Bone Marrow Transplantation (2001) 27, 1197–1200  2001 Nature Publishing Group All rights reserved 0268–3369/01 $15.00 www.nature.com/bmt Nursing observations Monitoring vital signs in a bone marrow transplant unit: are they needed in the middle of the night? S Sharda 1,2 , J Carter 3 , JR Wingard 1,2,4 and P Mehta 1,2 University of Florida College of Medicine, Departments of 1 Pediatrics and 4 Internal Medicine and 2 Bone Marrow Transplant Program, and 3 University of Florida undergraduate program, University of Florida, Gainesville, FL, USA Summary: Monitoring vital signs (VS) is a routine procedure in bone marrow transplant (BMT) units, but such moni- toring 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 monitor- ing 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 monitor- ing 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 accu- rately identify day time risk factors that can predict the need for night time monitoring. Bone Marrow Transplan- tation (2001) 27, 1197–1200. Keywords: vital signs; sleep; sleep disturbances; moni- toring Monitoring vital signs (VS) is a routine procedure in any critical care unit, including bone marrow transplant (BMT) units. Ordinarily, vital signs are monitored every 4 h round the clock during a patient’s entire stay. Although giving valuable information about a patient’s current physiologic status, such monitoring interferes with sleep of patients in the unit. We hypothesized that patients may not require rou- tine middle of the night (MON) monitoring throughout their stay but rather may require round the clock monitoring only Correspondence: Dr P Mehta, University of Arkansas for Medical Sciences, Hematology/Oncology, 4301 West Markham Street, Slot #508, Little Rock, Arkansas 72205–9985, USA Received 1 July 2000; accepted 21 February 2001 during certain times. We therefore undertook this study to determine the utility of continuous VS monitoring in a transplant unit, to determine the utility of MON VS moni- toring and to ascertain whether VS monitoring could be restricted to certain times and days in particular patient populations. In order to do this, we evaluated the charts of all patients hospitalized within the previous 4 month period, evaluated all vital signs to determine when MON VS moni- toring led to a medical intervention and tested whether day time factors predicted MON interventions. Materials and methods Patients Twenty consecutive patients who underwent stem cell transplantation from August to November l998 made up the study population (Table 1). The 20 patients evaluated in the BMTU had a mean age of 47.4 years ranging from 20 to 67 years. Nine were females and 11 were males. Their underlying diagnoses were acute lymphoblastic leukemia (three), acute myelogenous leukemia (four), chronic myel- ogenous leukemia (one), chronic lymphocytic leukemia (one), mixed lineage leukemia (one), multiple myeloma (three), non-Hodgkin’s lymphoma (three) and breast cancer (two). Types of transplants were autologous (nine), matched related allogeneic (five) and matched unrelated donors (six), and type of stem cells used were peripheral blood (13) and bone marrow (seven) stem cells. Table 1 Patient characteristics Age 20 to 67 years (mean 47.4 years) Sex Females (9) Males (11) Race White (17) Hispanic (2) African-American (1) Diagnosis Leukemia (10) Lymphoma (5) Multiple Myeloma (3) Breast cancer (2) BMT type Matched related allogeneic (5) Matched unrelated donor (6) Autologous (9)