2026 Eastern States Conference

Title
Analysis of Nursing RASS Assessment Appropriateness and Its Clinical Impact on Patient Oversedation in the Medical Intensive Care Unit
Authors
Syeda Rahman, PharmD, MPH; Ilanit Zada, PharmD, BCCCP; Amanda S. Rampersaud, PharmD, BCPS
Learning Objective
Participants will be able to identify the relationship between nursing RASS assessment appropriateness, oversedation, and key clinical outcomes in mechanically ventilated ICU patients.
Background/Objective
Deep oversedation in mechanically ventilated ICU patients is associated with prolonged mechanical ventilation, delirium, and increased mortality and may be driven in part by inappropriate bedside RASS assessments. The objective of this study is to evaluate the appropriateness of nursing RASS documentation, quantify the prevalence of oversedation, and assess the association between RASS assessment appropriateness, oversedation, and clinical outcomes at SBH Health System.
Methods
This single-center, retrospective cohort study will include adults aged 18 years and older admitted to the medical ICU who require invasive mechanical ventilation for at least 24 hours, receive continuous sedation, have a documented RASS goal, and have at least 6 documented RASS assessments during mechanical ventilation. Exclusion criteria include baseline coma or severe encephalopathy, status epilepticus requiring therapeutic coma, severe traumatic brain injury requiring deep sedation, ECMO support, DNR/comfort-measures-only status within 24 hours of ICU admission, incomplete records preventing assessment of primary outcomes, and receipt of neuromuscular blocking agents during mechanical ventilation. De-identified data collected will include patient demographics, comorbidities, admitting diagnosis, illness severity as measured by SOFA score when available, sedative and analgesic regimens, all documented RASS and CAM-ICU assessments with corresponding goals and timestamps, and ICU and hospital outcomes, including ICU and hospital length of stay, duration of mechanical ventilation, ventilator-free days at day 28, ICU-free days at day 28, delirium incidence and duration, and mortality. RASS assessments will be classified as appropriate or inappropriate using predefined criteria. Oversedation will be evaluated in relation to documented RASS scores and ordered sedation goals. Descriptive and comparative analyses will be used to evaluate the association between RASS assessment appropriateness, oversedation, and clinical outcomes.
Results
Data collection and analysis are in progress. We anticipate describing the prevalence of inappropriate RASS assessments and oversedation, as well as their association with duration of mechanical ventilation, delirium, and mortality. Results will be presented at the conference.
Conclusion
This study is expected to characterize the clinical impact of nursing RASS assessment appropriateness on oversedation and key patient outcomes and provide actionable data to support education, protocol refinement, and quality improvement in ICU sedation management.