Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Wong KW(1), Fung SS(1), Wan HYS(1), Wong LY(1)
Affiliation :
(1)Department of Cardiothoracic Surgery, Queen Mary Hospital
Introduction :
The majority of critically ill patients experience significant physiological and psychological distress during their Cardiothoracic Surgical Intensive Care Unit(CTSICU) stay. Achieving an optimal balance of sedation and analgesic is always essential but challenging. Purposeful sedation management by a structured clinical scoring system is advocated to guide treatment goals, reducing the iatrogenic complications as well as the ICU length of stay. The Richmond Agitation-Sedation Scale(RASS) is one of the recommended objective tools to determine ICU patients' consciousness and agitation level. It has demonstrated superiority in ease of application, logical scoring system, excellent reliability and validity in multiple studies. To improve the overall patient journey and outcome, our surgeon, anesthesiologist and nursing team have reached a consensus on translating RASS into clinical practice. Thus, an enhancement program was conducted between October and December 2023 to fulfill the service need.
Objectives :
1. Disseminate the utility and framework of RASS to our CTSICU nurses. 2. Foster the skills, precision and confidence of our CTSICU nurses in performing RASS in practice.
Methodology :
The enhancement program comprises both didactic and practical sessions. The didactic session aimed at theoretical acquisition via the modality of self-studying a 20-minute pre-recorded video with contents focusing on indications of sedation scale, the RASS procedures, scoring criteria and limitations. For the practical session, participants were invited to review six validated scenarios and performed the independent RASS ratings with the aid of scoring criteria and procedural reference. RASS scores obtained from practical sessions were collected for program evaluation. A post-program feedback survey was also conducted to assess the program effectiveness qualitatively.
Result & Outcome :
By the end of December 2023, 42 out of 51(82.3%) of our frontline nurses completed both the didactic and practical sessions. Results from practical session revealed that the participants can perform RASS independently and accurately with the aid of a procedural guide as evidenced by the strong association between the participant and the acknowledged RASS scores for all six scenarios(five out of six scenarios were 100% matched while 97.6% matching for the remaining scenario). According to the post-program feedback survey, 97.6% of participants strongly agreed that they gained a thorough understanding of the RASS procedures and 95.2% expressed confidence in performing RASS in future clinical practice. Participants also agreed that RASS is an effective tool to reinforce communication accuracy between healthcare providers. Conclusion: The efficacy of this program was proven with the positive feedback by both the quantitative and qualitative criteria. On the way forward, our team will monitor the compliance of RASS in clinical practice and institute an organized sedation protocol using the RASS.
