The limited reliability of the Ramsay scale

Introduction The Ramsay scale which is internationally one of the most frequently cited sedation assessment tools has not had adequate psychometric evaluation. The objective of this study was to test the inter-rater reliability of the Ramsay scale. Methods This study was based on a prospective, single-blinded randomized design targeted to provide a psychometric analysis of the Ramsay scale. Following informed consent nurses were provided with written instructions on use of the Ramsay scale. A total of 241 critical care nurses were recruited from seven specialty critical care units in a major teaching institution; 237 nurses completed the study. After reviewing the written instructions, nurses viewed one out of six randomly selected videos of a sedation assessment and then scored that video using the Ramsay scale. Each nurse viewed and independently scored only one video using the Ramsay scale. Results Across the 237 nurses, who scored one out of six videos using the Ramsay scale a Kappa of 0.28 was obtained. Conclusions Based on these findings, there is insufficient evidence to support the reliability of the Ramsay scale as a measure of sedation assessment.