Transfusion vital signs

[Sue Arata]

So, my question pertains to transfusion tag compliance and when the nurses are supposed to take vital signs. It has been my understanding that baseline vitals are taken immediately prior to starting a transfusion, and then again after 15 minutes of infusion, and again at the end of the transfusion.

I cannot find any information on the CAP requirements regarding the monitoring of this information.

Thank you in advance for any input.

Susan I. Arata MLS (ASCP)

Senior Lead Transfusion Services

Mercy Medical Center

Roseburg, OR

[John C. Staley]

You might want to check with the state, and/or national nurse organizations for this information.  They are the ones generally in charge of nursing practice.  Another place to look would be JCHO (or what ever they are calling themselves now).  They may have the information you are looking for.  Lab organizations such as CAP and AABB are reluctant to make rules or requirements telling nurses what to do.  

[Ensis01]

I liked the first vitals being taken just before the blood was picked up. This prevented many a wasted unit. Not sure if this policy was regulatory or if common sense had broken out. 

[carolyn swickard]

On ‎5‎/‎9‎/‎2019 at 5:51 PM, Ensis01 said:

I liked the first vitals being taken just before the blood was picked up. This prevented many a wasted unit. Not sure if this policy was regulatory or if common sense had broken out. 

Amen! 

Our nurses take vitals before, at 15 mins, at 1 hour, and at end (<4hrs).  Don't know where it came from but that is our policy.

[AMcCord]

On 5/11/2019 at 1:46 PM, cswickard said:

Amen! 

Our nurses take vitals before, at 15 mins, at 1 hour, and at end (<4hrs).  Don't know where it came from but that is our policy.

Nursing policy says that they must take pre-transfusion vitals no more than 15 minutes prior to checking out the blood product, then repeat vitals at 15 min and at the end (<4 hrs). Most of our transfusions run 90-120 minutes.

[SMILLER]

Besides at the start and at 15 mins, we document every hour, at the end, and 1 hour post.

Scott

[jnadeau]

After being cited by a NYS inspector a few years ago for vital signs not being documented as described in the blood administration policy (some pre- and post vitals were documented with the same time as the start and end times) I searched through numerous P&P's and regulations from around the world (English speaking anyway) to find a fix.  The citing was legitimate (pre=BEFORE START, post....) and I wanted the corrective action to reflect the most up-to-date best practice I could find.  There was an almost universal policy/regulation for pre-, 15 min and post vital signs.  The variations in the timing of vital signs (other than the 15 min ) was all over the map.  The multitude of situations patients are in make it difficult to be cut and dry in a P&P.  Decided to go with pre- and post within 30 min of start and stop;  must stay with patient first 15 min so that was easy.  More frequent vitals if provider indicated (almost never) or transfusionist deems patient requires - or if I recommend with my knowledge of the patient history / lab results.   You know though, that as soon as there's an incident they'll "fix" it by requiring more frequent vitals and the loop continues...keep your old policy handy.

[Andrea Pointer]

Hi all, this is a late response to the post, but I have some valuable info to add. I searched "vital signs" in the forum so it's still a relevant topic to me.

We just transitioned from CAP to TJC (JCAHO) for lab accred (before you ask why or judge, it was a legit reason; I also was hesitant, but it's been good so far!) and learned that CAP doesn't really care. It's all TJC.

TJC follows AABB guidelines for their standards. AABB published in the 19th Ed Technical Manual (the only one I have; not sure if a more recent version would change the info) indicates a pre-transfusion check, within 15 min of starting, during transfusion "at regular intervals", and after transfusion is done is advised, but there is a lack of published study evidence to actually assign the intervals. TJC will hold you accountable to whatever is in your policy and their transfusion tracers will review charted vitals. 

I'm keenly interested in the topic because we are needing to address our policy, which is a pre, 15 min in, 30 min in, hourly from there, and one hour post. Our initial surveyor is an SBB and said that the majority of facilities she had personally inspected were doing pre, 15 in, hourly, then one hour post, and her suggestion was to adopt that model. Anytime there is a lack of distinct guidance, TJC will direct you to check out the industry best practice. My suggestion is to take all this advice and check with your friends in other hospitals. 

I came here to ask about traumas/emergencies/MTPs and how often THOSE vitals should be taken. Like I said, we have to make a change and it was just suggested by an exec MD that we basically publish our policy to say whatever the hemorrhagic emergency, the patient's vitals will be trash until stabilized so we aren't going to check the vitals until the patient's bleeding event is stabilized. Unstable vitals in an unstable situation will not provide direction for care, per the exec's thinking. TJC will only hold you accountable to your own policy on this until further evidence-based best practice is established. Likely never. 

[John C. Staley]

On 12/29/2022 at 7:35 AM, Andrea Pointer said:

I came here to ask about traumas/emergencies/MTPs and how often THOSE vitals should be taken.

My experience, though it was a while ago, was that during those events the vitals are being monitored constantly whether transfusion is occurring or not.  The documentation may or may not reflect that but it is being monitored.  Personally I think the blood bank/transfusion service should start being in the loop concerning vitals when the crisis is over and transfusions are slowing down or stopping.  Then the vitals will be come relevant.  Just my 2 cents worth.