Ramsay Sedation Scale Project: Small, Easy Changes for a Big Effect on Patient Safety

Because of variability in individual practices and the potential for institutional bias,¹  discrepancy currently exists in sedation practices for the care of critically ill patients. Such discrepancies have been noted and studied since the 1980s, when a survey²  was published to highlight the practice of oversedation. Since then, practice has moved toward the use of structured protocols to reach patient-specific endpoints; however, this approach is underused.²  Inconsistent practice leads to over- and undersedation. Oversedation can prolong the use of mechanical ventilation, increase length of stay, and increase instances of mortality and organ failure in critically ill patients.³  Undersedation can lead to increased agitation and negative, long-term outcomes in critically ill patients.^1,4 

Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit (ICU) suggest that stable sedation is associated with improved clinical outcomes.⁴  However,...