Examining the Evidence for Frequency of Vital Sign Monitoring During Transfusion of Blood Products in the Stem Cell Transplant Patient Population

Abstract

Background:  Patients undergoing stem cell transplantation (SCT) receive copious amounts of blood products during the course of treatment.  This alone can be disruptive to patients and is further compounded by taking frequent vital signs during blood transfusions.  Current policy on a large SCT unit is to take routine vital signs every four hours.  During blood transfusions, vital signs are taken at baseline, 10-15 minutes after initiation, hourly, and 30 minutes after blood administration is complete.  Such frequent vital sign monitoring interrupts sleep and the patient’s ability to ambulate or participate in unit activities, consequently affecting inpatient stay and satisfaction.  Additionally, frequent vital signs monitoring can be uncomfortable for patient and time consuming for nurses.  The decision for the frequency of vital sign monitoring is arbitrary, as the current policy is not evidence based.  Relying heavily on vital signs may affect nursing judgment by becoming too focused on measuring vital signs and overlooking other non-measurable symptoms. 

Aim/Objective:  The staff nurses of a SCT unit identified the need to examine the evidence in the literature regarding the optimum frequency of vital sign monitoring for SCT patients receiving blood products in relationship to the institution’s current policy.

 Intervention:  An evidenced-based project was developed to review current evidence on frequency of vital signs for SCT patients receiving blood products and comparing those results to the current policy.  The literature reviewed suggests that taking vital signs before blood transfusions, after fifteen minutes, and upon completion was clinically sound.  In addition, the literature also supported patient observation as a key method to assess blood transfusion-related reactions rather than relying on vital signs alone.  All literature reviewed supported taking vital signs at baseline and after fifteen minutes, as this is the time period in which a reaction would most likely occur.  In addition, better training of staff was recommended to recognize a blood reaction should it occur. 

Results/Evaluation:  Findings were presented to the Nurse Practice Congress and a decision to form a PACT was made to investigate making an institutional policy change.  A multidisciplinary group is meeting to pursue this change in practice.