title: Reliable assessment of sedation level in routine clinical practice by adding an instruction to the Ramsay Scale.
abstract: 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.
  
  
  METHODS
  Reliability study.
  
  
  METHODS
  The Intensive Care Cardiology (ICC) and the Intensive Care Thoracic surgery (ICT) units of a university hospital.
  
  
  METHODS
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands. a.m.vandishoeck@erasmusmc.nl
authors.forename: Anne-Margreet
authors.initials: AM
authors.lastname: van Dishoeck
authors.forename: Truus
authors.initials: T
authors.lastname: van der Hooft
authors.forename: Maarten L
authors.initials: ML
authors.lastname: Simoons
authors.forename: Martin
authors.initials: M
authors.lastname: van der Ent
authors.forename: Wilma J M
authors.initials: WJ
authors.lastname: Scholte op Reimer
mesh_terms: D000368:Aged; D016292:Procedural Sedation / Q000451:nursing* / Q000592:standards* / Q000706:statistics & numerical data; D003422:Critical Care; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment / Q000592:standards / Q000706:statistics & numerical data; D015588:Observer Variation; D015203:Reproducibility of Results; D012121:Respiration, Artificial / Q000451:nursing*; D013041:Specialties, Nursing / Q000379:methods*