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

Abstract

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.

Bridging the gap: How investing in advanced practice nurses could transform emergency care in Africa

“…Recent studies have shown the potential benefits of APN in emergency care in Africa. For example, a study conducted in South Africa found that implementing a nurse‐led trauma service was associated with improved patient outcomes, including reduced mortality rates and shorter hospital stays; however, the enhanced outcomes might be seen as a result of both system‐ and nursing‐related contributions, illustrating the importance of integrating nursing expertise within the trauma care system to improve patient outcomes (Christmals & Armstrong, 2019a, 2019b; Wearmouth & Smith, 2019). Similarly, a study conducted in Nigeria found that utilizing APNs in emergency care was associated with improved triage and patient outcomes (Chimezie & Ibe, 2019).…”

“…The intervention involved training APN to provide trauma care and lead the trauma team. The study found that implementing the trauma service was associated with improved patient outcomes, including reduced mortality rates and shorter hospital stays (Wearmouth & Smith, 2019). This was similarly done in Uganda, where nurses were trained to provide care to trauma patients, and this showed a reduction in fatality rates compared with other rates in regions (Chamberlain et al., 2015).…”

Guest Editorial: Introduction to the Trauma Special Issue

“…Regarding emergency centre trauma care, Wearmouth and Smith report on their clinical governance project in a rural South African district hospital in KwaZulu-Natal, where they aimed to improve the administration of tranexamic acid to pertinent trauma admissions using a nurse-led protocol, since the delays to administration were identified in a prior audit at their facility. [9] They report a good experience and low protocol deviation rate and postulate that this intervention may reduce mortality in rural trauma cases.…”