Implementing the Richmond Agitation-Sedation Scale in a respiratory critical care unit: a best practice implementation project.

Jui-Yuan Su, C. Lockwood, Yi-Chen Tsou, P. Mu, Shu-Chen Liao, Wei-Chih Chen
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引用次数: 2

Abstract

INTRODUCTION Adequate sedation can lead to patient-ventilator synchrony, facilitation of treatment, and decreased physical and psychological discomfort for patients with respiratory failure in the intensive care unit (ICU). The Richmond Agitation-Sedation Scale (RASS) is considered to be the most appropriate tool in sedation assessment. OBJECTIVES This aim of this project was to implement evidence-based recommendations for sedation assessment using the RASS in mechanically ventilated patients in the ICU. METHODS This implementation project was conducted in an ICU at a tertiary medical center in Taiwan. Using the JBI Practical Application of Clinical Evidence System software, a baseline audit was conducted in the ICU, followed by an identification of barriers of RASS assessment and an implementation of management of strategies to improve the consistency of sedation assessment. RESULTS Results of the baseline audit showed that four of the six selected criteria had 0% compliance. Following the implementation of the strategies, which included education, visual management and development of a "RASS Reminder Card", there was an improvement in all the criteria audited, with each criterion achieving 83-100% of compliance. CONCLUSION The project successfully improved the implementation of RASS assessment in the respiratory ICU. Following the development and implementation of evidence-based resources, a high level of compliance was achieved for nurses using the RASS in the ICU to assess sedation in patients with a ventilator.
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在呼吸重症监护病房实施里士满激动镇静量表:最佳实践实施项目。
适当的镇静可导致重症监护病房(ICU)呼吸衰竭患者与呼吸机同步,促进治疗,减少身心不适。里士满激动镇静量表(RASS)被认为是最合适的镇静评估工具。目的:本项目旨在为ICU机械通气患者使用RASS进行镇静评估提供循证建议。方法本研究在台湾某三级医疗中心的ICU进行。采用JBI临床证据系统实际应用软件,对ICU进行基线审计,识别RASS评估的障碍,实施策略管理,提高镇静评估的一致性。结果基线审计结果显示,6个选定标准中有4个的符合性为0%。在实施包括教育、可视化管理和开发“RASS提醒卡”在内的战略之后,所有审计的标准都有所改善,每个标准的符合率达到83% -100%。结论本项目成功地促进了RASS评估在呼吸内科ICU的实施。随着循证资源的开发和实施,护士在ICU使用RASS评估呼吸机患者的镇静作用时达到了很高的依从性。
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