Improving Nursing Assessment Using the Richmond Agitation Sedation Scale (RASS)

Background 
Delirium is a significant problem found in critically ill patients; a form of acute brain dysfunction with prevalence ranging from 60-80% of mechanically ventilated patients and 20–50% of non-ventilated patients in the Intensive Care Unit (ICU) (Ely et al., 2001; Krewulaket al., 2018, Vasilevskis et al., 2018). Nursing practice has the greatest impact on medications and use of assessment tools related to Pain, Agitation, Sedation, Delirium, Immobility and Sleep (PADIS) (Waterfield & Barnason, 2020).

Local Problem 
At the care site, there is a lack of in person education about delirium for novice nurses and no opportunity to practice use of assessment tools.

Methods 
This was a Quality Improvement (QI) project focused on the Richmond Agitation Sedation Scale (RASS) as a foundational element of delirium assessment, using multimodal education intervention. Novice critical care nurses (NCCN) attended “Back to Basics” (BTB); an overview of delirium, opportunity to practice assessment skills, utilizing a pre and post test. Following education, nurses were validated using the RASS.

Results
Pre/post test revealed no significant change, indicating students had a high degree of knowledge prior to attending.
Prior to education RASS accuracy was assessed at 40%; post education accuracy was 100%.

Discussion
Accuracy using the RASS has significant implications. There is a need for ongoing QI efforts related to delirium, including practice using assessment tools.

Conclusions
This project will serve as a foundation for future training and skills validation of NCCN. Recommendations include the development of standardized onboarding education including delirium assessment tools.