Authors (including presenting author) :
Siy MY(1), Kong LH(1), Tang KB(1), Chan SKD(1), Kwan E(1), So HM(1), Li SC(1), Yan WW(1)
Affiliation :
(1)Intensive Care Unit/High Dependent Unit, Pamela Youde Nethersole Eastern Hospital
Introduction :
The use of sedation is common in intensive care unit (ICU) for reducing patients’ anxiety and agitation. Over-sedation can lead to complications such as prolong intubation while under-sedation causes unnecessary anxiety leading to self-extubation. Therefore, appropriate sedation is important to ensure patient comfort without limiting patient’s effort to wean off mechanical ventilation. Timely titration of sedation depends on the accurate assessment of patient status with a widely accepted and validated assessment tool. This project aimed to introduce RASS to our unit for assessing patient’s sedation level and guiding the titration of sedation.
Objectives :
1. To empower ICU nurses the necessary skills and knowledge to assess patients’ sedation level by adopting RASS 2. To facilitate frontline staff to adopt RASS in daily practice
Methodology :
This project classified into 3 phases (training on 4/2016, implementation on 2/2017, evaluation on 5/2018) A comprehensive training program was designed in phase 1 to orientate all ICU nurses and doctors on implementation of RASS. An interactive mode of teaching including a mini-lecture, tailor made video was adopted for theoretical input. RASS was implemented to all sedated patients. Project team facilitated nurses on using RASS in phase 2. For evaluation, all ICU nurses were assigned in a designed group to return demonstration on performing RASS assessment under supervision. A checklist was formulated to evaluate the performance. Constructive feedback was provided instantly to uphold standards. Participants were reinforced the skills on performing RASS if large discrepancy was identify.
Result & Outcome :
Results: RASS training were received by all ICU nurses and doctors. Quantity feedback were collected from frontline. Most of them commented supportive and encouraging in phase 2. While the education materials were adequate and nearly 87% expressed they were confident to use RASS after the training. And the rest of the comments expressed more time is required to familiarize with the scale. Around 70% of them felt RASS could help to titrate the sedation and 63% thought it could reflect the actual sedation level of patients. Others thought RASS were unable to reflect the whole presentation of sedated patients due to its existed limitations. In phase 3, over 95% of nurses were able to assess patients’ sedation states accurately by RASS and 100% of them were able to use RASS as a tool to titrate sedation concentration according to doctor prescribed target range. Conclusions: By, adopting titration of sedation is crucially important to promote patient comfort and prevent prolonged intubation and hospitalization.
Co-location with:
