Reliable assessment of sedation level in routine clinical practice by adding an instruction to the Ramsay Scale.
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.
van Dishoeck
Anne-Margreet
AM
Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands. a.m.vandishoeck@erasmusmc.nl
van der Hooft
Truus
T
Simoons
Maarten L
ML
van der Ent
Martin
M
Scholte op Reimer
Wilma J M
WJ
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*