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Reliable assessment of sedation level in routine clinical practice by adding an instruction to the Ramsay Scale
Anne-Margreet van Dishoeck1, Truus van der Hooft, Maarten L Simoons
1Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands. a.m.vandishoeck@erasmusmc.nl
Objective:
The level of sedation in mechanically ventilated patients is most often assessed with the Ramsay Scale. Its reliability, however, has never been evaluated in a large group of professionals using the Ramsay Scale in daily clinical practice, while differences in interpretations among professionals have been indicated. We developed a written stepwise instruction to optimize the inter-observer reliability of the Ramsay Scale within a large group of Intensive Care (IC) nurses.
Design:
Reliability study.
Setting:
The Intensive Care Cardiology (ICC) and the Intensive Care Thoracic surgery (ICT) units of a university hospital.
Patients And Participants:
The study population comprises randomly selected mechanically ventilated patients and IC nurses with a bachelor's degree in Nursing and an IC certification. In total 2x105 Ramsay measures were performed in 45 patients by 24 nurses.
Measurement And Results:
Analysis of 105 paired Ramsay scores showed an almost perfect agreement between observers (weighted K (Kw)=0.90). In both ICC patients and ICT patients, agreement between Ramsay scores was high (Kw=0.95 and Kw=0.86, respectively).
Conclusion:
By using a written stepwise instruction with the Ramsay Scale, the inter-observer reliability of the level of sedation measurements, performed in daily clinical practice within a large team of IC nurses, proved to be almost perfect.
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