Nursing implementation of a validated agitation and sedation scale: An evaluation of its outcomes on ventilator days and ICU length of stay

Background: Intensive Care Units (ICU) often initiate mechanical ventilation (MV) in conjunction with sedation for patients who cannot maintain adequate oxygenation or ventilation on their own. Continuous use of sedation increases the likelihood of negative events associated with ventilators such as ventilator-associated pneumonia while, at the same time, continuing to increase the length of MV. OBJECTIVES: This study sought to analyze the effects of implementing a mandated Richmond Agitation and Sedation Scale (RASS) entry with each sedative scan on a unit where no parameters were in place to monitor sedation levels. Methods: This was a retrospective cross-sectional study which included chart-review of a Medical ICU. The data was gathered on ventilator days and sedation use for patients prior to and after the implementation of the RASS. Results: A median weighted analysis and Mann-Whitney U test of 138 pre-RASS ventilator patients and 86 post-RASS ventilator patients appears to indicate that implementation of the RASS resulted in a 31% decrease of ventilator days (p = .0002). The pulmonary diagnosis subgroup showed a significant 39% reduction in ICU length of stay (U = 324, p = .042). Conclusions: The results of this study lead to the conclusion that the implementation of the mandated RASS score entry limits over-sedation of ventilated patients, thereby reducing the number of MV days in the ICU. Sufficient evidence suggests that the mandated RASS entry also reduces the length of stay in the ICU