Background: The development of healthcare services which address patients' perspectives of treatment and illness has been advocated. However, little is known about patients' beliefs and experiences of taking antidepressant medication. Aims: The current study aimed to identify factors of importance to patients beginning courses of antidepressant medication, in order to inform the development of partnerships between patients and healthcare professionals. Method: Patients beginning courses of antidepressant medication were recruited from general practice surgeries. Semi-structured interviews were performed. Interviews were audiotaped, transcribed verbatim and coded. Results: Antidepressant medication was found to have a paradoxical role in affecting the return to normal life and functioning. Medication enabled respondents to return to normality by reducing symptoms associated with the condition. However, it also had a stigma attached which reduced interviewees' sense of being normal. Respondents reported mechanisms of dealing with stigma, the majority of which reconciled taking antidepressant medication with previous self identity. Conclusion: Knowledge of mechanisms used to deal with stigma may aid healthcare professionals in building partnerships with patients with a diagnosis of depression. Declaration of interest: None.

Objective: To evaluate the management, clinical outcomes and adherence to chelation therapy in adult transfusion‐dependent patients with thalassaemia major. Design, setting and participants: We revie...

Background: About 25% of palliative medication incidents involve continuous subcutaneous infusions. Complex structural and human factor issues make these risk-prone interventions. Detailed analysis of how this safety-critical care can be improved has not been undertaken. Understanding context, contributory factors and events leading to incidents is essential. Aims: (1) Understand continuous subcutaneous infusion safety incidents and their impact on patients and families; (2) Identify targets for system improvements by learning from recurrent events and contributory factors. Design: Following systematic identification and stratification by degree of harm, a mixed methods analysis of palliative medication incidents involving continuous subcutaneous infusions comprising quantitative descriptive analysis using the PatIent SAfety (PISA) classification system and qualitative narrative analysis of free-text reports. Setting/participants: Palliative medication incidents ( n = 7506) reported to the National Reporting and Learning System, England and Wales (2016–2021). Results: About 1317/7506 incidents involved continuous subcutaneous infusions with 943 (72%) detailing harms. Primary incidents (most proximal to patient outcomes) leading to inappropriate medication use (including not using medication when it was needed) were underpinned by breakdowns in three major medication processes: monitoring and supply (405, 31%), administration (383, 29%) and prescribing (268, 20%). Recurring contributory factors included discontinuity of care within and between settings, inadequate time, inadequate staffing and unfamiliarity with protocols. Psychological harms for patients and families were identified. Conclusions: System infrastructure is needed to enable timely supply of medication and equipment, effective coordinated use of continuous subcutaneous infusions, communication and continuity of care. Training is needed to improve incident descriptions so these pinpoint precise targets for safer care.

Introduction Approximately 20% of serious safety incidents involving palliative patients relate to medication. These are disproportionately reported when patients are in their usual residence when compared with hospital or hospice. While patient safety incident reporting systems can support professional learning, it is unclear whether these reports encompass patient and carer concerns with palliative medications or interpersonal safety. Aim To explore and compare perceptions of (un)safe palliative medication management from patient, carer and professional perspectives in community, hospital and hospice settings. Methods and analysis We will use an innovative mixed-methods study design combining systematic review searching techniques with cross-sectional quantitative descriptive analysis and interpretative qualitative metasynthesis to integrate three elements: (1) Scoping review: multiple database searches for empirical studies and first-hand experiences in English (no other restrictions) to establish how patients and informal carers conceptualise safety in palliative medication management. (2)Medication incidents from the England and Wales National Reporting and Learning System: identifying and characterising reports to understand professional perspectives on suboptimal palliative medication management. (3) Comparison of 1 and 2: contextualising with stakeholder perspectives. Patient and public involvement Our team includes a funded patient and public involvement (PPI) collaborator, with experience of promoting patient-centred approaches in patient safety research. Funded discussion and dissemination events with PPI and healthcare (clinical and policy) professionals are planned. Ethics and dissemination Prospective ethical approval granted: Cardiff University School of Medicine Research Ethics Committee (Ref 19/28). Our study will synthesise multivoiced constructions of patient safety in palliative care to identify implications for professional learning and actions that are relevant across health and social care. It will also identify changing or escalating patterns in palliative medication incidents due to the COVID-19 pandemic. Peer-reviewed publications, academic presentations, plain English summaries, press releases and social media will be used to disseminate to the public, researchers, clinicians and policy-makers.