Elsevier

Pain Management Nursing

Volume 10, Issue 3, September 2009, Pages 154-164
Pain Management Nursing

Original article
Comparsion of Selected Sedation Scales for Reporting Opioid-Induced Sedation Assessment

https://doi.org/10.1016/j.pmn.2009.03.001Get rights and content

Abstract

A descriptive survey-based study was undertaken to test the validity and reliability of three scales that are used to assess sedation during opioid administration for pain management: the Inova Health System Sedation Scale (ISS), the Richmond Agitation and Sedation Scale (RASS), and the Pasero Opioid-Induced Sedation Scale (POSS). The study was conducted in a large (830 beds) suburban level I trauma hospital with a random convenience sample of 96 medical-surgical nurses. The study reports: measures of reliability and validity of each scale and significant findings related to correct nursing score and selected actions; nurses' ratings of each scale in terms of combined ease of use; information provided by the scale to inform clinical decisions; and nursing confidence measures. Both the RASS and the POSS demonstrated adequate measures of reliability and validity for measurement of sedation during opioid administration for pain management. However, the POSS scored higher in combined measures of ease of use, nursing confidence, and usefulness of information provided to make clinical decisions. The POSS also yielded the highest percentage agreement with the correct score and correct nursing actions chosen by the nurse among the three scales tested. Study results have clinical significance for accuracy of clinical assessments and subsequent actions on behalf of patients experiencing advancing sedation during opioid analgesia. The POSS can be recommended as a superior sedation scale for the measurement of sedation during opioid administration for pain management.

Section snippets

Nurse Assessment of Sedation Using a Sedation Scale

The observation that increased sedation always precedes respiratory depression indicates that nurses can play a major role in preventing life-threatening respiratory depression through systematic sedation assessments that lead to appropriate decision making during opioid administration (Pasero 2009, Pasero et al 2007, Pasero and McCaffery 2002, Pasero et al 1999, Smith 2007, Szalados and Boysen 1998). Sedation assessment is convenient, easy, and inexpensive. The use of a simple readily

Study Aims and Methods

The present research study was designed to report measures of reliability and validity of three sedation scales currently used to measure sedation as an outcome of opioid administration for pain management in noncritical care settings: the Inova Health System Acute Care Sedation Scale (ISS), the RASS, and the POSS. Reliability and validity had not been previously established for any of these scales in the noncritical care setting. The following research questions were addressed by the study:

Measures of Reliability and Validity

The panel of experts was able to establish content validity for both the RASS and the POSS. Comments from members indicated that there was not enough discrimination between scale items on the ISS to adequately establish advancing sedation. Consequently, validity was not established for the ISS. Initial data analysis measuring reliability using Cronbach alpha was performed on the study tool (18 items) and on each sedation measurement tool's subscale (4 items), which was made up of the items

Limitations

The study design did not allow for measures of inter-rater reliability, which are useful in making comparisons regarding the performance each of the scales between respondents. This study made comparisons between scales within groups (paired-sample t tests). It is noted that inter-rater reliability may have assisted in further describing accurate reliability of the ISS in this sample, who were already very familiar with that scale. Inter-rater reliability may additionally assist in further

Summary Recommendations

Sedation is an anticipated outcome of opioid analgesia, influenced by a variety of interacting factors, and is a known predictor of clinically significant respiratory depression. It occurs on a continuum that is both unknowable and unpredictable before its actual unfolding and, therefore, must be serially measured as accurately as possible. The use of a sedation scale that is valid, reliable, and easy to use, so that changes in the patient's condition can be clearly communicated and universally

Acknowledgements

The authors acknowledge the invaluable assistance of the Acute Pain Management Nurses at Inova Fairfax Hospital in collecting data and daily championing excellence and safety in pain management and the work of the Inova Health System Pain Quality Committee and the Inova Fairfax Hospital Nursing Research Committee in helping us to establish evidence-based postopioid sedation assessment across our hospital system. The also recognize the contributions of Dr. Jean Moore, PhD, RN, for assistance in

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