Weapons and other items with potential to cause harm are usually prohibited in mental-health hospitals and other psychiatric facilities. Detecting such prohibited items (PIs) can be problematic, particularly if concealed, and metal detectors are commonly used to search for such items. Our study compared two types of metal detection: continuous wave detection (CWD) by hand-held metal detector (HHMD) and magnetic anomaly detection (MAD) by a static pole device. In the study, real and dummy PIs were hidden on test subjects and in a simulated body cavity. The results showed MAD to be significantly superior to CWD in detecting small concealed PIs containing ferrous metal. The MAD pole found 100% of the real PIs on the test subjects and in the simulated body cavity. The CWD HHMD found only 5.2% of the real PIs, and these were limited to those on the test subjects, as it detected none in the simulated body cavity. In addition, the time taken to search by MAD pole was shorter than time taken to search by CWD HHMD.

This quality improvement project was inspired as an answer to a problem that many fellow psychiatric trainees had been struggling with while on-call covering the old age mental health hospital which includes a specialist dementia ward. The issue was that decisions around ceilings of care for patients were often not discussed or at least recorded in the electronic notes and as a result when reviewing deteriorating patients out of hours trainees would find themselves without any guidance on the treating medics opinion on what was in the best interests of the patient.This led to situations where unnecessary transfers to the acute hospital would occur overnight which could have been avoided with more consistent planning.Prior to initiating the changes it was recorded that nine out of 47 inpatients had documented decisions on ceiling of care of treatment in the consultant's ward round entries. Next policies from acute hospitals were reviewed, opinions were discussed in departmental meetings, and eventually there was agreed a change in procedure with the consultant on the dementia ward around resuscitation and ceiling of care status and consistent recording of this.Following the intervention there was seen an improvement in the recording of decisions around treatment and transfer of patients on the dementia ward of 80% (4/5) fully compliant with new criteria and then 71% (5/7) in successive cycles. Further communication both with relevant professionals on the old age ward and with the trainees on the on-call rota will be necessary to sustain any change but the centralised recording of resuscitation status and ceiling of care in the ward round entries have provided much more guidance than was previously available. In the future it may be possible to spread this policy throughout the entire old age mental health unit. ProblemThis project took place at an older persons mental health services (OPMHS) unit, 2gether NHS Foundation Trust, Gloucestershire, UK.The feeling is that the root concern of the trainees on-call at the old age psychiatry unit relates to ceiling of treatment decisions.Trainees are often called to see someone with advanced dementia, very frail, with numerous medical co-morbidities who drops blood pressure/oxygen saturations in the middle of the night. There is very rarely a plan in place on the electronic notes system ("rio") from the day team as to whether or not transfer is in the patient's best interests. When speaking to medical registrar's etc, they frequently ask about ceiling of care which the on call doctor feels should not be their role. It seems unreasonable to expect an on call junior to be calling the next of kin out of hours to have these difficult conversations, when they could have been pre-empted by speaking to family during working hours by the team in regular contact with the patient and their family.It was decided to plan a QI project to look at all the OPMHS admisisons as a snapshot and to work out what percentage of these patients have plans for event of deterioration in plac...

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