Facebook
Twitter
LinkedIn
Email
 |
Checking for direct PDF access through Ovid | |
Excerpt
During the early 1990s, personnel in the Shock Trauma Respiratory Intensive Care Unit (STRICU) at the LDS Hospital struggled to improve patient sedation. Although incorporation of a sedation scale was a major goal of the improvement process, available scales such as the Ramsay Scale (1) used ambiguous terminology (such as “restless,” “agitated,” and “tranquil”) that could lead to misinterpretation by nursing staff. In July 1993, Richard M. Riker, MD, shared with LDS Hospital the Sedation-Agitation Scale (SAS) that was subsequently published in 1994 (2) and recently validated (3).
As the STRICU trialed the SAS in 1993, it was modified through an iterative trial and improvement process. These modifications included making the categories more explicit by adding “and,” “or,” and patient responses to instructions and specifically defined stimuli. In addition, the numerical rating was modified from the −3 to +3 rating to a 0 to 6 rating. The nurses found this format to be more user-friendly and it was felt to be more compatible with future sedation protocol computerization. Although this revised SAS, deemed the Motor Activity Assessment Scale (MAAS), was altered to emphasize patient motor activity as a primary marker of sedation status, it retained many of the original characteristics of the SAS.
When the LDS group began working with the Institute of Healthcare Improvement’s Breakthrough Series on Adult Intensive Care Units, many participating teams wanted to work on improving the use of sedation. The LDS Hospital shared their sedation protocols from the STRICU with them and the MAAS score was embedded within the protocols. Each institution, although told each protocol would need to be modified and adapted for their individual environments, and that MAAS had not been validated, were not told the origins of the MAAS score. A recent validation of MAAS by Henry Ford Hospital (4) gives credit to MAAS by LDS, when in fact much of the scale evolved from the SAS (2, 3).
The development of a useful sedation scale is frequently a multiple-step process. In this current situation, many of the original concepts for the sedation score came from Dr. Riker and his colleagues at Maine Medical Center, a refining process subsequently occurred at LDS Hospital to make the score more explicit and functional in our STRICU, and finally, the validation of the score was performed by Devlin and colleagues (4) at Henry Ford Hospital. We feel all should be given proper recognition for their contribution in the development of the MAAS score and to acknowledge the evolution of the MAAS score from the SAS. Both scoring systems appear to function well in the intensive care unit (3, 4).
