Improving Knowledge of RASS Assessment in Air Medical Transport

Abstract

Purpose: Does implementing an educational module for medical flight staff regarding the Richmond Agitation and Sedation Scale improve knowledge, comfort, and intent to change current practice of assessing sedation in mechanically ventilated patients?Background: Oversedation in mechanically ventilated patients is associated with increased incidences of delirium, longer hospital length of stays, more ventilator-dependent days, and higher morbidity and mortality. Oversedation in this patient population can occur in up to 88% of air medical transport. The Richmond Agitation and Sedation Scale is a standardized, valid, and reliable assessment tool that can be used to assess sedation levels in mechanically ventilated patients. Methods: Participants were flight registered nurses and paramedics at a fixed-wing flight transport company. Participants were recruited via e-mail and invited to view an educational PowerPoint about oversedation, the Richmond Agitation Sedation Scale, and its use in assessing sedation in mechanically ventilated patients. Qualitative and quantitative data was collected via an 11-question post-education survey. Participants rated their pre- and post-education knowledge of RASS, confidence in using it in practice, and intent to change current practice. Current assessment practices and participant opinions of sedation in flight medicine were evaluated via open-text response. Demographic data, including role, years of practice, and years in flight medicine, were also collected. Descriptive statistics were used to analyze collected data. Results: A total of 13 participants completed the education and post-survey. Participants reported using widely varying assessment findings to assess sedation levels in mechanically ventilated patients. Participants reported improved knowledge of the Richmond Agitation and Sedation Scale and confidence in using it in practice following the education. The majority reported they were likely to change their current assessment practices following the education. Conclusions: Flight nurses and paramedics have varying degrees of knowledge and confidence regarding the use of RASS to assess sedation in mechanically ventilated patients. Assessment of sedation widely varies without formal Richmond Agitation and Sedation Scale education. An educational intervention improved flight staff knowledge, confidence, and intent to change their current sedation assessment practice.