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

Abstract

Summary: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, l48 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. Bone Marrow Transplantation (2001) 27, 1197-1200.

Sleep Disruption in Hematopoietic Cell Transplantation Recipients: Prevalence, Severity, and Clinical Management

“…Environmental interventions to improve sleep among inpatients may be more effective than patient-based interventions (e.g., minimizing of nighttime vital signs monitoring). A study conducted by Sharda and colleagues suggests that the vital sign monitoring might not be necessary for HCT patients with low-risk profiles (i.e., lack of daytime fever and CNS complaints) and may lead to improved sleep and health (73). In contrast, use of an hypnotic (zolpidem) has been associated with increased inpatient falls (74).…”

Ineffectiveness of the measurement of ‘routine’ vital signs for adult inpatients with community‐acquired pneumonia

“…In a study conducted at the University of Florida, Sharda et al. reviewed the effects of monitoring vital signs in a bone marrow transplant unit and concluded that, although frequent vital sign monitoring is presumed to be required for the safe management of transplant patients, the benefits thereof did not outweigh the detriments of sleep deprivation 15 . Specifically, sleep promotes growth hormone production, 16 which improves healing, 17 whereas sleep deprivation interferes with the immune system, 18–20 glucose metabolism, 21 cortisol and catecholamine levels 22–24 and decreases pain tolerance 25,26 .…”

Ineffectiveness of Measuring Routine Vital Signs in Adult Inpatients With Deep Venous Thrombosis

“…Sharda and associates reviewed the effects of monitoring of vital signs in a bone marrow transplant unit and concluded that although frequent vital sign monitoring is presumed to be required for the safe treatment of transplant patients, the benefits thereof did not outweigh the detriments of sleep deprivation (11). Specifically, sleep promotes increases growth hormone production (12), which improves healing (13), whereas sleep deprivation interferes with the functioning of the immune system (14-16); glucose metabolism (17); cortisol and catecholamine (18)(19)(20) levels; and decreases pain tolerance (21,22).…”