Comparsion of Selected Sedation Scales for Reporting Opioid Induced Sedation Assessment
Allison Theresa Nisbet , MSN, CPN, AOCNS, RN-BC; Florence Mooney-Cotter , MSN, CNS-BC, RN-BC
Allison Theresa Nisbet , MSN, CPN, AOCNS, RN-BC; Florence Mooney-Cotter , MSN, CNS-BC, RN-BC
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.
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 andsubsequent 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.
Introduction
Opioid-induced sedation represents a continuum of levels of consciousness and arousability ideally measured by reliable and valid criteria that are applied in clinical practice for safe and effective administration of opioid analgesics (American Society for Pain Management Nursing [ASPMN] , 2009). Opioid-induced respiratory depression is a concerning decrease in the effectiveness of an individual's ventilatory function after opioid administration (ASPMN, 2009).
For the purposes of this study, sedation is recognized as a relatively common side effect of opioid analgesia (Pasero & McCaffery , 2002; Szalados & Boysen, 1998), and advancing sedation has been identified as a precedent to clinically significant respiratory depression (Pasero & McCaffery, 2002). As such, nurses should systematically assess and document in the medical record the incidence and severity of sedation during opioid administration for pain management.
Furthermore, the assessment should lead the nurse to make appropriate decisions about how to proceed with opioid administration. Although sedation occurs on a continuum, it does not correlate directly with laboratory values of opioid drug levels (Szalados & Boysen, 1998). As a result, sedation, much like pain, must be serially assessed to identify discrete levels at any given moment in time and to identify incremental changes in direction of sedation level (increasing or decreasing). The incidence and severity of opioid-induced sedation is influenced by many factors, including whether the patient is opioid tolerant (taking regular daily doses of opioids for several days) or opioid naive (Pasero & McCaffery, 2002), concurrent administration of other sedating medications (such as benzodiazepines) (Szalados & Boysen, 1998), and the patient's general health and clinical condition (Smith, 2007).
Patients at extremes of age (the very young and the very old ), with end-organ damage affecting opioid metabolism and elimination, with obstructive sleep apnea (diagnosed or not ), and with baseline alterations in respiratory or neurological function are at a higher risk for increased sedation and subsequent respiratory depression as a complication of opioid therapy (Pasero & McCaffery, 2002; Smith, 2007). In addition, some pain management therapies , including intermittent intramuscular, intravenous, or subcutaneous opioid injections, intravenous patient- controlled analgesia (IV PCA), and intraspinal pain management , may increase the risk of sedation.
DOWNLOAD COMPLETE PDF HERE
Introduction
Opioid-induced sedation represents a continuum of levels of consciousness and arousability ideally measured by reliable and valid criteria that are applied in clinical practice for safe and effective administration of opioid analgesics (American Society for Pain Management Nursing [ASPMN] , 2009). Opioid-induced respiratory depression is a concerning decrease in the effectiveness of an individual's ventilatory function after opioid administration (ASPMN, 2009).
For the purposes of this study, sedation is recognized as a relatively common side effect of opioid analgesia (Pasero & McCaffery , 2002; Szalados & Boysen, 1998), and advancing sedation has been identified as a precedent to clinically significant respiratory depression (Pasero & McCaffery, 2002). As such, nurses should systematically assess and document in the medical record the incidence and severity of sedation during opioid administration for pain management.
Furthermore, the assessment should lead the nurse to make appropriate decisions about how to proceed with opioid administration. Although sedation occurs on a continuum, it does not correlate directly with laboratory values of opioid drug levels (Szalados & Boysen, 1998). As a result, sedation, much like pain, must be serially assessed to identify discrete levels at any given moment in time and to identify incremental changes in direction of sedation level (increasing or decreasing). The incidence and severity of opioid-induced sedation is influenced by many factors, including whether the patient is opioid tolerant (taking regular daily doses of opioids for several days) or opioid naive (Pasero & McCaffery, 2002), concurrent administration of other sedating medications (such as benzodiazepines) (Szalados & Boysen, 1998), and the patient's general health and clinical condition (Smith, 2007).
Patients at extremes of age (the very young and the very old ), with end-organ damage affecting opioid metabolism and elimination, with obstructive sleep apnea (diagnosed or not ), and with baseline alterations in respiratory or neurological function are at a higher risk for increased sedation and subsequent respiratory depression as a complication of opioid therapy (Pasero & McCaffery, 2002; Smith, 2007). In addition, some pain management therapies , including intermittent intramuscular, intravenous, or subcutaneous opioid injections, intravenous patient- controlled analgesia (IV PCA), and intraspinal pain management , may increase the risk of sedation.
DOWNLOAD COMPLETE PDF HERE
0 comments
Post a Comment