Quality standard
Quality statement 2: Tranexamic acid for adults
Quality statement 2: Tranexamic acid for adults
Quality statement
Adults who are having surgery and are expected to have moderate blood loss are offered tranexamic acid.
Rationale
Tranexamic acid can reduce the need for blood transfusion in adults having surgery. This avoids serious risks associated with blood transfusion, for example infection, fluid overload and incorrect blood transfusions being given. It may also reduce the length of hospital stays and the cost to the NHS.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Process
Proportion of adults who are having surgery and are expected to have moderate blood loss who receive tranexamic acid.
Numerator – the number of adults in the denominator who receive tranexamic acid.
Denominator – the number of adults who are having surgery and are expected to have moderate blood loss.
Data source: NHS Blood and Transplant national comparative audit of NICE quality standard QS138.
Outcome
Blood transfusion rates associated with surgery.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
What the quality statement means for different audiences
Service providers (secondary care services) ensure that systems are in place to offer tranexamic acid to adults who are having surgery and are expected to have moderate blood loss.
Healthcare professionals (such as doctors, nurses and blood transfusion specialists) offer tranexamic acid to adults who are having surgery and are expected to have moderate blood loss.
Commissioners commission services that offer tranexamic acid to adults who are having surgery and are expected to have moderate blood loss.
Adults who are expected to lose more than half a litre of blood during an operation are offered tranexamic acid. This helps blood to clot better and reduces blood loss during surgery.
Source guidance
Blood transfusion. NICE guideline NG24 (2015), recommendation 1.1.5
Definitions of terms used in this quality statement
Moderate blood loss
Adults who are expected to have blood loss greater than 500 ml during surgery, as recorded on the World Health Organization surgical safety checklist.
A NICE endorsed resource is available to support implementation of the NICE guideline on blood transfusion and the NICE quality standard. This NHS Blood and Transplant audit tool includes a list of elective surgeries expected to have blood loss greater than 500 ml that could be audited for provision of tranexamic acid:
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primary unilateral total hip replacement
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primary bilateral total hip replacement
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primary unilateral total knee replacement
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primary bilateral total knee replacement
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unilateral revision hip replacement
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unilateral revision knee replacement
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colorectal resection for any indication (open or laparoscopic)
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open arterial surgery such as scheduled (non-ruptured) aortic aneurysm repair, infrainguinal femoropopliteal or distal bypass
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primary coronary artery bypass graft
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valve replacement with or without coronary artery bypass graft
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simple or complex hysterectomy
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cystectomy
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nephrectomy
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fracture neck of femur (arthroplasty).
[NICE's guideline on blood transfusion, recommendation 1.1.5, the World Health Organization surgical safety checklist and the NHS Blood and Transplant QS138 quality insights audit tool user guide, appendix 3]