

Key concerns / areas for improvement:

1. Only 24.2% completion of independent MDT reviews during a period of seclusion.

2. 64.4% resident doctor reviews are done within 1 hour of commencement of seclusion.

3. Daily MDT reviews were completed in only 66.6% cases. This was noted to be due to incorrect documentation on the seclusion proforma.

This audit highlights high compliance for first MDTs and out of hours reviews but also highlights areas for improvement such as low rates of completion of independent MDT and initial 1 hour reviews. Recommendations included prompts for independent MDT reviews, including seclusion toolkit in new doctors’ induction training and discussing with Responsible Clinicians about accurate documentation of daily seclusion reviews.

Seclusion is a restrictive procedure and therefore ensuring adherence to trust guidelines on seclusion reviews is important.

To assess the appropriate use of FP-10 prescriptions against the NICE-BNF and Trust Guidelines.

This was a retrospective audit, and reaudit to include all FP-10 prescriptions written for the patients coming under the Community mental health teams in Halton (that is Assessment and HTT, Recovery Team, EIP, LLAMS and CAMHS).The sample was identified from Appendix 3 data sheets,RiOnotes, Clinical documents.The data were extracted from Data from existing databases, electronic systems and case notes.The total size of the population was 23 for the initial audit and 97 for the re-audit.The sample time period for the initial audit was 01/01/2022 till 25/07/2022 and reaudit was from 07/07/2024 to 07/08/2024. The sample selection was all consecutive FP 10 prescriptions used during the time period.

Initial audit had 97% overall compliance level but the criteria on completing appendix 3 for the completed FP-10s and scanning or documenting the FP-10s to patient records were met with a moderate compliance level of 83% and 87% respectively.

Action plan following the audit was to include a column in Appendix 3 to identify NHS numbers of the patients given FP-10s and to insert an information sheet to FP-10 bundle with guidance on recording details.

In both audits 100% compliance was met for storing the FP-10s and managing them securely and Prescription writing guidelines were followed according to NICE- BNF standards. This was not a prescribing audit and the doses and appropriateness of medication were not audited

Following the action plan in the re-audit the compliance level was met at 99% with the above-mentioned criteria improving compliance to 100% and 97% respectively.

In both audits the FP-10s were given to prescribe psychotropics only and were written according to NICE-BNF guidance.

In both audits the FP-10s were stored and managed according to the local trust guidance.

The recording of FP-10 details improved following the simple intervention of including a prompt sheet with the prescriptions.

A secondary outcome was that the procedure for management of FP10s in the community has been reviewed and rewritten.

Background

The decision to detain an individual under mental health legislation represents one of the most profound and important decisions in psychiatry. It is a decision that must be grounded in a meticulous and clearly documented clinical justification as to why someone should be deprived of their liberty. Section 2 and section 3 medical recommendation statutory forms state that reasons should be given to explain how symptoms and behaviour lead you to an opinion. These forms are scrutinised and anecdotal evidence suggested the need for an improvement in documentation quality.

Aim

The aim of this audit was to compare current practice in South West Yorkshire Partnership Teaching NHS Foundation Trust to statutory guidance in the Mental Health Act 1983: Code of Practice and to what the statutory forms state should be included in a medical recommendation.

Ethical Consideration and Project Advice

We held a preliminary meeting with the Head of Research, in the Trust Clinical Research Team - this meeting was held for project advice and to discuss ethical considerations.

Key points discussed:

1. The project would involve no patient contact.

2. It will not alter patient care of the patients whose medical recommendations are being assessed for the audit.

3. It was classified as a significant safety project from the perspective of the Head of Research and Information Governance Manager.

4. Head of Research provided an exemption record to authorize access to the necessary patient records.

Data Sources

• • Sample of 50 medical recommendations - from January 2025 onwards (until reached 50).

• • For admission for assessment (under section 2 MHA 1983), or for admission for treatment (under section 3 MHA 1983), both single and joint recommendations in the Wakefield area.

• • Mental Health Act Office – sent a list of NHS numbers via email.

Data Collection

A Microsoft Excel spreadsheet was designed as the primary data collection tool to streamline and standardize the process. The form included fields aligned with the key parameters outlined in the Mental Health Act 1983: Code of Practice and statutory forms. Data was collected from the sample, between August and September 2025.

Data Analysis

Anonymous data was added to the Excel spreadsheet, and this was reviewed by two reviewers / assessors (one of which was section 12 approved). On occasions where the assessors were unable to agree, the recommendation was then sent to another reviewer (who was section 12 approved).

Audit Standards - Compliance of 100% Expected

1. Did the doctor state that the patient was suffering from a mental disorder?

2. Did the doctor describe symptoms of the mental disorder?

3. Did the doctor cover nature OR degree sufficiently?

4. If necessary for the patient’s own health, were adequate reasons given?

5. If necessary for the patient’s own safety, were adequate reasons given?

6. If necessary for the protection of other persons, were adequate reasons given?

7. Did the doctor explain why community treatment was not available and appropriate?

8. Did the doctor explain why informal admission was not appropriate?

The below results were found in terms of compliance with standards set.

1. Did the doctor state that the patient was suffering from a mental disorder? - 100%

2. Did the doctor describe symptoms of the mental disorder? - 100%

3. Did the doctor cover nature OR degree sufficiently? - 100%

4. If necessary for the patient’s own health, were adequate reasons given?-100%

5. If necessary for the patient’s own safety, were adequate reasons given? - 62%

6. If necessary for the protection of other persons, were adequate reasons given? - 81%

7. Did the doctor explain why community treatment was not available and appropriate? - 90%

8. Did the doctor explain why informal admission was not appropriate? - 100%

Key Successes

We found 100% compliance with stating the patient was suffering from a mental disorder, describing symptoms of the mental disorder, covering nature or degree, giving adequate reasons for why detention necessary for patient’s own health and explaining why informal admission was not appropriate.

Key Concerns / Areas for Improvement

We found partial compliance for giving adequate reasons for why detention was necessary for the protection of other persons and why community treatment was not available and appropriate. There was poor compliance for giving adequate reasons why it is necessary for the patient’s own safety.

These statutory forms are the basis on which individuals are deprived of their liberty. There are elements of the form which are mandatory and despite the vast majority of medical recommendations being made by those who are section 12 approved, for at least one of the statutory criteria (why it was deemed necessary for the patient’s own safety), only 62% of these doctors provided the required evidence to support that element of their opinion.

Limitations of the Project

• • The samples provided by the Mental Health Act office only had section 3 medical recommendations and single recommendations which may have skewed the results.

• • The data collection was based on the subjective opinion of assessors – but the forms were reviewed by two assessors and discussed with third assessor if the two assessors could not agree.

• • The data was collected over a five-month period, and we considered if a longer period of data collection may have given a more longitudinal view.

Key Actions to be Implemented

• • We shared the results locally with doctors in the Trust and plan to share the results with the Trust Mental Health Act Committee.

• • We have proposed a system of giving feedback to doctors about their medical recommendations and the introduction of an agreed template to improve the quality of these as well.

• • We plan to re-audit following implementation of changes after three to six months.

ADHD is a neurodevelopmental condition which affects approximately 3-4% of UK adults. ADHD has been linked to a range of co-occurring conditions such as Autism, Substance use disorders and Anxiety.

The aim of this study was to examine the frequency of co-occurring psychiatric conditions among a cohort of adult patients diagnosed with ADHD at the Brighton and Hove Neurodevelopmental Clinic between June 2022 and June 2024.

Notes of 200 patients, who had received a diagnosis of ADHD by the Neurodevelopmental service (NDS) in Sussex Partnership Foundation Trust (SPFT) between June 2022 and June 2024, were reviewed using the Electronic Health Record system used by SPFT, and by using the Plexus software to review GP records.

We reviewed; ADHD referral, assessment, the first 3 NDS reviews post assessment, each patient’s GP record and any previous psychiatric clinic letters that were available to collect data on co-occurring or historic conditions.

Conditions that we recorded included current or historical substance misuse, Autism, Bipolar affective disorder (BPAD), Major Depressive Disorder (MDD), Generalised Anxiety Disorder (GAD), Post traumatic Stress Disorder (PTSD), Personality disorder (any kind and either an active or historic diagnosis). We also collected data on any history of psychosis.

This study was registered with and approved by SPFT Quality improvement support team (QIST).

Of the 200 records reviewed 173 had ADHD referrals, assessments and diagnoses. Of those records the mean age at diagnosis was 31.9 years, with a median age of 30.

The patients records included showed current or historical evidence of the above conditions in the following proportions; Substance misuse 29%, Autism 38% with a further 5.7% awaiting assessment, BPAD 7%, MDD 17.9%, GAD 18.5%, PTSD 19%, Personality disorder 19% and Psychosis 4.6%.

Our findings provided further evidence of the high rate of co-occurring Autism, Substance misuse, anxiety and depression in those who receive a diagnosis of ADHD in adulthood. This highlights complexity and burden of having ADHD diagnosis. It also indicates the need of revising the service model to ensure an appropriately trained workforce is able to provide comprehensive assessment and diagnosis as this is likely to provide patients with a better experience of care and outcomes.