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Development of a nurse-led tranexamic acid administration protocol for trauma patients in rural South Africa

INTRODUCTION: Administration of tranexamic acid (TXA) has been shown to effectively reduce all-cause mortality in trauma patients when given within three hours of injury. We found that many trauma patients in our hospital were not receiving TXA. This was due to a variety of factors, including late p...

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Autores principales: Wearmouth, Christopher, Smith, Jacob
Formato: Online Artículo Texto
Lenguaje:English
Publicado: African Federation for Emergency Medicine 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440919/
https://www.ncbi.nlm.nih.gov/pubmed/30976502
http://dx.doi.org/10.1016/j.afjem.2018.10.001
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author Wearmouth, Christopher
Smith, Jacob
author_facet Wearmouth, Christopher
Smith, Jacob
author_sort Wearmouth, Christopher
collection PubMed
description INTRODUCTION: Administration of tranexamic acid (TXA) has been shown to effectively reduce all-cause mortality in trauma patients when given within three hours of injury. We found that many trauma patients in our hospital were not receiving TXA. This was due to a variety of factors, including late presentation to hospital, lack of staff awareness, short staffing, and unavailable drugs or equipment. Our aim was to develop a protocol for safe, nurse-led administration of TXA in the emergency centre in order to increase the number of eligible patients treated. METHODS: We developed a protocol based on the inclusion criteria of the CRASH-2 study, opting to use physiological observations along with criteria from the South African Triage Scale to allow nursing staff to identify patients with, or at risk of, significant haemorrhage. We tailored the protocol to the equipment and training available in our poorly resourced rural healthcare setting. RESULTS: In a two-month period, 14 patients were given TXA by nurses before the arrival of a doctor. 13/14 (92.9%) were deemed appropriate, with 1/14 (7.1%) deemed inappropriate due to the time since injury. 12/13 (92.3%) patients received the correct infusion dose, with 1/13 (7.7%) only receiving the infusion once the doctor arrived. No adverse events were reported. CONCLUSIONS: Nursing staff in resource poor rural settings can use a protocol based on the South African Triage Scale and the CRASH-2 study to safely administer TXA to trauma patients. We believe this to be the first published literature on nurse-led administration of TXA. Mortality from trauma may be reduced in rural settings by the timely administration of TXA in the prehospital and rural primary healthcare settings.
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spelling pubmed-64409192019-04-11 Development of a nurse-led tranexamic acid administration protocol for trauma patients in rural South Africa Wearmouth, Christopher Smith, Jacob Afr J Emerg Med Article INTRODUCTION: Administration of tranexamic acid (TXA) has been shown to effectively reduce all-cause mortality in trauma patients when given within three hours of injury. We found that many trauma patients in our hospital were not receiving TXA. This was due to a variety of factors, including late presentation to hospital, lack of staff awareness, short staffing, and unavailable drugs or equipment. Our aim was to develop a protocol for safe, nurse-led administration of TXA in the emergency centre in order to increase the number of eligible patients treated. METHODS: We developed a protocol based on the inclusion criteria of the CRASH-2 study, opting to use physiological observations along with criteria from the South African Triage Scale to allow nursing staff to identify patients with, or at risk of, significant haemorrhage. We tailored the protocol to the equipment and training available in our poorly resourced rural healthcare setting. RESULTS: In a two-month period, 14 patients were given TXA by nurses before the arrival of a doctor. 13/14 (92.9%) were deemed appropriate, with 1/14 (7.1%) deemed inappropriate due to the time since injury. 12/13 (92.3%) patients received the correct infusion dose, with 1/13 (7.7%) only receiving the infusion once the doctor arrived. No adverse events were reported. CONCLUSIONS: Nursing staff in resource poor rural settings can use a protocol based on the South African Triage Scale and the CRASH-2 study to safely administer TXA to trauma patients. We believe this to be the first published literature on nurse-led administration of TXA. Mortality from trauma may be reduced in rural settings by the timely administration of TXA in the prehospital and rural primary healthcare settings. African Federation for Emergency Medicine 2019 2019-01-08 /pmc/articles/PMC6440919/ /pubmed/30976502 http://dx.doi.org/10.1016/j.afjem.2018.10.001 Text en 2019 African Federation for Emergency Medicine. Publishing services provided by Elsevier. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Article
Wearmouth, Christopher
Smith, Jacob
Development of a nurse-led tranexamic acid administration protocol for trauma patients in rural South Africa
title Development of a nurse-led tranexamic acid administration protocol for trauma patients in rural South Africa
title_full Development of a nurse-led tranexamic acid administration protocol for trauma patients in rural South Africa
title_fullStr Development of a nurse-led tranexamic acid administration protocol for trauma patients in rural South Africa
title_full_unstemmed Development of a nurse-led tranexamic acid administration protocol for trauma patients in rural South Africa
title_short Development of a nurse-led tranexamic acid administration protocol for trauma patients in rural South Africa
title_sort development of a nurse-led tranexamic acid administration protocol for trauma patients in rural south africa
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440919/
https://www.ncbi.nlm.nih.gov/pubmed/30976502
http://dx.doi.org/10.1016/j.afjem.2018.10.001
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