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Aims: Individuals with severe mental illness (SMI) face a significantly reduced life expectancy, primarily due to preventable physical health conditions. This project aimed to enhance the timeliness and comprehensiveness of physical health checks for inpatients in an acute psychiatric ward. An initial audit cycle identified gaps, prompting targeted interventions, with subsequent re-audit assessing their impact. Methods: The first audit cycle (March 2023) reviewed adherence to physical health assessments, including physical examinations, observations, height and weight measurements, ECGs, blood tests, and cardiometabolic checklist completion. Interventions implemented included daily reviews in the Multi-Disciplinary Team (MDT), integration into daily job lists, and master list documentation. These measures reduced delays in completing assessments. The second cycle (November 2023) involved 35 inpatients over four months. Interventions included the introduction of a whiteboard for task tracking, post-MDT reviews, staff reminders, and induction sessions emphasising physical health monitoring. Colour coding was introduced to enhance task visibility and efficiency. Specific patient needs, such as those with heart failure and left bundle branch block (LBBB) or end-stage renal disease (ESRD) requiring dialysis, were incorporated into tailored care plans. Results: The second cycle demonstrated that, overall, there were visible improvements in clinical practice. The whiteboard intervention significantly improved the timeliness and completion rates of physical health checks. Key findings included: Physical examinations: Success rates increased from 93% to 100%. BMI measurements: Reduced delays and increased completions. Physical observations: Maintained at 100% completion. Challenges included gender-based refusals for ECGs and reluctance from patients with eating disorders to undergo BMI measurements. These findings highlight the importance of personalised approaches to monitoring and addressing barriers to compliance. Conclusion: Implementing a whiteboard for tracking physical health checks demonstrated substantial improvements in timeliness and completion rates through simple, cost-effective interventions. Despite challenges, this project underscores the potential of structured systems to enhance physical healthcare for patients with SMI. Scaling and expanding these strategies hospital-wide may contribute to addressing health disparities and improving outcomes for this vulnerable population.

Abstract Disclosure: J. Porto: None. E. Ssemmondo: None. N. Obike: None. A. Abobaker: None. R. March: None. N. Tun: None. T. Pawlak: None. Objective: A clinical audit was conducted to assess if there was any improvement in management of hypophosphatemia among patients admitted to the medical wards using the local Trust protocol, following structured edcational sessions to the junior doctors covering medical wards. Design and methodology: The 2 cycles of the audit were conducted between March 2020 and September 2021 in Scarborough district Hospital. The clinical notes of 52 patients (20 in the first cycle and 32 in the re-audit) with hypophosphatemia were reviewed. These were identified using the electronic laboratory results of patients within the study period. The aspects of the trust protocol for management of hypophosphatemia that were audited; documentation of symptoms associated with low phosphate levels, cardiac monitoring in severe hypophosphatemia, identification of the likely cause of hypophosphatemia, the presence or absence of associated acute kidney injury (AKI) and initiation of phosphate replacement. The results of the first audit were presented at the local hospital clinical governance meeting (August 2020). Following this, 2 teaching sessions and 2-case based discussion on hypophosphatemia were organised for all the doctors in the department of medicine. The re-audit was subsequently conducted after the fourth teaching session. The proportions of each audited item were compared between the first audit and the re-audit using Fisher exact probability test. Results:25% of patients in the first audit had severe hypophosphatemia compared to 28% in the re-audit. In patients with severe hypophosphataemia, only 33.3% had cardiac monitoring during the re-audit cycle compared to 60% in the first cycle, and the difference was not statistically significant (p=0.58). There was significant improvement in the documentation of symptoms of hypophosphataemia amongst inpatients during the re-audit cycle compared with the initial cycle; 62.5% vs only 10% (P 0.002). Most patients had an underlying cause of the hypophosphatemia identified (80% and 62.5%-first and second cycle respectively). AKI was associated with hypophosphataemia in 15% & 34.4% (P 0.2) in the first and second cycles respectively. Despite low phosphate levels, 25% and 28.1% at the initial audit and the second cycle respectively did not receive any form of phosphate replacement. Conclusion: The two-cycle clinical audit showed that the teaching sessions on management of hypophosphatemia increased the awareness of the importance to document whether the patients were symptomatic or asymptomatic following the drop in their phosphate levels, which can help to identify patients at risk of developing complications, such as cardiac arrythmias. However, these sessions were not sufficient to improve overall management of patients with low phosphate levels. Presentation: 6/1/2024

Aims: UK National Institute for Health and Care Excellence Guidelines recognise the importance of effective family and carer involvement in ensuring good patient care and outcomes. We aim to embed infrastructural changes supporting carer involvement through Cygnet’s Model of Acute and Rehabilitation Care (CMARC), embed rolling audit processes ensuring maintenance of standard adherence across wards and optimise carer support services at Churchill Hospital. Methods: Triangle of Care (TOC) is an alliance between patient, carer and therapeutic staff. The Carers Trust’s TOC partnership (CTTOCP) accreditation was identified as a basis of the initial audit criteria. Stakeholders were identified and on boarded which included: Cygnet Healthcare Senior Steering Group (CHSSG); Hospital Senior Management Team (SMT); Lambeth Carer’s Hub (local community services) and Carer’s Advocacy Service (CAS). Carer information packs and feedback forms were created by CHSSG and personalised by the Hospital Carer Lead Team (HCLT) for each ward (multidisciplinary clinical and administrative staff) with LCS/CAS sited. Interventions implemented across 3 audit cycles included 3 areas: formalising communication across stakeholders (shared calendars; audit and carer communications in SMT/Heads Of Department Meetings and Clinical Governance Reports); increasing HCLT personnel (recruitment; Carer Awareness Training and intra hospital promotion); administrative changes (introduction of Carer Communication forms (CCF) clarifying consent status and Carer communication log tables created to improve consistency in record-keeping in ward rounds) and carer engagement initiatives (monthly inter-disciplinary topic-based carer events delivered by HCLT tailored to carer feedback). Significant changes in results were achieved after the introduction and subsequent iteration of the infographic Carer Involvement Protocol, which aligns with CMARC and Audit criteria in achievable SMART steps. This was disseminated at Stakeholder and HCLT meetings. Results: An audit was carried out in April 2024 with compliance to standards being 87% for rehabilitation and 68% acute wards. Limited carer communication was in place with ad hoc feedback provided. Triangle of care Accreditation was achieved in May 2024. Audit Cycles 2 and 3 in September 2024 and November 2024 both resulted in 100% adherence. Carer engagement has significantly improved with an increase in attendance overall since conception of monthly events by 28%. Conclusion: There has been significant improvement in the infrastructure of carer services at Churchill Hospital which has relied upon the inter-disciplinary, multi-tiered teamwork and resulted in positive feedback from carers and patient outcomes. Expert-by-experience led carer events are being introduced in February 2025 with aims to further develop community links and achieve TOC 2 star accreditation.

IntroductionERAS is an evidenced based care improvement programme which contains fundamental nutritional components which reduce the body’s response to surgical stress and improves postoperative outcomes. In our Trust, there was no formal nutritional guidelines to support ERAS within the colorectal specialty to ensure patients were receiving optimal nutrition postoperatively.MethodThe aim of this project was to audit current adherence of nutritional ERAS principles for colorectal surgery against the ERAS Society Guideline (2018). Nutritional components included early initiation of oral nutrition post-surgery and the addition of oral nutritional supplements (ONS) from day 0-day 4 post-operatively, regardless of nutritional status. A retrospective audit of current ERAS practice was undertaken on the colorectal ward (cycle 1). Post initial audit, an action plan was developed and implemented, ready to re-audit after a Nutrition in Enhanced Recovery after Colorectal Surgery Guideline was created, reviewed and approved at Trust level (cycle 2).The primary outcomes measured in relation to nutrition were:Initiation of early oral nutritionPrescription of ONSWeight lossPatients were identified from a prospective database provided by colorectal nurse specialists and via theatre lists from colorectal multidisciplinary team meetings. The electronic records of these patients were reviewed and information pertaining to outcomes were collated.ResultsDuring the first audit cycle, 46 patients were identified as suitable for inclusion.100% commenced on oral fluids day of surgery89% commenced on oral diet day 1 post–surgery0% were prescribed ONS• Of the 28 patients that had weights taken pre-operatively and prior to discharge, there was an average weight loss of 2.67kg.During the second audit cycle, 20 patients were identified as suitable for inclusion.100% commenced on oral fluids day of surgery80% commenced on oral diet day 1 post–surgery75% were prescribed ONSOf the 10 patients that had weights taken pre–operatively and prior to discharge, there was an average weight loss of 1.19kg. (55% reduction)A two sample t-test, using T distribution showed that the difference in weight loss between cycle 1 and cycle 2 is not big enough to be statistically significant.On further evaluation of ONS prescriptions, 53% had prescription errors including wrong formulation, wrong dosage and wrong duration.ConclusionOverall adherence of ERAS nutritional components in relation to ONS is low and requires ongoing training and education within the Trust to ensure accurate prescriptions are issued. Average weight loss reduced with the implementation of ONS, and continued adherence to nutritional components of ERAS pathway may help to optimise nutrition post-operatively in colorectal patients.

Background Patients with upper gastrointestinal malignancy often require admission to hospital with dysphagia or jaundice requiring therapeutic endoscopy. Endoscopic intervention is often effective permitting rapid discharge. An efficient service would permit rapid discharge for patients who are often at the end of life. We noted that a majority of patients in hospital under the gastroenterological oncology were admitted with symptoms requiring therapeutic endoscopy. Methods We conducted an audit cycle of the inpatient days before and after pathway implementation. A wait of 1 day was set as acceptable for patients with bleeding as defined by NICE guidance and we set an arbitrary standard of 2 days for patients without bleeding but requiring therapeutic endoscopy. Between the audit cycles, a pathway was built to accommodate these patients. Results Inpatient waits improved from a median of 3 days to 1 day. There was no difference in outcome between those presenting with bleeding and other symptoms or any difference in patients requiring different procedures. Conclusions Waiting times for endoscopy can be improved with the introduction of a targeted pathway of cancer patients. Further issues including cost, quality of life and nutrition require further intervention.

Why did you do this work?My motivation was centered on the crucial role of clinic letters in ensuring effective communication between healthcare professionals. Clear and comprehensive clinic letters are essential for maintaining continuity of care and minimizing the risk of miscommunication. By evaluating the quality and completeness of these letters in the Department of Paediatrics at a District General Hospital in Derby and using the Sheffield Assessment Indicator for Letters (SAIL) as a benchmark,1 we aimed to identify and address gaps in documentation practices.What did you do?From August 1 to 30, 2023, a retrospective analysis was conducted on 30 randomly selected clinic letters from the hospital system, with 15 written by consultants and 15 by middle-grade doctors. The SAIL standard was used to evaluate the letters against 20 specific criteria across 7 domains. Each letter received a score out of 20 based on the criteria met, and results were analyzed using Excel. In March 2024, an intervention was implemented to improve the quality of letters. This included creating and displaying posters with guidelines for effective letter writing, strategically placed near every computer used by middle-grade doctors and consultants. Training sessions were conducted for both, focused on best practices in clinical documentation. Following this intervention, second cycle was conducted from April 1 to May 3, 2024, focusing on the domains identified for improvement in the initial audit.What did you find?In the first audit cycle, only 1 of 15 (4%) letters written by consultants required improvement in overall assessment. In contrast, letters from middle-grade doctors showed more significant issues: 3 (20%) needed clarity enhancements, 2 (12%) had management issues and 2 (12%) required improvement in overall assessment. The second audit cycle targeted the identified areas for improvement: overall assessment, management, and clarity. From the second audit cycle, it appeared that the intervention yielded positive results, with consultants showing improvements across all domains. For middle-grade doctors, the second audit cycle showed notable progress in the areas of clarity and overall assessment. Only 1 (6%) of letters required improvement in overall assessment, and 2 (12%) had room for improvement in clarity. However, the management domain still presented a challenge, with 3 (20%) of letters needing improvement in this area.Abstract 7803 Figure 1What does it mean?This audit highlights the effectiveness of simple interventions, such as posters and training sessions, in enhancing clinical communication. It demonstrates that low-cost, straightforward strategies can lead to measurable improvements when properly implemented. However, the limited sample size may restrict the generalizability of the findings. Despite this, the audit successfully identifies areas needing continued focus, particularly management documentation for middle-grade doctors. The results can guide future training initiatives and serve as a model for similar improvements in clinical documentation.ReferenceCrossley JGM, Howe A, Newble D, Jolly B, Davies HA. Sheffield assessment instrument for letters (SAIL): performance assessment using outpatient letters. 2002.

Aims: Controlled drugs are defined as substances, products or preparations that are either known to be or have the potential to be dangerous or harmful to human health, including being liable to misuse or cause social harm. The Misuse of Drugs Regulation 2017 came into force on 4 May 2017 and all prescribers must adhere to these regulations. The objectives of this audit were to assess, intervene and improve compliance of a POLL Community Mental Health Team (CMHT) service with the gold standard prescribing guidelines illustrated in the “Safe Prescribing and Dispensing of Controlled Drugs” Joint Guidance by the Irish Medical Council and Pharmaceutical Society of Ireland in order to allow best practices to develop in the care of patients. Methods: Prescriptions required certain details to be included e.g. strength, form and quantity of medication (words and figures) to be deemed valid and compliant. During the initial stage of the audit, every patient file was reviewed and the most recent prescription checked to assess if the patient was prescribed a controlled drug since receiving treatment from the service. A data collection tool was utilised to compare each prescription to the gold standard guidelines and all omissions were recorded. The results of the initial audit were circulated to the prescribing members of the CMHT and presented at the weekly multidisciplinary team meeting. Improving inclusion of components deemed poorly compliant on the initial stage of the audit was emphasised. Results: Of the 158 files initially audited, 70 patients were prescribed controlled drugs (exclusively benzodiazepines and z-hypnotic medications) by the POLL CMHT. 100% compliance was observed regarding inclusion of date, name of patient, strength of medication, dosing frequency, signature, profession and registration number of prescriber. 98% compliance was observed regarding inclusion of name of prescriber and telephone number of prescribing setting. 97% and 94% compliance was observed regarding inclusion of address of prescriber and patient respectively. 61% and 47% compliance was observed regarding inclusion of form and quantity of medication respectively. Re-audit was completed 3 months later which showed 15/70 patients had been reissued prescriptions. The compliance rate improved to 100% for all components. Conclusion: Compliance greatly improved particularly regarding components of prescriptions frequently omitted during the initial audit stage i.e. form and quantity of medication. Other components were largely compliant during both stages. As a result of this audit cycle, controlled drug prescribing patterns underwent significant quality improvement and became more aligned with the gold standard.

Aims: This audit project aims to assess whether the Crisis Resolution and Home Treatment Team North East Kent (NEKCRHTT) is following the trust protocols for requesting blood tests, or according to clinical indication. Methods: For the first cycle, data collection was done from 1 August to 31 October 2023 from all clients under NEKCRHTT who had undergone blood tests and were under psychotropics. Information regarding documentation of clinical indication and which investigations were requested was collated and checked for compliance with trust policy. For the re-audit cycle, data collection was done from 1 July to 31 September 2024 and results were compared for improvements in adherence to the trust policy. Results: First cycle results showed that the trust policy was not followed in 33.3% cases, in which mostly TFT, folate and B12 levels were requested without clear documentation of clinical indication. Results were presented with following recommendations: To have the trust policy poster easily accessible in clinical areas; prescribers to be aware of the policy and follow guidelines when appropriate; if there is clinical indication that deviates from policy, for this to be clearly documented on client’s notes. The re-audit cycle results showed an improvement in adherence to the trust policy: only 13.3% cases did not follow the policy. Documentation of rationale for requesting blood tests has also improved. When deviating from policy, it is still mostly by requesting TFT, B12 and folate, although the frequency has reduced. Conclusion: The use of blood tests in a mental health crisis can serve many purposes, such as identifying potential damage secondary to overdose, aid in the differential diagnosis when considering organic causes for current presentation, ascertain renal/liver function before prescribing a new medication, among others. Having blood tests done according to the clinical indication and following a clear protocol assures accuracy in the management of the results. The implementation of change has resulted in improvement in adherence to the trust policy and the documentation of rationale for requesting investigations. This will hopefully assure accuracy in the management of the results, as well as avoid confusion of incidental findings.

Aims: Valproate is widely prescribed for psychiatric conditions, particularly bipolar disorder, but carries significant teratogenic risks. The Medicines and Healthcare products Regulatory Agency (MHRA) mandates strict prescribing guidelines, particularly for women of childbearing potential, to mitigate these risks. Additionally, emerging evidence suggests potential risks for men, including infertility and neurodevelopmental concerns. This audit aimed to assess adherence to MHRA guidelines within a Community Mental Health Team (CMHT), focusing on the documentation of risk discussions for all patients under 55 prescribed valproate, including discussions on infertility risks for men. It also evaluated the completion of risk acknowledgement forms for eligible patients and the enrolment of women of childbearing potential in the Pregnancy Prevention Programme (PPP). A secondary aim was to implement a targeted intervention and reassess compliance in a second audit cycle. Methods: A retrospective review of electronic patient records was conducted for all patients under 55 prescribed valproate for psychiatric conditions at the CMHT. Patients with neurology-led prescriptions or aged over 55 were excluded. The first cycle, conducted in August 2024, included 22 patients (16 male, 6 female). Compliance with MHRA standards was assessed based on documented discussions, risk acknowledgement forms, and PPP enrolment. Following the first cycle, an intervention was introduced in the form of an email sent out to prescribers, emphasizing guideline adherence and areas for improvement. A second audit cycle was conducted in December 2024 to evaluate the impact of this intervention. Results: The first audit cycle identified suboptimal compliance, particularly for male patients. Risk discussions were documented for all 6 female patients (100%) but only for 7 out of 16 male patients (43.75%). Risk acknowledgement forms were completed for 4 out of 6 female patients (66.67%). PPP enrolment was achieved in 3 out of 5 eligible female patients (60%).Following the email intervention, the second cycle demonstrated improvements. Risk discussions were documented for 9 out of 16 male patients (56.25%). Completion of risk acknowledgement forms improved to 5 out of 6 female patients (83.33%). PPP enrolment increased to 4 out of 5 eligible female patients (80%). Conclusion: This audit highlights gaps in adherence to MHRA guidelines, particularly in documenting risk discussions for both male and female patients. The email intervention effectively improved compliance, but further efforts are needed. Future recommendations include electronic reminders in health records, and ongoing audits to ensure sustained adherence. Continuous clinician education is essential to enhance patient safety and regulatory compliance in valproate prescribing.

Aims: The aim of this audit was to evaluate and enhance referral practices from general practitioners (GPs) to the Balbriggan Community Mental Health Team (CMHT), Dublin. Appropriate referrals are crucial for effective mental health care. The initial audit, conducted in mid-2024, sought to identify barriers to successful referrals, particularly regarding psychotherapy initiation and medication management. Following these findings, guidelines were developed and disseminated to GPs to improve the referral process. A follow-up audit was then conducted to assess the impact of these interventions on referral practices and identify any remaining challenges. Methods: An audit cycle was conducted, comprising a retrospective initial audit followed by a prospective follow-up audit. The initial audit reviewed 110 referrals from 1 May to 1 August 2024, while the follow-up audit analysed 77 referrals from 1 September to 30 November 2024. Following the initial audit, local guidelines were created and shared with GPs on 19 August 2024, focusing on appropriate referral procedures, psychotherapy initiation, and medication management. Data collection focused on referral acceptance rates, reasons for rejection, and the initiation of psychotherapy and psychotropic medication. The effectiveness of the guidelines was also evaluated. Results: The results of the audits showed significant improvements in referral practices. In the initial audit, 110 referrals were reviewed, resulting in 60 accepted (54.5%) and 50 rejected (45.5%). Key barriers included 16% of patients not receiving psychotherapy and 11% receiving suboptimal medication dosages. Additionally, 9% of referrals were declined due to non-initiation of psychotropic medications, indicating GPs’ hesitancy to refer patients without prior treatment. In contrast, the follow-up audit, which reviewed 77 referrals, showed a marked increase in acceptance rates, with 71 accepted (92.2%) and only 6 rejected (7.8%). However, 14% of patients still did not receive psychotherapy, suggesting persistent hesitancy among GPs. Notably, the percentage of rejected referrals for ADHD/ASD assessments increased from 21% to 33%, indicating that misalignment between GP expectations and CMHT services remains a challenge. Conclusion: This audit demonstrates the importance of effective communication and collaboration between GPs and the CMHT in enhancing referral practices. The implementation of guidelines led to improved referral acceptance rates. However, challenges still exist regarding psychotherapy initiation and specific service offerings, particularly for ADHD/ASD assessments. Ongoing monitoring and education for GPs are essential to sustain these improvements and ensure optimal patient access to mental health care.