Performance Improvement: Joint Care Center
State University of New York Plattsburgh
Blood loss in a total joint replacement surgery may subject the patient to allogeneic blood transfusion. This places a patient at risk for the potential of transfusion reactions, graft-versus-host disease, hyperkalemia, fluid overload, and infections.( Qintong 2014) Not to mention the fact that most patient’s satisfaction or even more significant avoidance of the surgery increases with the fear of receiving an allergenic blood transfusion. This in all sense and purposes is an organ transplant. Cost of an allogeneic blood transfusion and having a sufficient blood supply are also a factor. ...view middle of the document...
(Huang 2014) Meta-analysis showed that the use of TXA for patients undergoing major orthopedic surgery is effective and safe for reducing blood loss, the number of patients needing transfusion, and the number of blood transfusions, and did not appear to increase DVT risk. TXA is administered both intravenously before and after tourniquet application or inter capsular as the surgeon is closing up the surgery.
Cost of TXA is approximately fifteen dollars a dose comparing this to the cost of an allogeneic blood transfusion or an auto-transfusion device is impressive. With a unit of packed red blood cells costing approximately $500 not including the nursing time involved in safely completing the transfusion. An auto transfusion device with filter and tubing is approximately $175 not including nursing time and reducing the patient’s mobility therefore extending length of stay. These added risks, expenses or increased length of stay is not what any of our customers want.
TXA literature along with recommendations from the pharmacy committee were presented to Dr. Volk of orthopedics and Dr. Curry of the anesthesia dept. The approach of intra-capsular injection prior to closure was chosen by Dr. Volk and was implemented in the 4th quarter of 2013. Of the first 10 patients that received TXA; not one required an allogeneic transfusion. Dr. Volk and the team were very encouraged, so much that 2 more surgeons started using it in their practice at the beginning of 2014. The 4th surgeon then began at the end of the 2nd quarter.
Education to the nursing staff was provided in 2 areas; the orthopedic nurses on R6 were provided a quick facts sheet on TXA that was created by the R6 management team and a clinical pharmacist. The pre-op and operative staff were provided with more education as they were the nurses preparing and administering TXA. An online learning course on use,...