Objectives To improve the quality and consistency of physical examination of young people in adolescent inpatient psychiatry wards after incidents of ligature tying. Also to increase confidence of ward staff in recognising symptoms and signs of concern

Method Reviewed recent episodes of ligature tying recorded in care notes in order to look at the range of physical examinations that had been undertaken after a ligature tying event. Liaised with specialists in paediatric emergency care for advice re appropriate physical examinations. Medical literature was reviewed for existing guidelines on appropriate physical examinations in children and adolescents.

Findings Case notes revealed a wide range of examinations performed. A relatively small proportion of these were aimed at the main concerns which had been identified during this project as potentially being key, post ligature tying.

Conclusions Although no current evidence related to examination of children and adolescents after ligature tying could be found, it was still felt to be of value to create a guideline (which had to be based on best practice in adults) to help improve quality of physical examinations performed and confidence of ward staff in recognising symptoms and signs of concern. It is hoped that this guideline could be introduced to staff at Trust induction and that a poster could be produced for the ward office and examination room.