Richmond Agitation-Sedation Scale (RASS)

When it activates

Scribeable activates a calculator from the encounter. The Richmond Agitation-Sedation Scale (RASS) can activate when the transcript or pasted chart context documents any of these:

• Sedation level assessment
• Agitation management
• Sedation titration in ICU
• Pre-CAM-ICU consciousness assessment
• Ventilator sedation monitoring

Inputs the note needs

1 input. Each is resolved from the transcript, the pasted chart context and charted labs; an input marked "asks you" is requested as a clarification when it is undocumented.

Scoring

+4: Combative — violent, immediate danger to staff. +3: Very agitated — pulls at tubes/catheters, aggressive. +2: Agitated — frequent non-purposeful movement, fights ventilator. +1: Restless — anxious/apprehensive but movements not aggressive/vigorous. 0: Alert and calm. -1: Drowsy — not fully alert, sustained awakening to voice (>10 sec). -2: Light sedation — briefly awakens to voice, eye contact (<10 sec). -3: Moderate sedation — movement or eye opening to voice but no eye contact. -4: Deep sedation — no response to voice, movement or eye opening to physical stimulation. -5: Unarousable — no response to voice or physical stimulation.

Interpretation

Target RASS 0 to -1 for most ICU patients (light sedation) per PADIS guidelines. RASS +1 to +4: Evaluate and treat underlying cause (pain, delirium, anxiety, physiologic disturbance) before increasing sedatives. RASS -3 to -5: Minimize sedation, daily sedation awakening trial (SAT). RASS -4 to -5: Too deep for CAM-ICU assessment — document as unable to assess. Light sedation (RASS 0 to -2) associated with shorter ventilation duration, shorter ICU stay, and lower mortality. Assess RASS before CAM-ICU — prerequisite for delirium screening.

Evidence

Sources carried in Scribeable's citation registry for this calculator; guideline version: Sessler 2002.

• Sessler CN et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patientsSessler et al. (RASS) 2002 · 2002 · Level I · link last verified 2026-03-28

How Scribeable handles it in the note

When an encounter activates the Richmond Agitation-Sedation Scale (RASS) at the mandatory tier, Scribeable resolves its inputs from the transcript, the pasted chart context and any charted labs, and asks you for a missing input you can supply before the note is finalised. Bedside-exam and separately ordered study values are not requested one input at a time; a calculator that carries a combined clarification question may still put that single question to you.

The score is computed in code from the resolved inputs, not recalled by the language model. If the draft states a Richmond Agitation-Sedation Scale (RASS) value that disagrees with the computed one, the disagreement is flagged to the second drafting pass, which is instructed to correct the score and its interpretation before you see the note.

Classified as a risk score: activated strictly, by a documented trigger, never by a permissive reading of the encounter.

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Can activate in: Emergency Medicine, Neurology, Pulmonology, Anesthesiology, Critical Care / ICU.