What is the Richmond Agitation Sedation Scale (RASS)?
, or the RASS Scale for short, was developed to assess hospitalized patients with critical illnesses or injuries, but primarily for mechanically ventilated patients. The scale assesses them in terms of how agitated or sedated they are while undergoing treatment in an emergency room or intensive care unit.
It considers factors such as the patient being anxious, if they fight off healthcare professionals trying to put ventilators on them, if their eyes keep opening or moving during treatment, their verbal responsiveness, and their motor responsiveness.
The RASS Scale is scored between -5 to +4. The negative values are for measuring sedation, while the positive values are for rating agitation.
This particular scale is relatively easy to use because it has a set scoring system with specific designations. The only thing that healthcare professionals need to do to accomplish this assessment is make careful observations of their patients as they are undergoing treatment, and then assign the scores accordingly.
What healthcare professionals need to aim for when using this scale is to get to the point where the patient will score between -2 to +1, which means they are properly sedated, though this will depend on the sedation protocols for the kind of illness or injury they are treating.
How to use the Richmond Agitation Sedation Scale (RASS)
As mentioned earlier, healthcare professionals will have to observe the patient while undergoing treatment in an emergency room or intensive care unit.
To properly assign specific scores to the patient, the professional using the RASS Scale needs to answer the following questions:
- While they are being treated, is the patient alert? Are they calm? Are they exhibiting any signs of being restless or agitated? Depending on what you notice, this may score anywhere between +1 to +4
- If they are not alert, they are likely to be sedated. If that’s the case, try saying your patient’s name in a loud speaking voice. Direct them to open their eyes and look at you. If they are still unresponsive the first time around, you may choose to repeat this once or twice. If they do respond, you may also tell them to continue looking at you as you talk to them. Depending on what you notice, this may score anywhere between -1 and -3.
- If they don’t respond to your voice at all, they are likely to be deeply sedated. What you need to do is to shake them by the shoulder. If they don’t respond to that, rub their sternum. They will either get a score of -4 or -5, depending on if they respond to being physically nudged or if they don’t respond at all.
How do you score the Richmond Agitation Sedation Scale (RASS)?
The Richmond Agitation Sedation Scale (RASS) is easy to score because you simply need to select one score based on your observations. Here are the choices that you can select from:
- +4 means that they are combative, violent, and a danger to you and the rest of the staff.
- +3 means that they are very agitated, aggressive, and they try to pull or remove tubes or catheters.
- +2 means that they are agitated. They frequently exhibit non-purposeful movement and even tries to fight off a ventilator.
- +1 means that they are restless. They are anxious, but they are not aggressive.
- 0 means they are alert and calm.
- -1 means they are drowsy. They aren’t fully alert, but they are awake and can open and move their eyes when talked to for 10 or more seconds.
- -2 means they are lightly sedated. They are briefly awake when nudged via speech and can make eye contact, but for less than 10 seconds.
- -3 means they are moderately sedated. They exhibit some movement and can open their eyes but can’t make eye contact.
- -4 means they are deeply sedated. They don’t respond to voices but move a bit or open their eyes when physically nudged.
- -5 means they are unarousable. They don’t respond at all to voices or being physically nudged.
After you have assigned a score to your patient, the next steps would be for you and your team to determine what adjustments to make to keep your patient properly sedated as needed by their specific treatment. If they are already adequately sedated, then continue with your treatment as planned.
Richmond Agitation Sedation Scale (RASS) Example
Now that you know what the RASS Scale is all about, what you need to do to use it properly, and what the scoring designations are, you are all set to use it! But before you do, it’s also best for you to see what it looks like, so here below is a fully-accomplished Richmond Agitation Sedation Scale (RASS) sample for your reference.
This is a widely used tool in hospitals, especially in emergency rooms and intensive care units, so we highly recommend that you use this to help your team determine if your treatment is effective or if you need to make adjustments. If you’d like, we have a free downloadable copy of the RASS Scale! You can choose to print it, but you may also use it digitally since you can tick the radio buttons to score the patient’s level of agitation or sedation.
When is it best to use the Richmond Agitation Sedation Scale (RASS)?
The RASS Scale’s target population are patients dealing with critical illnesses or injuries. The most appropriate time to use this clinical assessment is when such patients are sent to the emergency room or intensive care unit for treatment.
Part of the scoring criteria are statements like the patient being aggressive and fighting off ventilators and pulling off tubes or catheters. When you are at the stage of treatment where your team has to use these devices, you might want to use this template to observe and record what the patient is like as they undergo treatment.
This is an effective tool in this kind of scenario because you and your team can see how a patient responds to a certain kind of treatment. Is your team’s specific treatment effective and is the patient responding well? Then perhaps whatever you are doing for that specific treatment should be maintained. But what if you have several patients that don’t respond well to a specific treatment? Then you might have to make adjustments to it.
The goal of this tool is to help healthcare professionals be successful with the treatment they are applying to the patient while also ensuring that the patient is comfortable and properly sedated based on the kind of treatment they are getting.
Who can use the Richmond Agitation Sedation Scale (RASS) and for whom is it?
To reiterate, the Richmond Agitation Sedation Scale (RASS) is meant to be used on patients dealing with critical illnesses or injuries. Since these patients are likely to be placed in hospital emergency rooms and intensive care units, the healthcare professionals that are (likely) to use this are:
- Critical care doctors and nurses
- Emergency doctors and nurses
- Respiratory therapists (in the event ventilators are used)
So long as the professionals are highly trained in treating patients in these settings and have been educated enough when it comes to making decisions based on what they observe in their patients, they can definitely use this.
It’s highly recommended that only such healthcare professionals use this scale to ensure that the interpretations made are backed by expertise and experience. The goal is to ensure that patients are properly sedated and that whatever pain they are feeling is being managed well, plus, to ensure that the treatment reaches a favorable outcome.
Measuring sedation is tricky, and the level of sedation required will depend on the kind of issue the patient is dealing with and the treatment that is needed to address it. That’s why it’s best for experts to use it because what if you need to make adjustments? You don’t want to overly sedate the patient by accident and cause unwanted complications.
What are the benefits of using the Richmond Agitation Sedation Scale (RASS)?
It can help guide professionals with their treatment plans.
Responses to treatments will vary from patient to patient. It also depends on the kinds of issues that they are being treated for. Using the Richmond Agitation Sedation Scale (RASS) will help professionals determine what decisions they have to make while they are applying treatment. What is the appropriate level of sedation required for a particular treatment? Do we need to apply analgesics? If so, what particular analgesic do we use and what is the dosage? These are just some of the questions that can be answered by checking the scale and the assigned score for the patient.
It can help ensure the safety of the patient.
To jump off the previous point, patients may respond violently to treatments, most likely because it is painful for them and they aren’t properly sedated enough. Through careful observations based on the scale’s scoring criteria, medical teams will be able to find ways to properly treat the patient in a way that reduces their level of pain.
The same goes when it comes to sedation itself. You don’t want to overly sedate the patient to the point that they experience unwanted complications. The scale can help teams ensure that the patient is getting the appropriate level of sedation required for their particular treatment.
It’s an inexpensive tool that is quick to accomplish.
The Richmond Agitation Sedation Scale (RASS) does not require any special tools. Rather, it takes into consideration tools commonly used in emergency rooms and intensive care units. You don’t need anything other than a printed version of this and a pen to tick which score you are giving. Engaging with the sheet shouldn’t take you more than ten seconds if you already have all the information you need based on your observations. It’s the observing part that will take time.
Why use Carepatron for hospital-related tools and software?
If you are a healthcare professional that specializes in treating patients sent to emergency rooms and intensive care units, then you have one of the most stressful and busiest jobs on the planet. Given this, we’re sure you experience a decent amount of stress, so we highly recommend that you check out Carepatron!
Here at Carepatron, we’re all about helping healthcare professionals with their work by streamlining their workflows and processes, and providing them with resources that benefit them and their patients in more ways than one!
The Richmond Agitation Sedation Scale (RASS) is one of many assessments that can be found in our resource repository. If you haven’t been using this for your work, then you might want to in order to improve your team’s performance and guide your decisions as you apply treatment to patients with critical illnesses or injuries.
We also have other hospital-related worksheets, assessments, surveys, and even general treatment plan templates. Check them out and see which ones you think will benefit you and your team! You’ll be spoiled for choice.
Carepatron also has a storage system where you can store all your clinical documents in a HIPAA-compliant manner. You can even set up who can access the files! Make sure to give access to your whole team so everyone can easily access documents without having to search for them in physical folders inside filing cabinets! Also, storing your files in our storage system is a good way to preserve your work.
Convenience. Accessibility. Security. You get all three with Carepatron.