Aneurin Bevan University Health Board Research Articles

Delivering a mental health response vehicle service in Wales: a pilot initiative.

NHS emergency services, including ambulance services and emergency departments (EDs), are under considerable pressure due, in part, to the lack of availability of alternative healthcare services. People with mental health issues often contact ambulance 999 services when they cannot access the care they require from other sources. Welsh Ambulance Services NHS Trust (WAST) employs mental health professionals in its 999 call centres to provide remote mental health triage and support. While this has been effective in reducing ambulance conveyance to EDs, many patients still require a face-to-face assessment. To address this, WAST explored the option of providing a mental health response vehicle (MHRV) service, which has been shown to be effective in some ambulance trusts in England. This article gives an overview of a pilot MHRV service that was delivered by WAST across the Aneurin Bevan University Health Board locality in south-east Wales in between January and March 2024. Results suggest that the MHRV service can reduce ED conveyance rates and potentially provide cost savings for WAST and the wider NHS in Wales.

FP1.3 - SPEC MDT in Aneurin Bevan University Health Board

Abstract Aims The SPEC (significant polyp and early cancer) multi-disciplinary team (MDT) meeting was started in ABUHB in 2022 to discuss complex colonic and rectal polyp cases, such as polyps >20mm, likely to be sessile, or difficult to remove endoscopically. The aim was to evaluate the effectiveness and clinical role of the SPEC MDT. Methods Data for patients discussed in SPEC MDT since its conception in January 2022 until September 2023 was retrospectively collected from the SPEC MDT database, a prospectively collected database. This included patient demographics, reason for referral, polyp characteristics and MDT outcomes. Results In 21 months, there have been 38 SPEC MDTs, with 355 cases discussed (average of 9 cases per MDT). There was at least one laparoscopic colorectal surgeon, gastroenterologist and a histopathologist in every MDT in accordance with BSG guidelines. Main referral reasons included endoscopy findings (72%) and re-discussion post-procedure (22%). Twenty-three patients had adenocarcinomas and three had NETs. MDT outcomes were EMR (23%), endoscopic surveillance (21%), clinic to discuss (no) surgery (19%), TAMIS (16%), urgent endoscopy (13%) or other (8%). Conclusion As the busiest Health Board in Wales for Colorectal Cancers, the formation of SPEC MDT has been an important step in improving the detection and treatment of advanced polyps and early cancers. Although too early to measure the impact on early cancer detection rates and improved decision making for these patients, formalising the MDT process in line with BSG guidelines has been an important step in improving the service offered to patients.

654 Laparoscopic Cholecystectomy in Class III (Morbid) Obesity

Abstract Background High Body Mass Index (BMI) has been associated with increased operative-time, conversion to open-surgery and poorer outcomes. Criteria for day surgery often includes BMI, with centres excluding patients with BMI>40kg/m2 . However, as cholecystectomies are routinely performed laparoscopically with low complication rates in patients with higher BMI, this cut-off is being reviewed. Aim To examine outcomes of Laparoscopic Cholecystectomy in patients with increased BMI, particularly when comparing patients with morbid obesity (Class-III;BMI>40 kg/m2) to those with lower BMI. Method Data was collected between 01/01/2022 and 31/07/2023 from hospitals throughout the Aneurin-Bevan University Health-Board, South Wales, UK. Data on BMI, surgical indication, operative duration, length of admission and 30-day complications, amongst others, was collected. Results This study included a total of 1007 patients (77.92% female, 22.08% male). Patients were placed into 5 BMI categories: BMI<25(n=117),25-29(n=284),30-34(n=285),35-39(n=193), and>40(n=135). The median BMI was 31kg/m2 and overall complication-rate 5.36%. There were three 30-day mortalities, one in BMI category <25(p=0.19) and two in 25-29(p=0.06). When comparing patients with BMI>40 to those with lower BMI there was no significant difference in complications including bile-leak (0%vs1.79%;p=0.35), significant bleed (0.10%vs0.20%;p=0.41) or bile-duct injury (0%vs0.1%;p=0.71). The duration of surgery was increased, almost reaching statistical significance (83.5vs78mins;p=0.05). Due to existing Health board admission criteria, length of admission was significantly raised for BMI>40 (median1vs0days;p=0.00). Conclusions This retrospective study finds Laparoscopic Cholecystectomy safe in patients with Class-III obesity with no increased association with intraoperative or post-operative complications. Criteria for day-surgery based solely on BMI>40 appears inappropriate.

648 Predictive Factors for Subtotal Cholecystectomy

Abstract Introduction Subtotal-cholecystectomy (STC) is a rescue procedure in dealing with difficult gallbladders undertaken when a critical view of safety is not possible to allow complete cholecystectomy, thereby avoiding complications. Aim Determine what patient factors increase risk of STC in patients undergoing elective laparoscopic cholecystectomy (LC) and therefore aid prediction in patients reduced suitability for day surgery. Method Data was collected between 01/01/2022 and 31/07/2023 from three hospitals throughout the Aneurin-Bevan University Health-Board, Wales, UK. All patients receiving elective LC had data collected on age, BMI, gender, ERCP preceding operation, surgical duration, length of stay and 30-day complications, amongst others. Results Of a total of 1060 patients were included in this study(77.36%female, 22.64%male), 81 where STC (7.64% of total LC; 56.8%female, 43.2%male). There were three 30-day mortalities, one of whom underwent STC(p= 0.09). The overall complication rate was 6.41%, significantly raised in the STC group(13.58%vs5.82%;p=0.007). As expected, there was a significant increase in bile-leak following subtotal(12.35%vs1.12%; p=0.0001) , however, there was no increase significance for bleed (0%vs0.41%;p=0.5644), wound infection(0%vs3.68%;p=0.079), collection(0.09%vs0.51%;p=0.404) or bile duct injury(0%vs1.02%; p=0.0001). Predictors for STC were higher age(70-79years;p=0.0016), male gender(p=0.0001), and ERCP preceding surgery(p=0.0001). Both length of stay(median 1vs 0days;p=0.0001) and length of procedure (median 122vs 76minutes;p=0.0001) were increased following STC. High BMI, diabetes(p=0.1991) and smoking(p=0.7921) had no association. Conclusions Subtotal cholecystectomy is a safe alternative when facing difficult cholecystectomy where critical view of safety is not achievable. Factors predicting STC were male gender, advanced age and prior ERCP.

Improving Communication Between the Community Learning Disability Team, Patients, Their Carers and Primary Care Services Within Aneurin Bevan University Health Board

Improving Communication Between the Community Learning Disability Team, Patients, Their Carers and Primary Care Services Within Aneurin Bevan University Health Board

O265: Laparoscopic Cholecystectomy in Class III (Morbid) Obesity

Abstract Background High body-mass index (BMI) has been associated with increased operative-time, conversion to open surgery, and poorer perioperative outcomes. Criteria for day-surgery often includes BMI, with centers excluding patients with BMI>40kg/m2. However, as cholecystectomies are routinely performed laparoscopically with low complication rates in patients with higher BMI, this cut-off is being questioned. Objectives To examine outcomes of Laparoscopic Cholecystectomy in patients with increased BMI, particularly when comparing patients with morbid-obesity (Class-III;BMI>40 kg/m2) to those with lower BMI. Methods Data was collected between 01/01/2022 and 31/07/2023 from hospitals throughout the Aneurin-Bevan University Health-Board, South-Wales, UK. Data on BMI, surgical indication, surgical duration, length of admission, and 30-day complications, amongst others was collected. Results This study included a total of 915 patients, 77.92%female 22.08%male. Patients were placed into 5 BMI categories: BMI<25(n=98),25-29(n=255),30-34(n=253),35-39(n=176), and>40(n=133). Median BMI was 31kg/m2, median surgical duration was 79-minutes, length of stay 0-days, the complication rate was 7.3%. There were two 30-day mortalities, one in each of BMI categories <25 and 25-29. Comparing patients with BMI>40 with others showed a significantly higher surgical duration (median 90.05mins vs83.5mins;p=0.045) but no difference in complications including bile-leak (2.3%vs1.8%;p=0.1823), significant bleed (0.7%vs0.4%;p=0.4779) or bile-duct injury (0%vs0.1%;p=0.4060). Due to existing day-surgery criteria, there was significantly increased length of admission in this group (median 1vs0 days;p=0.00). Conclusion This retrospective study finds Laparoscopic Cholecystectomy safe in patients with Class-III obesity with no increased association with intraoperative or post-operative complications. Criteria for day-surgery based solely on BMI>40 appears inappropriate.

Cymraeg yn y Gweithle? An exploration into the proficiency and development of the Welsh language in psychology, counselling, and arts therapy services

The Welsh language has garnered increasing recognition and importance in Welsh healthcare. This study uses a mixed methods design to understand the use and development of the Welsh language within therapeutic services. 113 staff members from the psychology, counselling, and arts therapies service in Aneurin Bevan University Health Board completed a survey, exploring participants’ proficiency and confidence using the Welsh language, and their perspectives of the Welsh language within their respective services. Preliminary findings displayed a range of Welsh language proficiencies, from fluency to non-proficiency. Participants reported a lack of confidence in utilising the language, and resources, in their work. Qualitative findings further explicate the need to encourage development of proficiency by providing time for learning work-related skills and networking with other Welsh speakers. The findings illustrate a need to recognise language diversity and to understand the needs and development of multilingual practice within the therapeutic context.

Rationing of resources in the National Health Service.

The National Health Service was set up to provide healthcare to every citizen, based not on the ability to pay, but on need. However, the Secretary of State for Health's duty under section 1 of the National Health Service Act 2006 to promote a comprehensive health service is to provide services that can be provided within the resources available. As those resources are not unlimited, it is necessary to ration them. The issue of rationing of resources in the NHS came up again in R (Wallpott) v Welsh Health Specialised Services Committee and Aneurin Bevan University Health Board [2021] EWHC 3291 (Admin). This paper reviews that case and comments on it, looking at why there is rationing of NHS resources and at the approach of the courts to the issue. It concludes that, although rationing of NHS resources is controversial, it is lawful and necessary.

450 Patient Care and Flow in Patients Admitted with Rib Fractures Under General Surgery: One Centre's Experience

Abstract Aim Following the introduction of the ‘South Wales Trauma Network’ in September 2020, patients admitted with traumatic rib fractures who meet the criteria for conservative management are admitted under the care of General Surgery at the Grange University Hospital (GUH). Conservative management includes chest drain placement, pain management, respiratory physiotherapy, and rehabilitation. Our aims were to look at the outcomes of these patients and the efficacy of patient flow. Method Quality improvement methodology was followed. Retrospective data collection on patients (115) diagnosed with rib fractures between January to September 2021 at GUH, Aneurin Bevan University Health Board. Demographics, method of injury, management, admission duration, discharge destination, readmission rate and mortality were collected. Results The mean age of the 115 patients admitted was 68 years (range 20 to 97). Mean age increased to 80 in those who were stepped down for rehabilitation. Over half (60%) of patients sustained rib fractures from mechanical falls. A third of patients needed simple analgesia and 10% had chest drains. Half of patients had no antibiotics and 20% received prophylactic antibiotics. Mean admission duration was 13 days (range 0–103 days). Eleven percent of patients were readmitted within one week. The one-year mortality rate was 2.6%. Conclusions Those who require admission following traumatic rib fractures commonly have complex medical and rehabilitation needs. There is currently a paucity of National Guidelines for these patients, despite advances in ‘Silver Trauma’. We believe a multi-specialty approach towards the establishment of such guidelines is needed and are in the process of coordinating a multi-centre re-audit.

A Quality Improvement Project to Evaluate Satisfaction With Alternatives to Face to Face Consultation in a Learning Disability Service

AimsCOVID-19 pandemic has had a great impact on all groups in society. People with intellectual disability (ID)/learning disability (LD) are especially vulnerable. As a result, restrictions were put in place to protect this group, including limiting face to face visits/consultations. Restrictions on usual activities of people with learning disability are likely to induce stress leading to an escalation in challenging behaviors. Regular assessments and follow-ups are essential to evaluate the patients and provide the best care, so virtual consultations (via telephone or video call) were identified as a potential alternative to face-to-face consultationsAim: Evaluation of the service provided during the COVID-19 pandemic including virtual clinics.MethodsA questionnaire was designed to evaluate the patients and their careers’ satisfaction with the virtual clinics, seeking their feedback about positives and limitations of the service and exploring their preferences for future clinical contact. Data were collected during May 2021. Different professions including (psychiatrists, psychologists, nurses, occupational therapists and speech and language therapists) in community services for adults with learning disabilities in Aneurin Bevan University Health Board have participated in the survey. The questionnaires were filled by service users, their carers or by the service provider.Numbers of DNA (Did not attend) across the whole service during May 2021 were compared to DNAs in May 2018, 2019 and 2020.Results140 surveys were completed. Patients and their carers were happy with many aspects of the service provided through the pandemic. It was reported that virtual clinics are an efficient way to meet with professional carers and families where there are difficulties bringing patients to clinics, however home visits were preferred for assessing patients.No noticeable change in DNA rates has been identified.ConclusionVirtual clinics have been well tolerated by patients and their carers during the pandemic and have provided an extremely efficient tool to overcome the restrictions which were imposed.Carers and patients expressed satisfaction with clinic appointments provided remotely.

Review of Remote Consultations in Learning Disability During COVID Pandemic

AimsThe aim of this project was to assess the efficacy of remote consultations in patients with Learning Disability (LD). In Aneurin Bevan University Health Board, teleconsultation or “Attend Anywhere” (Video) platforms are the two types of remote consultation that is being offered.MethodsA 9- point Questionnaire was used to assess the efficiency of the consultation. During consultation (Either telephone or attend anywhere), data were collected by the consultants by answering the questionnaire. 23 clinics organised between 04/06/2020 to 23/06/2020 for Service Users' (SU) follow-up.The following key points were covered in the questionnaire: 1.Mode of consultation- telephone or attend anywhere2.Presence of the SU3.Introduction4.Availability of information (patient notes/shared drives) prior to consultation5.Time constraints6.Information not covered due to lack of face-to-face consult7.Technical difficulties8.Expectations from SU9.Feedback from SUResults1.The most common mode of consultation was via telephone (70%), followed by Attend Anywhere (30%)2.The majority of conversations were with SU's family or carers (70%); consultations with SU were only 30%. SU were unable to attend the consultation due to: Communication difficulty (26%), follow-ups provided by carer's/family's feedback (21.7%), SU away due to physical health reasons, or in day care (17.3%).3.Introductions were done and sufficient information regarding the service users were available in all consultations.4.Expectation of SU/carers/family was with regards to medication review (43%).5.52% of remote consultation were disrupted due to technical problems, for instance call drops and line disruptions, microphone issues and SU not being able to use attend anywhere because of its complexity.ConclusionIt was demonstrated that remote consultation could possibly be most effective for medication reviews or regular follow-up appointments.Some of the aspects that were not covered due to the shortcomings of remote consultations were: a.Difficulty in assessing body language and facial expressionsb.Difficulty in assessing the level of function of SUc.Unable to monitor physical health parametersd.Difficulty in picking up non-verbal cues, and assess eye contact to ascertain mood component of presentation.In summary it seems in the early stages of the pandemic, telephone consultation was the predominant form of remote consultation. Further work would be useful to obtain the views of people with LD, their carers and families as to which form of consultation would be their preference and whether remote consultation is acceptable for this patient group.

Learning Needs Assessment of Multidisciplinary Staff Working Within the Memory Assessment Services – Survey Study

AimsTo assess the learning needs of the memory team multidisciplinary (MDT) staff working in South East Wales, in relation to diagnosis of dementia, types of dementia, anti-dementia medications and risk associated with dementia.MethodsAn online anonymised survey was designed and distributed via email among memory team MDT staff of 3 different health boards of the South East Wales area which included Aneurin Bevan University Health Board, Cwm Taf Morgannwg University Health Board and Cardiff and Vale University Health Board.The survey was designed to gather information about their understanding of the common type of dementia, treatment with medication, indications and cautions related to medications, the potential side effects and risks associated with Dementia. The survey had a mixture of `Likert Scale` format with free text segments where their opinion was sought in their own words.ResultsTwenty-one (21) staff members responded to the survey. The majority (16) were psychiatric nurses, rest were psychologists and support workers.Thirteen (13) staff members reported they feel confident in identifying subtypes of dementia whereas the rest reported they can benefit from additional knowledge. Majority of staff felt they understood the indications of anti-dementia medication side effects of medications and risks associated with Dementia but do not fully understand the contra-indications and cautions related to anti-dementia medications.Participants suggested that regular teaching, lectures and updates should be arranged especially targeting the diagnostic criteria, medication and risk assessment. Sessions providing bite-size information on a regular basis to build on their knowledge base were suggested.Participants also suggested shadowing doctors and consultants in memory clinics as a useful tool to improve their knowledge base.ConclusionMDT staff working with memory teams are at the front line of screening, assessments and providing help and treatment to patients and their families. It is important to make sure our staff are equipped with evidence-based accurate knowledge and training.This survey study indicated that MDT staff working within the memory team appreciate more training and helped identify the specific areas and mode of teaching required.Prescription of medication may be seen as a doctor's responsibility but we need to ensure our MDT staff has up to date knowledge of types of medications used, their indications, contra-indications, monitoring requirements, and side effects.Regular teaching, online modules and experience of shadowing with doctor's clinics should be offered to all the MDT staff.

P.109 Separating elective and emergency streams - the benefit of centralisation of maternity services at Aneurin Bevan University Health Board (ABUHB)

P.109 Separating elective and emergency streams - the benefit of centralisation of maternity services at Aneurin Bevan University Health Board (ABUHB)

Adapting student practice placements in response to COVID-19: ‘Get there together’ a digital stories project for people living with dementia

ABSTRACT The impact of COVID-19 has been harshly felt by occupational therapists in practice and students requiring practice education placements. A collaboration between Aneurin Bevan University Health Board (ABUHB) and Cardiff University enabled 10 undergraduate students to undertake their final placement by participating in a Digital Stories Project. This placement was innovatively designed to allow students to meet their learning objectives remotely, reducing clinical days in adherence to social distancing measures. The ‘Get There Together’ project was created by the national steering group after identifying the devastating impact COVID-19 had on people affected by dementia when accessing community occupations. The students collaborated with service users to identify areas that they wanted to visit, creating digital recordings explaining what to expect due to COVID-19 rules. This paper will focus on the conception and development of the Digital Stories Project, which helped increase placement capacity for occupational therapy students, during the COVID-19 pandemic.

An audit of liaison service provision in Aneurin Bevan University Health Board

AimsAneurin Bevan University Health Board (ABUHB) isundertaking a review of the Mental Health Liaison Service provision within it's acute general hospitals. The current liaison service is a small nurse led team which is available between 8am and midnight. ABUHB has recently opened a new Specialist Critical Care Hospital with the liaison service moving into a new base. A new model of care has been developed across the healthboard which has stretched the Liaison Service across several sites. Therefore, the liaison service may need to expanded to be able to provide high quality and timely care across a wide geographical area. The audit aims to idenitfy areas in which the liaison service is performing well in while identiying areas that need improvement. This audit may provide a focus for recommendations to enhance the current liaison provision.MethodThe liaison service was audited against RCPsych Psychiatric Liaison Accreditation Network (PLAN) quality standards. PLAN identified eighteen functions of a liaison team and provided details of quality standards within each function. These standards are either considered essential, expected or desirable. An accredited service is expected to meet 100% of essential standards, 80% of expected standards and 60% of desirable standards. Data were taken from a combination of sources including ABUHB policies, service managers and senior clinicians within both mental health and acute services.ResultWhen comparing the current liaison service provision in ABUHB, 30% of essential standards were not met and 21% were only somewhat met. Particular domains that were identifed as needing improvement included policies and procedures and urgent and emergency mental health care. 36% of expected standards were met with 41% not met. Notable domains that the service was performing poorly in included governance; induction, and providing teaching and support to acute colleagues. 89% of desirable standards were not met.ConclusionThe audit idenitifed that the current liaison service fails to meet core standards set out by RCPsych. This audit provides quantitative data to demonstrate that the liaison service is in need of improvement and investment. As a result, enhaving the current liaison service is now a priortity for the health board. A business case is being developed to consider enhancing the liaison service with a view to developing a Consultant led multidisciplinary team. The business case can use PLAN quality standards to make recommendations for improvements to the service.

A quality improvement project on the discharge summary completion process in an addictions service

AimsDischarge summaries are vital documents that communicate information from hospital to primary care providers. The documents contain description of the patient's diagnostic findings, hospital management, laboratory results, medications list and arrangements for post-discharge follow-up. Ineffective communications between healthcare providers in the form of delayed or poor quality discharge summary may adversely affect patient care and safety.The setting of this project is Gwent Specialist Substance Misuse Service (GSSMS) which is the statutory specialist addictions service within Aneurin Bevan University Health Board (ABUHB). GSSMS has been arranging and managing inpatient alcohol detoxes for many years. One of the issues highlighted by an inpatient alcohol detox audit in 2017 was discharge summaries were not being completed for every patient who was admitted with a compliance rate of only 57.7%. A quality improvement project was initiated following the presentation of the audit on a Staff Education Day.The aim of the project is to increase the discharge summary completion rate from 57.7% to 80% by June 2019.MethodA discharge summary process map was developed to understand the possible causes of delay then Plan, Do, Study, Act (PDSA) methodology was utilised. The result of the original audit was taken as the baseline measurement and benchmarking activities and PDSA cycle were performed. Interventions included root cause analysis by way of brainstorming, education, communication and constructing a checklist.ResultThere has been significant improvement with the compliance rate following the PDSA cycle. It went up to 100% before tapering off to 85% by the end of the project.ConclusionAwareness building, continuous monitoring and engagement of teams alongside regular feedback were shown to be the important factors to achieve and sustain the improvement.

Audit on prolactin monitoring for patients on oral risperidone, intramuscular risperidone, and intramuscular paliperidone

AimsThe aim of this audit was to investigate whether sufficient Prolactin monitoring was completed in a patient sample in the Torfaen area of Aneurin Bevan University Health Board. This audit targetted patients an oral or intra-muscular formulation of Risperidone in the year 2018 with the hypothesis that Prolactin monitoring is done less frequently than recommended.BackgroundRisperidone is the anti-psychotic drug most frequently associated with hyperprolactinemia which is often asymptomatic but can present with symptoms of oligomenorrhea, amenorrhea, galactorrhea, decreased libido, infertility, and decreased bone mass in women. Men with hyperprolactinemia may present with erectile dysfunction, decreased libido, infertility, gynecomastia, decreased bone mass, and rarely galactorrhea. The BNF advises monitoring of Prolactin at baseline, after 6 months, and then annually.MethodRetrospective review of 150 patients’ clinical letters to identify if they are on the above medications, using the local digital records system EPEX. Emails were also sent to community psychiatric nurses asking them if they could highlight any patients they were caseholding on the above medication. Depot clinic lists were also examined. Patients identified as being on the above medication had their blood tests reviewed on the online system Clinical Workstation (CWS) to determine whether they had their Prolactin level tested. A single spot sample of all patients on Talygarn ward in January 2019 was also included.Result1. 28 Risperidone2. 23 of 28 never had any Prolactin measurements3. 2 of 28 patients had the appropriate level of monitoring done for the year of 2018a. One patient complained of Galacotorrheab. Another patient had baseline done while on the ward and isn't due for any further monitoring at the time of writing.ConclusionThe above results identify that Prolactin monitoring is not being routinely completed for patients on the studied medication at an acceptable compliance level. Limitations around utitlity of prolactin monitoring may be the contributing factors; eg. Prolactin levels or medication dose may not be positively associated with adverse effects.. Further efforts were made to highlight the importance of baseline prolactin monitoring, as well as including a baseline Prolactin as an admission blood test for patients presenting with psychotic symptoms or on an anti-psychotic. A complete audit of metabolic monitoring and Prolactin levels for all patients on anti-psychotics would be an appropriate next step.

Melatonin prescribing practices and the provision of sleep hygiene/parent-led sleep behavioural Interventions in S-CAMHS, Aneurin Bevan University Health Board (ABUHB)- Service evaluation as part of quality improvement project

AimsTo identify the number of patients currently on melatoninTo determine the average duration of use of melatonin in patients under the care of S-CAMHS in ABUHBTo investigate whether behaviour interventions were tried and reinforced from time to timeTo identify any areas of improvementMethodData were collected at St. Cadoc's hospital, in January, 2021. S-CAMHS database was used. Out of total 346 patient currently being managed with pharmacological therapies, 115 (33.2%) are currently on melatonin. 57/115 were randomly selected as a sample for this this project. Patient notes and EPEX software were also used to collect information regarding the sleep management practices.ResultDuring analysis, it was noticed that within the sample, only 46 patients were actively on melatonin. Melatonin is prescribed for sleep related issues in ASD (8/46), ADHD (15/46), ASD and ADHD (10/46), ADHD and mood disorder (0/46), ASD and mood disorder (6/46), ADHD and behaviour difficulties (2/46), ASD with behaviour difficulties (1/46), mood disorder (4/46).39/46 patients are currently on melatonin for more than a year (85%). These patients also include 10 patients who have been using melatonin for 5 years or more.35 patients (76%) reported improved sleep or some benefit from melatonin.Evidence for implementation of parent-led sleep behavioural interventions:Prior to commencing melatonin- Clear evidence available for 35 patients only (76%). These interventions were however not deemed helpful by most of the service users.While prescribing melatonin- Clear evidence available for 39(85%) patients. Evidence base for melatonin was also discussed during this visit.During last follow-up visit- Evidence available for 31 patients only (67%).ConclusionMajority of patients under S-CAMHS ABUHB remain on melatonin therapy for longer than one year. Most of these patients have reported benefit from this therapy and preferred to remain on it despite being informed about evidence base for melatonin. Also, there is evidence for implementation of sleep behavioural interventions prior to prescribing melatonin, however their benefit remains unclear.Recommendations:The quality of education on sleep hygiene offered should be assessed and improved if neededFormal group sessions/workshops on sleep hygiene/parent-led sleep behavioural interventions at regular intervals might be useful in reducing the chances of long term polypharmacy or unlicensed drugsUse of outcome measures such as Child Sleep Habits Questionnaire at intervals can be helpful in identifying any improvement from educational/pharmacological interventionsS-CAMHS database (for patients actively on medications) needs a review and update

The Rowan Hillson Inpatient Safety Award 2019 for the best perioperative pathway for people with diabetes

Introduction: The annual National Diabetes Inpatient Audit (NaDIA) in the UK continues to show a high incidence of insulin errors in patients admitted to hospital with diabetes. New initiatives are urgently required to mitigate this risk.Method: The Joint British Diabetes Societies for Inpatient Care (JBDS-IP) organised the sixth national Rowan Hillson Inpatient Safety Award on the theme of the best perioperative pathway for people with diabetes.Result: The winner was the team from Aneurin Bevan University Health Board led by Dr David Burckett-St Laurent for their innovative re-design of the perioperative pathway by a cross-specialty working group. The main elements of the new system were standardised patient assessment, optimisation of perioperative diabetes control, personalised diabetes management plans generated from a drop-down menu with information on usual drug treatment, pre-op/day of surgery diabetes medication modification, advice on hypoglycaemia management and sick-day rules, anaesthetic review for people with HbA1c >69 mmol/mol, secondary care diabetes review for people with suboptimal diabetes control, new inpatient charts with guidance on diabetes drug management, streamlining of time and place of admission and greater engagement and education of people with diabetes and staff looking after them. This resulted in significant improvement in outcomes and reduction in risks.The Newcastle upon Tyne NHS Foundation Trust team led by Dr Nicola Leech and colleagues received the runners-up award for their 3-year quality improvement project involving multiple specialties. The project included development of trust-wide policies and protocols, educational initiatives, targeted diabetes specialist nurse in-reach, innovative electronic whiteboard alerts for glycaemic control and electronic hypo alerts. The result was a reduction in insulin errors and hypoglycaemia on surgical wards by over 50%, a reduction in Datix incidents and fewer patients suffering harm events.Summary and conclusion: These and similar schemes need to be developed, promoted and shared to reduce insulin errors in hospitalised patients with diabetes.

27 - Impact of the COVID-19 pandemic on the use of systemic anti-cancer therapy for patients diagnosed with malignancy at thoracoscopy in Aneurin Bevan University Health Board

27 - Impact of the COVID-19 pandemic on the use of systemic anti-cancer therapy for patients diagnosed with malignancy at thoracoscopy in Aneurin Bevan University Health Board