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Ramsay Sedation Scale and Richmond Agitation Sedation Scale

A Cross-sectional Study

Rasheed, Akram M., MSN, RN; Amirah, Mohammad F., MSN, RN; Abdallah, Mohammad, PharmD; P.J., Parameaswari, PhD; Issa, Marwan, MSN, RN; Alharthy, Abdulrhman, MD, PhD

Dimensions of Critical Care Nursing: March/April 2019 - Volume 38 - Issue 2 - p 90–95
doi: 10.1097/DCC.0000000000000346
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Background Many sedation scales and tools have been developed and compared for validity in critically ill patients. However, selection and use of sedation scales vary among intensive care units.

Objective The aim of this study is to compare the reliability of 2 sedation scales—Ramsay Sedation Scale and Richmond Agitation-Sedation Scale (RASS)—in the adult intensive care unit.

Method Four hundred twenty-five patients were recruited in the study. Informed consent had been obtained from each patient guardian/relative. However, only 290 patients (68.24%) completed the study and were independently assessed for sedation effect by investigator and bedside nurses simultaneously using Ramsay scale and RASS.

Results Agreement between the nurse and investigator scores on Ramsay scale (weighted κ = 0.449, P < .001) indicated weak level of agreement. Agreement between the nurse and investigator on RASS (weighted κ = 0.879, P < .001) indicated a strong level of agreement. Cronbach α analysis showed that 10 items of RASS had an excellent level of internal consistency (α = .989) compared with good level of internal consistency of Ramsay scale (α = .828).

Discussion Richmond Agitation-Sedation Scale showed excellent interrater agreement compared with weak interrater agreement of Ramsay scale. The results also support that RASS has consistent agreement with clinical observation and practice among different observers. The results suggest that use of RASS is linked to a more reliable assessment of sedation levels in the intensive care unit.

Akram M. Rasheed, MSN, RN, is part of the Nursing Education & Development Committee at the Critical Care Department in King Saud Medical City, Riyadh, Saudi Arabia.

Mohammad F. Amirah, MSN, RN, is part of the Nursing Education & Development Committee at the Critical Care Department in King Saud Medical City, Riyadh, Saudi Arabia.

Mohammad Abdallah, PharmD, is currently employed at the Pharmaceutical Care Services in King Saud Medical City, Riyadh, Saudi Arabia.

Parameaswari P.J., PhD, is a biostatistician at the research center in King Saud Medical City, Riyadh, Saudi Arabia.

Marwan Issa, MSN, RN, is part of the Nursing Education & Development Committee at the Critical Care Department in King Saud Medical City, Riyadh, Saudi Arabia.

Abdulrhman Alharthy, MD, PhD, is an intensives MD consultant at the Critical Care Department in King Saud Medical City, Riyadh, Saudi Arabia.

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Address correspondence and reprint requests to: Akram M. Rasheed, MSN, RN, Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia (arasheed@ksmc.med.sa).

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