# Improving Perioperative Tranexamic Acid Administration in Hip Fracture Surgery: A Two-Cycle Quality Improvement Project at Dorset County Hospital

## TL;DR

This study shows that clear guidelines and better staff awareness improved the use of a blood-clotting drug during hip fracture surgeries at a hospital.

## Contribution

The study demonstrates how targeted interventions and updated protocols can improve tranexamic acid administration in hip fracture surgery.

## Key findings

- TXA administration increased from 70% to 85.2% after implementing interventions.
- Improved uptake was linked to better staff awareness and adherence to updated protocols.

## Abstract

Background

Tranexamic acid (TXA) is widely used in surgical practice to reduce bleeding by inhibiting fibrinolysis. Despite its established role, utilisation in hip fracture surgery varies across institutions. This quality improvement project evaluated perioperative TXA administration within a district general hospital and assessed the impact of targeted interventions on prescribing practices.

Methods

A quality improvement project was initiated at Dorset County Hospital (DCH), Dorchester, England, to evaluate the utilisation of TXA in patients admitted with hip fractures that were surgically treated. All patients aged 65 and over undergoing surgical management of hip fractures were included, excluding those with contraindications (recent thromboembolic events, active clotting disorders, hypersensitivity, or recent stenting). Two audit cycles were conducted, i.e., September-November 2021 and September-October 2023, assessing perioperative TXA administration rates.

Results

TXA use increased from 70% (n = 37) in the first cycle to 85.2% (n = 27) in the second cycle. Improved uptake correlated with enhanced staff awareness and adherence to updated local protocols.

Conclusion

Implementing clear local guidelines and ensuring documentation of contraindications significantly improved TXA administration in hip fracture surgery. These measures supported more consistent practice and contributed to an overall improvement in perioperative care within the department.