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

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.