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Weaning from sedation: don't ignore the score.

The use of sedation and analgesia in critically ill children is necessary for clinical management but can result in undesirable side effects such as physical dependence, tolerance and withdrawal symptoms. Weaning from sedation aims to prevent such unpleasant effects. Regular scoring of signs and symptoms of withdrawal is an essential part of the weaning regime, allowing the clinician to assess whether reduced doses are causing withdrawal symptoms. However, there are wide variations in whether and how scoring systems are used. This variation may be the result of high workload, other external pressures, traditional ways of working or other factors. Strategies such as an easily accessible scoring flow chart, a poster display, improved staff induction or other measures could help to improve safety and quality in sedation management.