Richmond Agitation-Sedation Scoring Implementation in a Critical Access Hospital

Document Type

Article

Publication Date

Summer 5-28-2026

Abstract

Mechanically ventilated patients who are boarding in rural emergency departments face an increased risk of inconsistent sedation management due to the lack of standardized protocols and the extended transfer times to higher levels of care. The variability in sedation practices can lead to both under- and over-sedation, which negatively affects patient comfort, safety, and clinical outcomes. Research suggests that sedation protocols incorporating the Richmond Agitation-Sedation Scale (RASS) can shorten mechanical ventilation duration and improve clinical outcomes. The purpose of this project was to evaluate the effectiveness of a targeted educational intervention on improving nursing knowledge and comfort with the RASS tool to promote appropriate sedation management in mechanically ventilated patients boarding in the ED.

A pre-post education design was utilized with independent samples of ED nursing staff. Participants completed a Likert-scale survey assessing knowledge and comfort with RASS use before and after the educational intervention. A total of 35 pre-education surveys and 21 post-education surveys were included in the analysis. Data were assessed using descriptive statistics and a Mann–Whitney U test to evaluate differences in overall scores between groups. Results exhibited a statistically significant improvement in overall survey scores following the educational intervention (pre: M = 15.88; post: M = 25.47; U = 68.5, p < .001). The nearly 10-point increase in mean scores indicates a substantial improvement in both knowledge and self-reported comfort with RASS utilization.

The educational intervention proved effective in improving nursing competency in utilizing a validated sedation assessment tool. By improving knowledge and comfort with the RASS, the intervention can foster more consistent and appropriate sedation practices, especially in rural emergency departments where patients may endure extended boarding times. These outcomes reinforce the importance of adopting standardized education and sedation protocols to strengthen patient safety, minimize care variability, and ultimately improve clinical outcomes for mechanically ventilated patients.

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