Background Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0•9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0•9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124.

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In 1999, a review of medication policies and practices for The Geelong Hospital, a Victorian regional acute care hospital, was conducted under the leadership and direction of the Executive Nursing Director. The findings of the review suggested that a study be conducted to examine the safety of single-person (registered nurse division 1) checking of a designated group of medications that had previously been double-checked. The present study was conducted as a descriptive study in adult inpatient units and speciality and midwifery services of The Geelong Hospital, and included the monitoring of medication errors for the designated group of medications under a single-person checking protocol for a 7-month period. A similar number of medication errors were reported when compared with a similar time-frame in which double-person checking was standard practice. At the completion of the study, a convenience sample of 129 nurses from the participating units and services completed questionnaires. The majority of the nurses appreciated the increased autonomy the change to single-person checking of medications provided. They also identified benefits for patients, including that they were able to be more responsive to patient needs.