A Retrospective Study to Describe the use of the Richmond Agitation Sedation Scale (RASS) for Assessing Sedation in the Traumatic Brain Injured Patient

Persistent Link:
http://hdl.handle.net/10150/293450
Title:
A Retrospective Study to Describe the use of the Richmond Agitation Sedation Scale (RASS) for Assessing Sedation in the Traumatic Brain Injured Patient
Author:
Jullette-Fantigrassi, Andrea
Issue Date:
2013
Publisher:
The University of Arizona.
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Abstract:
Background: Traumatic brain injury (TBI) patients are often sedated, yet sedation assessment scales have not been thoroughly studied in this population. This project inquiry describes the use of the Richmond Agitation Sedation Scale (RASS) in assessing sedation in TBI patients. Methods: A retrospective, descriptive analysis of 38 ventilated, sedated TBI patients was performed to describe 1) the characteristics of the study TBI population, 2) the use of the RASS to guide titration of sedation medication, and 3) the nursing perspective of a sedation titration protocol that includes the use of the RASS. Results: Prescribed RASS score for the study population was -2; the actual RASS score was -2.04 +/-1.05. The days spent on mechanical ventilation were 3.46 +/- 1.95. The Injury Severity Score (ISS) correlated with sedation titration (r = -0.373; p<.05). The ICD-9 code also correlated with the RASS (r = -0.400; p<0.05). There was no correlation between RASS and sedation titration (r = -0.061; p = 0.717). The majority of nurses perceived that when using the RASS, sedation level did not affect their feeling of accuracy of neurological assessment (56%), and the patient's agitation level did not affect their feeling of accurate neurological assessment (58%). Conclusion: While the degree of injury was associated with the ability of the TBI patient to maintain the prescribed RASS level, there was no association between the RASS score and sedation titration, indicating that in this small study, the RASS did not guide sedation titration in the TBI population. However, the time spent at the prescribed RASS level and days of mechanical ventilation, which was similar to reported norms, suggest that the RASS is an adequate tool for assessing sedation in the TBI population. From the nursing perspective, the use of the RASS was not a barrier in assessing sedation titration. To our knowledge, this is the first study to describe the use of RASS for assessment of sedation in TBI patients. Additional prospective studies are necessary to fully understand the ability of the RASS to guide sedation titration.
Type:
text; Electronic Dissertation
Keywords:
traumatic brain injury; Nursing; Richmond Agitation Sedation Scale
Degree Name:
D.N.P.
Degree Level:
doctoral
Degree Program:
Graduate College; Nursing
Degree Grantor:
University of Arizona
Advisor:
Ritter, Leslie

Full metadata record

DC FieldValue Language
dc.language.isoenen_US
dc.titleA Retrospective Study to Describe the use of the Richmond Agitation Sedation Scale (RASS) for Assessing Sedation in the Traumatic Brain Injured Patienten_US
dc.creatorJullette-Fantigrassi, Andreaen_US
dc.contributor.authorJullette-Fantigrassi, Andreaen_US
dc.date.issued2013-
dc.publisherThe University of Arizona.en_US
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.abstractBackground: Traumatic brain injury (TBI) patients are often sedated, yet sedation assessment scales have not been thoroughly studied in this population. This project inquiry describes the use of the Richmond Agitation Sedation Scale (RASS) in assessing sedation in TBI patients. Methods: A retrospective, descriptive analysis of 38 ventilated, sedated TBI patients was performed to describe 1) the characteristics of the study TBI population, 2) the use of the RASS to guide titration of sedation medication, and 3) the nursing perspective of a sedation titration protocol that includes the use of the RASS. Results: Prescribed RASS score for the study population was -2; the actual RASS score was -2.04 +/-1.05. The days spent on mechanical ventilation were 3.46 +/- 1.95. The Injury Severity Score (ISS) correlated with sedation titration (r = -0.373; p<.05). The ICD-9 code also correlated with the RASS (r = -0.400; p<0.05). There was no correlation between RASS and sedation titration (r = -0.061; p = 0.717). The majority of nurses perceived that when using the RASS, sedation level did not affect their feeling of accuracy of neurological assessment (56%), and the patient's agitation level did not affect their feeling of accurate neurological assessment (58%). Conclusion: While the degree of injury was associated with the ability of the TBI patient to maintain the prescribed RASS level, there was no association between the RASS score and sedation titration, indicating that in this small study, the RASS did not guide sedation titration in the TBI population. However, the time spent at the prescribed RASS level and days of mechanical ventilation, which was similar to reported norms, suggest that the RASS is an adequate tool for assessing sedation in the TBI population. From the nursing perspective, the use of the RASS was not a barrier in assessing sedation titration. To our knowledge, this is the first study to describe the use of RASS for assessment of sedation in TBI patients. Additional prospective studies are necessary to fully understand the ability of the RASS to guide sedation titration.en_US
dc.typetexten_US
dc.typeElectronic Dissertationen_US
dc.subjecttraumatic brain injuryen_US
dc.subjectNursingen_US
dc.subjectRichmond Agitation Sedation Scaleen_US
thesis.degree.nameD.N.P.en_US
thesis.degree.leveldoctoralen_US
thesis.degree.disciplineGraduate Collegeen_US
thesis.degree.disciplineNursingen_US
thesis.degree.grantorUniversity of Arizonaen_US
dc.contributor.advisorRitter, Leslieen_US
dc.contributor.committeememberRigney, Ted S.en_US
dc.contributor.committeememberGallek, Matthew J.en_US
dc.contributor.committeememberRitter, Leslieen_US
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