Accuracy and Documentation of Richmond Agitation-Sedation Scale Assessments in a Cardiothoracic Critical Care Unit: A Prospective, Cross-Sectional Audit.

This was a single-centre audit in a cardiothoracic ICU with transplant and ECMO patients, so it may not apply to other units or patient groups. The audit did not measure patient outcomes or test any intervention, so it cannot show that better RASS scoring improves safety. The auditor's score was used as the reference standard, and the auditor assessed the patient immediately after observing the nurse, which may introduce confirmation bias. Completeness was judged from electronic records, so an assessment may have been done but not documented. Patients were not randomly sampled, and the small sample plus univariable analysis means associations may be affected by selection bias and confounding. Nurse training and confidence were self-reported, so recall bias may affect these variables.

No conflicts of interest were declared. The first author received a research grant from the Medtronic External Research Program.

Do not conclude that these audit findings prove poor sedation scoring caused worse patient outcomes. The study measured documentation and agreement with an auditor, not outcomes, and it did not test an intervention.