Optimizing Monitoring Frequency During Blood Transfusions: A Review of Guidelines and a Retrospective Cohort to...

Background/Objectives: Vital signs monitoring during blood transfusion is important but inconsistently practiced across contexts. This paper aimed to consolidate the available evidence to determine the optimal monitoring frequency that balances efficiency and safety in clinical practice. Methods: Evidence was gathered through a literature review, review of international guidelines, investigation of local practices and analysis of study institution's retrospective data on transfusion reaction patterns. Expert opinions were consulted on the proposed changes, prior to the pilot feasibility study. Results: The majority of the reviewed guidelines and practices monitored vital signs at three time-points: before transfusion, 15 min after initiation and upon completion. However, study hospital data revealed that transfusion reactions predominantly occurred within the first two hours, particularly among males aged 50-70 who received red packed cells in the oncology wards and had abnormal pre-transfusion vital signs. Thus, the original 10-point frequency practiced by the study hospital was modified to seven time-points instead of the widely adopted three time-points: prior to blood transfusion; 15 min after commencement; 30 min at the forty-fifth minute; hourly thereafter until completion; and within 1 h post-transfusion. Conclusions: Despite existing guidelines recommending only three vital signs monitoring time-points, institutional data suggests that using seven time-points is optimal to minimize missed transfusion reactions while preventing an unnecessary workload, balancing patient safety and operational efficiency. These proposed revisions will be evaluated through an upcoming pilot trial to assess their feasibility and the impact on patient outcomes.