Monitoring vital signs in a bone marrow transplant unit: are they needed in the middle of the night?

Abstract

Monitoring vital signs (VS) is a routine procedure in bone marrow transplant (BMT) units, but such monitoring can interfere with sleep. We hypothesized that middle of the night (MON) monitoring may not be needed in all patients. Charts of 20 consecutive patients who underwent BMT were reviewed for MON monitoring to determine the frequency with which monitoring resulted in a nursing intervention, call to the physician or change in treatment by the physician. Charts were also reviewed for day time events, which could predict the need for monitoring at night. MON monitoring was done on 457 of the 543 nights evaluated, 148 nursing interventions were performed during these 457 nights (32%) of which only 20 (4%) were the result of monitoring VS. In five instances, the nurse called the physician as a result of monitoring VS and in three of these five instances, the treatment was changed. The only day time event that was significantly associated was fever (P = 0.0002). There was also a trend for CNS events (P = 0.057) to be associated with MON intervention. Larger, prospective studies need to be done to accurately identify day time risk factors that can predict the need for night time monitoring.