Objective: The level of sedation in mechanically ventilated patients is most often assessed with the Ramsay Scale. Its reliability, however, has never been evaluated in a large group of professionals using the Ramsay Scale in daily clinical practice, while differences in interpretations among professionals have been indicated. We developed a written stepwise instruction to optimize the inter-observer reliability of the Ramsay Scale within a large group of Intensive Care (IC) nurses. Design: Reliability study. Setting: The Intensive Care Cardiology (ICC) and the Intensive Care Thoracic surgery (ICT) units of a university hospital. Patients and participants: The study population comprises randomly selected mechanically ventilated patients and IC nurses with a bachelor's degree in Nursing and an IC certification. In total 2x105 Ramsay measures were performed in 45 patients by 24 nurses. Measurement and results: Analysis of 105 paired Ramsay scores showed an almost perfect agreement between observers (weighted K (Kw) = 0.90). In both ICC patients and ICT patients, agreement between Ramsay scores was high (Kw= 0.95 and Kw= 0.86, respectively). Conclusion: By using a written stepwise instruction with the Ramsay Scale, the inter-observer reliability of the level of sedation measurements, performed in daily clinical practice within a large team of IC nurses, proved to be almost perfect.

Intensive care, Ramsay scale, Reliability, Sedation
dx.doi.org/10.1016/j.ejcnurse.2008.10.004, hdl.handle.net/1765/24341
European Journal of Cardiovascular Nursing
Erasmus MC: University Medical Center Rotterdam

van Dishoeck, A.M, van der Hooft, T, Simoons, M.L, van der Ent, M, & Scholte op Reimer, W.J.M. (2009). Reliable assessment of sedation level in routine clinical practice by adding an instruction to the Ramsay Scale. European Journal of Cardiovascular Nursing, 8(2), 125–128. doi:10.1016/j.ejcnurse.2008.10.004