AimsTo ensure that the PPE guidance is strictly adhered to.To ensure that patient care is not compromised.To help us in areas of need in order to educate the staff regarding the techniques of PPE and thus ensure patient and staff safety and care during the pandemic.MethodNovel coronavirus 2019 was first described in December 2019 in Wuhan in China. Since those initial few cases, it has rapidly proliferated to a global pandemic, putting an inordinate amount of strain on healthcare systems around the world. We believe that the technique of donning and doffing if followed as per PHE guidelines would be of help in both preventing the infection and improve the care and safety of both patients and staff.This Audit includes both In-patient and Out-patient units in Psychiatric services across North Wales. Data were collected from 19 units out of 39. We observed covertly 325 staff members belonging to various cadres. Apart from the Donning and Doffing techniques, we also observed the availability of designated areas for this purpose and the availability of PPE as well.Data collection was by junior and senior doctors from various sites of the mental health unit in North Wales. A proforma was provided, the standards were based on PHE guidelines.ResultIt was noted that just about 50% of the staff followed donning as per guidance. Amongst all three sites, the Central team showed a better adherence with 85% of them donning PPE correctly. whereas only 22% adhered to donning in the West team.Only 21% of them managed to doff PPE as per guidance amongst all 3 centres in North Wales.It was also noted that there are no designated areas to Don and Doff in outpatient units. Staff, in general, seem to not adhere to the guidance of utilising a mask, especially when within 2 meters distance of other staff.ConclusionWe will be presenting the Audit at the regional meeting. After discussion with the infection prevention control team and Health and safety lead, we intend to improvise the wards with designated areas for donning and doffing. Teaching sessions for the staff in all three sites, reminders in various areas of the community mental health units and inpatient units.We are hoping that these recommendations will help us in achieving our aim of health and safety during this pandemic.

AimsWith extensive evidence and track record on efficiency, third-wave psychotherapies, i.e. mindfulness-based interventions (MBIs), have gained popularity in the United Kingdom (UK) as the mainstream tool for mental health and well-being. During the COVID-19 pandemic, a lot of MBI training has shifted from physical meetings to online to improve access nationally. To date, there is limited data on the differences of online MBIs available in the UK. This web pages review is aimed to elucidate the available resources for online training on MBIs in the UK.MethodsGoogle Search engine was used to identify web pages providing MBI training in the UK from February 2021 to March 2021. The search words used were “mindfulness”, “acceptance commitment therapy”, “dialectical behaviour therapy”, “DBT”, “Compassion focused therapy”, “CFT”, “England”, “Northern Ireland”, “Scotland”, “Wales”, and “United Kingdom”. The search word “ACT” was omitted due to a high number of irrelevant search results. Inclusion criteria were any web page providing mindfulness training in the English language, based in the UK. Exclusion criteria were web pages that were not from the UK with limited information and the web page was not about the provision of mindfulness training. Given the high number of web pages appearing in the Google Search for each of the localities, further search was stopped when all ten web pages that appeared on a Google search page were all excluded.ResultsThe total number of web pages returned from searches was 23,030,000 of which were 13.1 million for England, 2.89 million for Scotland, 3.09 million for Wales, 2.18 million for Northern Ireland, and 1,770,000 were unspecified. Only 165 web pages offering MBI training were included. Among those, 57% were for the general public while 30% had information for both professionals and the public. The majority of them, i.e. 65% offered online training courses when only 25% of them offered both online and face-to-face training. There were 25% of web pages offering free basic courses for the public. There was a similar split between the group, individual and mixed training.ConclusionThere is a significant amount of MBI training resources available online for both public and professionals. One interesting finding is that a significant portion of them provide free basic training which is very encouraging and certainly has a positive impact on the accessibility of mindfulness education during the pandemic disruption.

AimsTo evaluate Young-onset dementia (YOD) services in terms of referral, its appropriateness, time to diagnosis and other criteria as per protocol that we have adapted.MethodCase notes of those under 65 referred to Memory service for cognitive assessment between July 2017 and June 2018 were retrospectively reviewed to look at the time to diagnosis, appropriate referrals, post-diagnostic support, etc.ResultCompared to the previous evaluation, the number of patients referred to had increased from 47–48/ year earlier to 63/year. Only 1/3 were appropriate referral over the 10-year period whereas between 2017 and 2018 more than half were appropriate referrals. More than half of them were seen within 12 weeks of referral (35/63 available). Only 132/252 were diagnosed as having some form of dementia in the previous evaluation which was about 13 cases of YOD a year. In contrast, in our new evaluation 19 patients were diagnosed with some form of dementia. Inappropriate referrals had reduced by more than 50%. Appropriateness and timely referral had improved in this time frame.ConclusionDementia is considered ‘young onset’ when it affects people under 65 years of age. It is also referred to as ‘early onset’ or ‘working age’ dementia. However, this is an arbitrary age distinction that is becoming less relevant as increasingly services are realigned to focus on the person and the impact of the condition, not the age. Teaching sessions to educate primary & secondary care clinicians on appropriateness and timely referrals have helped in improving the care for patients with YOD. Services need to be developed further to be able to diagnose & support those with YOD. Repeat evaluations every year would help to inform improvement in quality & appropriateness of referrals.

AimsPsychotropic medication is commonly used in people with Intellectual disabilities (ID). This may be attributed in part to an increased prevalence of mental illness in this population and the presence of challenging behaviour which has been shown to increase rates of prescribing. Whilst there are a number of studies looking at regularly prescribed medication there are few studies on “as and when” required (PRN) medication.Psychotropic medication continues to be used to manage behavioural disturbances in people with ID. Where there is no clear cut psychiatric illness, the role of psychotropic medication is an adjunct to a comprehensive multimodal treatment plan.The aim is to find out if prn psychotropic medication for behavioural disturbance is being used appropriately and safely in these individuals.MethodFiles and PRN protocols of individuals known to be using prn psychotropic medications for the management of acute episodes of agitation and behavioural problems and supported by professional staff teams was studied.We collected the data by contacting the residential homes, carers, Collecting details from case notes, from the Staff nurse who made the protocol for their patientsA questionnaire based on the standards mentioned above was developed and files and prn protocols were marked against these standards.ResultThe standards from the medical file were 100 % achieved. Thus indicating the importance of the psychotropic prn medication and documentation of the same.However, the protocol that needs to be with the patient/carers had some lacuna/deficits. Overall only in 53% of the case, standards were achieved. This needs to be highlighted to the team.The Audit gave an insight into what needs to be improved.THE FOLLOWING AREAS NEEDED IMPROVEMENT 1.There should be a prn protocol/ similar instruction to the staff about the use of prn medication(written by appropriately trained professional)2.Prn protocol should be accessible to direct care staff3.There should be a description of when to use the prn medication4.There should be a description of what non-pharmacological de-escalation methods ought to be tried before using prn/ is there a detailed behaviour support plan available5.Protocol should describe what the medication is expected to do6.Protocol should describe the minimum time between doses if the first dose has not worked7.Protocol should state the maximum dose in 24 hour period8.Use of prn should be recordedConclusionI hope this audit will help in improving the patient care with the right psychotropic prn medication, with correct doses and further details as mentioned in the standards of the protocol.We also hope to ensure that in our area, prn psychotropic medication used for agitation and behavioural disturbance is used safely, appropriately and consistently by staff teams. This would be in accordance with the guidelines.

AimsThere had been ongoing concerns with regard to covering daytime duty bleeps across the three sites in the Mental health Department, BCUHB, North Wales.Frequent empty on-call slots meant some doctors being asked to hold the bleep between 9-5 in-order to cover the vacancy.Some felt this added to the existing workload and that it was unfair and unsafe.This issue was raised during a supervision session with the Educational supervisor, North Wales and an initial data collection was suggested.MethodData were collected over 2 week period to look at the Daytime bleep duties between 9 am to 5 pmWe hoped the data would demonstrate certain patterns of the task being asked to perform.ResultThe total number of bleeps were noted to be 249Discharge notification and prescription writing was noted to be the commonest reason for bleep in East and Central while Routine review and Discharge notification was the reason to be bleeped major number of times in the WestNearly 70% and 90% of the bleeps were found to be appropriate by the East and West respectively, while only a mere 15% were reported so in Central.While 30% of these bleeps in the West were considered to be deferred, 70% bleeps were deferrable in the East and almost 95% in Central.The general trend in all 3 centres was as follows:All three centres have high numbers of bleeps for discharge, prescribing tasks and routine patient reviewsMost think planned discharge paperwork could be done in advance and jobs can be deferred if there is a ward/team doctor availableConclusionA simple solution could be some jobs being planned ahead (e.g TTO/Discharge Summaries, Re-write charts) and done by the team/ward doctor. ECG could be arranged to be done by nurses/ECG technicians. Some nurses/HCAs are trained in phlebotomy, however, they have not been utilising the skills. That needed to be reinforced in safety huddles meeting.Apart from these suggestions, we were also wondering about the impact of the service models and how the juniors placed in the community mental health unit could stay involved in their team inpatients