The aim of this re-audit was to review whether inpatientprescription cards are completed correctly by doctors and administered by nurses, and to compare the results with the previous audit.

We carried out a re-audit of Medical Prescription and Nursing Administration of Medication in Learning Disabilities In-patient Settings. Black Country Partnership NHS Foundation Trust is committed to managing medicines safely, efficiently and effectively as a key part of delivering high quality patient centred care. In BCPFT medications are recorded by doctors on paper prescription cards and administered by registered nurses.

This audit compared results against the standards for prescribing medication in BCPFT Medicines Policy.Prescription charts were retrospectively reviewed against 22 standards for all LD inpatients as outlined in the LD trust policy across all 3 of the Learning Disabilities in-patient units during May 2019 as long as they were still inpatients during this month. 27 prescription cards were reviewed in total.

100% of prescription cards had patients full names , address , ward name, were fully legible , written in black ink, route of administration, approved abbreviation for route, date of prescription, signature of prescriber , prescription labelled as 1of 1 /2, frequency of prn meds and indication . Whereas only 96% had generic drug names, clearly documented doses and time of administration along with acceptable abbreviation and appropriate code for omission. 85% drugs had a stop date once drug was stopped and 85% had allergies recorded in red and had a line drawn through once drug was omitted.

The re- audit was highlighted to inpatient managers, nursing staff, The Medicines Management Committee (MMC) anddoctors in the Learning Disability division. Prescribers werereminded of the importance of documenting a stop date for the prescriptions and signing off once drug is crossed out. It was discussed in MMC to consider removing the standard for recording allergies in red ink as the box is already red in colour. The PRN section for medication does not have an area to sign when the drug is cancelled and this in particular is the case when PRN medication is re-written. It was discussed to limit this standard to regular medication and to be taken in consideration if the current drug chart requires redesigning in the future. We also recommended a re- audit in 2 years’ time.

To assess how well MHAS meets the service specification

To ascertain areas of good practice

To examine whether the referral form is being used in an appropriate manner

To elucidate areas of good communication and whether any improvement can be made

Launched in 2012, MHAS is the single point of access service for mental health services for patients aged 16–65 years, with a general practitioner (GP) in Dudley, who are not currently open to secondary care. Assessments are completed by a medic, community psychiatric nurse or jointly. It aims to identify the most appropriate care pathway for patients. This audit was a comprehensive assessment of how effective MHAS is at ensuring patients are adequately triaged.

10 cases from each month between April 2018 and March 2019 were randomly selected from all 980 anonymised MHAS referrals. A proforma was developed based on current practice, previous audits and service specification. A team of four doctors assisted in the data collection and only electronic health records (EHR) were reviewed.

88.3% of referrals were recorded on the EHR. Only 61.7% of referrals used the proforma with the other referrals mostly being in the form of a letter, which often missed out information vital to the triaging process. Only 4.2% of referrals are from Primary Care Mental Health Nurses (PCMHN) with 85.8% arising from GPs. Urgent referrals were not discussed with MHAS via telephone contact in about 60% of cases. The majority of patients had telephone screening completed the same day and were then discussed the next working day at the daily referral meeting. Although a brief summary for the GP was being sent the same day in all cases, over half of the comprehensive assessments were not being sent within the five day timeframe.

All referrals must be uploaded to the EHR and completed using the service's proforma. PCMHNs may be currently under-utilised or effectively doing their jobs at managing mental health patients in primary care. GPs regularly referring via letter require further training and support to use the proforma. The proforma may require simplification to make it easier to complete. The service specification requires review as it makes unrealistic demands of the service. All referrals must be discussed at the daily referral meeting. Further investigation is required to understand why MHAS is struggling to meet timeframes for appointments and letters.

Psychiatric illness is associated with premature mortality, which is largely attributable to physical health conditions. Low fruit and vegetable intake is a risk factor for cardiovascular disease, which contributes significantly to this disparity in physical health. This study used routinely collected data from electronic health records to assess fruit and vegetable intake among psychiatric inpatients across a UK mental health trust.

We conducted an anonymised search of de-identified electronic patient records from the Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) research database. We collected data on ICD-10 diagnosis and fruit and vegetable intake for patients aged 18 years or over, with a recorded ICD-10 psychiatric diagnosis, admitted to CPFT inpatient facilities between March 2013 and January 2019 inclusive (n = 1031). Information on fruit and vegetable intake is recorded as part of a General Health and Lifestyle questionnaire, routinely performed within a week of admission. Fruit and vegetable intake in different ICD-10 diagnostic categories was compared using a one-way ANOVA.

Among patients for whom data on fruit and vegetable intake was recorded (n = 768), the prevalence of low fruit and vegetable intake (defined as <5 portions/day) was 75.9%, and mean fruit and vegetable intake was 2.85 portions/day (95% CI 2.72-2.98). Fruit and vegetable intake was lowest among patients with schizophrenia (mean = 2.3 portions/day), significantly worse than other diagnostic groups. In patients with schizophrenia, prevalence of low fruit and vegetable intake was 86.5%.

Low fruit and vegetable intake is common among CPFT psychiatric inpatients, particularly those with schizophrenia. Interventions to improve dietary habits, such as increasing tailored for individuals with psychiatric illness may help to reduce the risk of physical illness.