Implementation of the RASS-Pal Tool to Improve Sedation Practices for End-of-Life Care
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Authors
Grimm, Haley
Issue Date
2025-05
Type
Thesis
Language
en_US
Keywords
Alternative Title
Description/Abstract
Background: Symptom management for patients at the end-of-life has been identified as an important part of care for patients and their families. Sedative medication should be proportionate to the patient’s suffering and the level of sedation should be monitored to ensure patient comfort (Vivat et al., 2019). A hospital based acute palliative care unit providing end-of-life care was found to lack an assessment tool for sedation and agitation approved for utilization for patients receiving end-of-life care.
Purpose: This quality improvement project implemented the RASS-Pal assessment tool to determine its impact on end-of-life nursing care provided and nurse confidence in the ability to assess, treat, and report patient sedation levels.
Methods: Prior to education on the RASS-Pal tool, nurses completed an anonymous survey to measure knowledge and confidence related to end-of-life sedation practices. Education on the tool was provided, and the tool was implemented for patients meeting inclusion criteria. Nurse confidence was assessed following implementation utilizing self-reported anonymous surveys. Medication administration trends were assessed during implementation via chart review.
Results: There was no statistically significant change in nursing confidence in reporting sedation or in medication selection but there was a strong correlation between the ease of use of the tool and its helpfulness monitoring patient sedation at end-of-life. Following implementation of the RASS-Pal tool, an average of more than 10 sedation assessments were documented for each patient compared to no sedation assessments documented before the tool was implemented.
Conclusion: Implementation of the RASS-Pal tool may be beneficial for use in patients receiving end-of-life care to facilitate standardized assessment of patient sedation. Further studies would be helpful to better understand the impact of the RASS-Pal tool on patient comfort and medication administration practices.