Improving Adherence to National Institute for Health and Care Excellence (NICE) Guidelines for the Use of Tranexamic Acid in Primary Total Knee Arthroplasty: A Quality Improvement Initiative.

Background: Tranexamic acid (TXA) is a pharmacological agent used in reducing blood loss during orthopaedic surgeries, including total knee arthroplasty (TKA). Despite its proven efficacy and National Institute for Health and Care Excellence (NICE) guidelines recommending combined topical and intravenous administration, compliance in clinical practice often lags.

Objective: This study aimed to evaluate and improve adherence to NICE guidelines for TXA use during TKA through a quality improvement initiative.

Methods: A two-cycle audit was conducted at Good Hope Hospital, Birmingham, United Kingdom, assessing compliance with TXA guidelines in 93 TKA cases reviewed retrospectively. Educational interventions including presentations, emails, and instructional posters, were implemented between cycles to address non-compliance barriers. Data from operation notes were analyzed, and adherence improvements were evaluated using statistical tests.

Results: The first cycle revealed a 51.2% non-compliance rate. Following interventions, compliance improved significantly, with TXA usage rising from 48.8% to 73.1% (p = 0.016). Combined topical and intravenous administration increased from 7.3% to 30.8% (p= 0.005). Subgroup analyses of the second cycle indicated better compliance in non-tourniquet cases and improved adherence among patients with renal impairment.

Conclusion: Targeted educational interventions significantly improved adherence to TXA guidelines in TKA. Incorporating TXA administration into surgical checklists and further education on its safety, especially in patients with renal impairment, may be helpful in improving compliance.