Moline - Roberts Pharmacotogic Sedation Scale@

Revised 10/09

The pueose of this scale is to aid the decision-makina process regarding administmtion of opioids and sedatives. At all times, the individual's physiologic status and unique response to opioiddsedatives must be included in the decision process. Do 4q! use fhrs scale tor any patient with neurological impairment which prevents cammands.

nomal response to a stimulus or ability to follow

* See Assess Patient Risk on reverse side Copyright 2008 Poudre Valley Health System

Instructions for Using

MOLIIIE-ROBERTS PIIARMACOLOGIC SEDATION SCALE O

Purpose of the Tool This tool is dsigned to provide a coDsistent method of assessing pharmacologic sedation and assist in the decision-making process regarding the admidshatiot of opioids, sedatives, and other agents which produce sedation. It is divided inio seven colusns: PresntatiorL Auditory Stimulus, Tactile Stimulus, Response, Sedation Level, Action for Attentive Pain Management and Action for Moderate Sedatior/Analgesia

How to Us the Tool

witlout providing any tactile or auditory stimulatiotr and match the patied's presentation with the descdpto$ itr the Presentation (fust) colrrll)Ir. Ifthe patient is steping initiate auditory stimulation with/without tactile stimulation staxting at level 2 ggdgseltgd-i4 the sca.le. Ifno response move to level3, and ifno rcsponse move progrcssively to level4, 5 and 6 until a patient response is rcted and matched to the descriptors in the Response (fouth) column. When a response occu$ note the sedation level in the Sedation (fifth) column.
Observe the patient

1)

2)

Note: Provide edy_the stimuli described. AlwTys sturt at lower rutings (lighter sedation) and progress to highel rutings (deeper sedation). Failwe to do so riq) inaccurately place the patient .tt a highet rutirrg. Ifyou're assessiug sedation in the patient experiercing pain, use the sixth column labeled "Action for Attentive Pain Matagement", to help in your decisiou-making process. Ifyou'rc assessitrg sedation in the patient receiving moderate sedation, use the last column labeled "Action for Modente Sedatior/Analgesia", to help in your decision-uraking process.

Limitrtionr ofthc Tool

This tool is not itrtended for use in any patient with neurological impairmeDt which prvents normal respome to a stimulus or ability to follow commands. Remember that the puipose ofthis scale is to aid in the decision-making process regarding the administration ofopioids and sedatives. At all times, the individual's physiologic status aod previous medications (dose, halfJife, respome to drug, etc.) must be incorporated into the decisionmaking process. In addition, when providing moderate sedation coNideration must also be given to expected length oftime to completiou ofthe procedure and anticipated future pain associated with the procedure. ,*rr**********************t ** ** ** *****,t**+* *+ ** ** t* ** ** '** *,t * * * * *,1**'t ** ** *+* *,+++++++* l,*** ** ** ** *** ** *,1*{'* *,1*{'** ** ** ** ** *.1
*Assess

Prlieni Risk - Consider potentiat for negative outcome

based on:

PhysiolsC!9_Egp@lc: Crment illness/injury, major organ system dysfunction, age, respiEtory stability, general ability to compensate for physiologic stress/insult (especially hyaercarbia and hl,poxia). PharmaEoloeic Facto$: Opioid status (tolerant or mive), first 24 hous ofopioid therapy, resporue to previous doses, additior of trew sedating agents, recent change in drugs dose, rcute or interval. Monitorinq Factors: Conceming values or conceming trcnds of: vital sigrrs, orygen saturatioq end tidal carbon dioxide, oxygen requirements, pain and sedation levels. !!gg[gg@Is: Ifassessment is occuning dwing normal sleep hous following physically exhausting vents, discem if diminished rcspoose is due to "nonnal" sleep as opposed to potential pharmacologic sedation