Abstract:
The management of sedation in critically ill patients is a complex issue for
Intensive Care Units (ICU) worldwide. Notable complications of sedation
practices have been identified and efforts to modify these practices in ICUs have
begun. While sedation-scoring tools have been introduced into clinical practice in
intensive care few have been tested for validity and reliability. One tool which has
reliability and validity established is the Sedation-Agitation Scale (SAS). This
study is an extension of a previous study by Riker, Picard and Fraser (1999) to
determine whether doctors and nurses rate patients similarly using the SAS in a
natural ICU setting. It is essential to establish whether these different
professionals provide consistent scores and have a mutual understanding of the
SAS and its constituent levels. This will help ensure that clinical decisions
relating to sedation-needs can be made appropriately and consistently. This
quasi-experimental reliability study was set in a 12-bed tertiary general ICU in
New Zealand. The SAS had recently been introduced into this unit and a
convenience sample of 42 nursing and medical staff performed paired ratings on
69 randomly selected adult ICU patients over an eight week time frame. The
mean patient age was 58 years, and 79% of patients were on continuous
infusions of Propofol. Intubated patients made up 91% of the sample. 74% of
patients were given the same SAS score by the doctor-nurse pair. The weighted
kappa score for inter-rater agreement was 0.82 indicating very good agreement.
Of the 26% of scores where there was a difference, the two readings were only
one score apart. Most of the difference occurred around SAS scores of 1-2 and
3-4. Further analysis found no staff or patient variables to be statistically
significant in impacting on the ratings. The SAS was found to be a reliable
sedation-scoring tool in a general ICU when used by nurses and doctors of
varying experience. The implementation of the SAS should improve the quality of
sedation management in critically ill patients, facilitate communication between
nurses and medical staff with regard to the effectiveness of sedation regimes,
and assist with the development of optimal sedation and analgesia guidelines for
ICU patients.
