Doctors’ and Nurses’ Perceptions on the Use of Richmond Agitation-Sedation Scale (RASS) for Sedation Management in a Neurosurgical Intensive Care Unit

Doctors’ and Nurses’ Perceptions on the Use of Richmond Agitation-Sedation Scale (RASS) for Sedation Management in a Neurosurgical Intensive Care Unit

Wu WM(1), Wan PK(1), Boo MS(1) 

(1)Department of Neurosurgery, Queen Mary Hospital

Introduction: 

By using a validated sedation assessment scale for sedation monitoring and drug titration to achieve a predefined sedation score target was believed to enhance communication and unify sedation practices among members of the healthcare team, facilitate the control over sedation administration, improve patient outcomes, and reduce treatment costs. The Neurosurgical Intensive Care Unit of Queen Mary Hospital (NS ICU) has adopted the use of Richmond Agitation-Sedation Scale (RASS) with prescription of target RASS score for sedation management since December 2017.

Objectives: 

This study investigates the doctors’ and nurses’ perceptions on the use of RASS for sedation management in NS ICU in order to reveal whether the practice can achieve its potential effects and benefits mentioned above or not and also to identify any barriers impairing its compliance.

Methodology: 

A questionnaire adopted from a previous Belgian study was distributed to the doctors and nurses in NS ICU in September 2018 using convenience sampling. It consists of 17 items in the form of a six-point Likert scale which assesses the common perceptions on the effects and uses of sedation scales.

Results: 

Response rate was 90% (37/41 participants). High agreement was shown on most stated potential benefits of using RASS for sedation management, including: better communication (100%), consistent sedation practice (97%), aid in monitoring sedation prescription (94%) and sedation administration (100%), higher control over sedation prescription (72%) and sedation administration (83%), and enhancement in patient outcomes (100%). The agreement on the effect of the practice on cost control was relatively low (53%). The only barrier to the practice compliance which could be identified was limited motivation for change. 57% of doctors and 32% of nurses thought that they could measure the level of sedation without using RASS. Overall there was no significant difference between doctors’ and nurses’ perceptions on the practice (p-values ranging from 0.133 to 0.79).

Conclusion: 

Using RASS with prescription of target RASS score for sedation management can generally achieve its potential benefits. No obvious barriers to its compliance other than limited motivation for change were identified. Measures aiming at improving the motivation should be considered.