Question 1

How reliable is RASS between different assessors?

Accepted Answer

RASS has excellent inter-rater reliability (weighted kappa 0.80–0.91) across nurses, physicians, and respiratory therapists. Training takes approximately 15 minutes.

Question 2

Can RASS be assessed in paralysed patients?

Accepted Answer

No — neuromuscular blockade eliminates all behavioural responses. Document RASS as 'not assessable' and rely on physiological and EEG-based monitoring.

Question 3

What is the relationship between RASS and delirium detection?

Accepted Answer

Delirium assessment with CAM-ICU requires RASS as step 1. CAM-ICU cannot be performed at RASS −4 or −5. RASS + CAM-ICU is part of the ABCDEF bundle.

Question 4

How does RASS compare to the Ramsay Scale?

Accepted Answer

RASS has replaced Ramsay in most modern ICUs due to clearer anchor definitions, better inter-rater reliability, and inclusion of separate agitation levels (+1 to +4).