Role of Ramsay Sedation Scale in Sedative Dosage Modulation for Critically-Ill Intubated Patients

SESSION TITLE: ICU Management SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Titratable palliative sedation (TPS) is frequently applied in sedative therapeutics to ameliorate unendurable and refractory distress via reduction in patient consciousness. TPS may be adjusted based on objective and subjective data: vitals, labs, Ramsay Sedation Scale (RSS) and Richmond Agitation Sedation Scale (RASS). Inappropriate dosing, including oversedation from variability in clinician assessment of sedation scales, can contribute to significant negative clinicaloutcomes. We evaluated interrater reliability (IRR) and its relationship to variations in dosing to determine whether additional training in sedation scale assessment is necessary at our community institution. METHODS: This was a prospective study assessing sedation in ICU mechanically ventilated patients without neurogenic abnormalities. Non-nursing healthcare personnel conducted independent sedation assessments using the RSS and compared their evaluations to those documented by nursing staff. Data obtained from the patients' chart included: demographics, Ramsay Score, past medical history, diagnosis, and BMI. Post-analysis, non-nursing healthcare personnel scores were classified into three categories: equal to, higher than, or lower than those charted by nursing staff. RESULTS: There were 83 random RSS assessments conducted in 44 patients with a mean age of 63.6 +/- 10.09 years (range 38-82) and a mean BMI of 31.2 +/- 12.4 (range 15-77). 19/42 (45%) patients had a diagnosis of respiratory failure or pneumonia. Other diagnoses included CHF (3), seizures (5), AVR (1), SBO (1), drug overdose (2), cardiac arrest (2), and UTI (1), STEMI (2), PE (2), CABG (1), SEPSIS (1), hemoptysis (1), AMS (1). Non-nursing healthcare professionals' assessments were compared to nurses' and observed to be equal in 29%, higher in 59%, and lower in 12% of the cases. Of the 83 assessments, the average RSS score non-nursing healthcare professionals assigned was 4.8 +/- 1.6 while the nurses' charted average was3.39 +/- 0.97; a mean difference of 1.45, 95% CI (1.04 - 1.85)p< 0.0001. CONCLUSIONS: Our data demonstrated equal RSS ratings in only 29% of cases for non-nursing healthcare personnel and nurses’ evaluations. Without proper education the RSS may not be a reliable tool for sedation assessments, and may result in oversedation of critically ill patients. CLINICAL IMPLICATIONS: Recurrent nursing education is warranted to ensure proper use and optimization of the RSS. DISCLOSURE: The following authors have nothing to disclose: harmeet deol, Francis Dimtri, Arash Minaie, Salim Surani, George Udeani No Product/Research Disclosure Information