Should adding pain, oxygen saturation and physical assessment to vital signs become the new standard of care for detecting blood transfusion reactions?

BACKGROUND AND OBJECTIVES: Clinicians sought to ascertain what frequency of vital signs best detects blood transfusion reactions. This review discusses early and delayed blood product transfusion reaction detection through the lens of scientific literature. METHODS: A comprehensive appraisal of published literature was conducted using Integrative Research Review methodology through June 2022 not limited to English or research in Cumulative Index to Nursing and Allied Health Literature, Cochrane Library of Systematic Reviews, Medline and PubMed. RESULTS: Full-text articles in the final sample included four articles discussing vital signs detecting blood transfusion reactions and four articles reporting the importance of adding physical assessments for early reaction detection. None of the studies provided evidence regarding how often vital signs should be monitored to detect transfusion reactions. No studies included identical screening components for detecting blood product transfusion reactions. Main themes emerged including variations in what was included in vital signs, importance of respiratory assessment, inclusion of physical assessment, nurse documentation and reporting compliance, and patient and family inclusion in transfusion reaction recognition. CONCLUSION: Vital sign components varied across reviewed studies. Respiratory rate and pain were not always included in 'vital signs' to identify transfusion reactions. Only low-level data and no clinical trials loosely informing frequency of vital sign monitoring to transfusion reaction detection were found. Respiratory (to include oxygen saturation, lung sounds and respiratory rate) and pain assessment emerged as crucial to acute and delayed transfusion reaction recognition. The disconnect between 'vital signs' and the varied vital sign components reported to detect transfusion reactions in scientific literature requires further exploration.

Modified early warning scoring (MEWS): evaluating the evidence for tool inclusion of sepsis screening criteria and impact on mortality and failure to rescue.

AIMS AND OBJECTIVES: To evaluate current research evidence reporting outcomes from modified early warning scoring system tools utilisation to prevent failure to rescue in hospitalised adult medical-surgical/telemetry patients. BACKGROUND: Early sepsis detection exhibits clinical significance to practitioners and patients. Thorough and timely clinical observations, along with a willingness of nurses to call for help, are pivotal to survival of hospitalised patients. This project examined effects of modified early warning scoring system tool usage on patient mortality and failure to rescue events in hospitalised adult medical-surgical/telemetry patients as reported in the literature. DESIGN: A comprehensive review and evaluation of published peer-reviewed literature was conducted. METHODS: Electronic databases searched included PubMed, MEDLINE, CINAHL, Cochrane Library of systematic reviews and Agency for Healthcare Research and Quality through 2014. RESULTS: Eighteen articles were identified for review. Evidence ratings included 6% (1) Level I, 44% (8) Level IV, 6% (1) Level V, 33% (6) Level VI and 11% (2) Level VII. Six reported mortality predictive value and/or reduction, three measured impact on emergency calls, and four reported impact on mortality and rapid response team utilisation. CONCLUSION: While modified early warning scoring system tools have been widely adopted and are recommended for utility in detection of inpatients at-risk for clinical deterioration, limited high-level data and no clinical trials linking use of modified early warning scoring system tool usage to robust outcomes were found. Established criteria for validating modified early warning scoring system criteria, organisational-specific reliability testing and multi-site trials are recommended. RELEVANCE TO CLINICAL PRACTICE: Development of all-cause illness screening tools, including sepsis, is imperative. The clinical picture may be quantified with scoring tools to assist nurses' clinical decision-making, thus leading to improved outcomes and decreased incidence of failure to rescue. Clinical outcomes of interest should be measured and reported in peer-reviewed literature to disseminate the impact on clinical outcomes.