Original articleComparsion of Selected Sedation Scales for Reporting Opioid-Induced Sedation Assessment
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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Opioid-Induced Sedation and Respiratory Depression: Are Sedation Scales Enough to Prevent Adverse Drug Events Postoperatively?
2020, Pain Management NursingCitation Excerpt :The POSS has been found to be most commonly adopted as the scale of choice within the current literature; however, its reliability, although significant at α = .903, has only been tested in one study (Nisbet & Mooney-Cotter, 2009). The authors concluded that the POSS is a superior sedation scale and is recommended for the assessment of sedation in adult patients during opioid administration outside the critical care setting (Nisbet & Mooney-Cotter, 2009). The POSS was found to have the highest percentage of agreement with the correct scores and correct nursing actions taken compared with the RASS and ISS.
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