Victoria- the sign tool is an excellent idea- similar to other efforts (falls risk, fluid restriction, no bp's for fistula etc)
wondering if access to- would include changes in the order set that allow physicians to order "no nighttime vitals". other things might be educational tools for nursing/hospitalists on the type of patients that might be able to benefit from not checking vitals (and vice versa- those patients who shouldn't have this policy).
access removed- another one may be the ability for nurses to "check in" on the patient physically. the q4 vitals policy allowed nurses to periodically see and check in on the pt and this behavior would be lost at night with your intervention