Table 4 Qualitative comments: limitations of utilising the RASS-PAL tool and its potential to improve patient care
Limitations of RASS-PAL tool | ||
|---|---|---|
Challenge in differentiating agitation from delirium | ||
Nurse | “…when you called their name I think some people (and they woke up), some people didn’t really know how to rate them. They might not have been agitated but they were very confused and….sometimes I had trouble doing that.” | ID 1001 |
Palliative care physician | “…but when you’re dealing with an agitated patient, there’s so…for example, hyperactive delirium, there’s so many other components then just motor agitation or something and that you can’t really assess you know and it change so fast you now…” | ID 1005 |
Challenge in capturing mixed delirium | ||
Palliative care physician | “I found it difficult to score because …in the time-frame that we were looking at them they had elements of both…so mixed delirium could be more difficult to score.” | ID 1007 |
Palliative care physician | “…but I don’t think it was as easy to do…when they’re calm or like seem to be calm and then you know that they were just really agitated a little while ago.” | ID 1002 |
Burden on health care professional | ||
Nurse | “If we were going to add these two forms of evaluation…that’s a lot of paperwork for me to do that with 4 different patients to have 3 different surveys throughout the day, that is very hard…very hard.” | ID 1004 |
Potential to improve patient care? | ||
Assessing, informing, following-through | ||
Nurse | “I think if staff follow through and medicate patients appropriately, then it’s good.” | ID 1001 |
Palliative care physician | “I think it informs us a lot better and guides decision making, in terms of whether somebody is going to get medication or not.” | ID 1007 |
Nurse | “it’s a good guide….it’ll improve in the sense that it’s a good guide, give us an idea, but not as far as hands-on care.. we’re still…not going to go to a paper.” | ID 1009 |
Nurse | “I would say it improves patient care for sure because you’re assessing the degree of delirium or agitation and….you’re paying attention.” | ID 1008 |
Need for further education/communication when integrating tools into practice | ||
Nurse | “…we’d need …a bit more education if it’s going to be used on a regular basis like our other paperwork.” | ID 1009 |
Palliative care physician | “…staff if they don’t understand how to use it, they’re not going to use it, so they need to be educated. And some staff will fill it out, but then you’ll look and they won’t give meds.” | ID 1002 |