Problem: Dexmedetomidine (DEX) is a continuous intravenous sedative used commonly in pediatric intensive care units (PICU). Absence of a validated withdrawal assessment tool and provider rotation contribute to variable practice and inadequately assessed and managed withdrawal syndrome (WS), increasing patient discomfort and morbidity. Protocolized sedation weaning shortens wean time, and clonidine use is recommended for WS management. Practice can be improved using an evidence-based algorithm. Purpose: The purpose of this quality improvement project was to implement a successful DEX weaning algorithm, assess adherence, and evaluate WS incidence. Methods: A withdrawal-risk stratified DEX weaning protocol considers a patient’s cumulative dose of DEX to adjust tapering schedules and amounts, and includes evaluation of tachycardia, hypertension and clinical signs of DEX withdrawal. Clonidine dosing is provided. Medical, nursing and pharmacy staff received education prior to implementation from September-December 2023. A multidisciplinary team developed an audit tool assessing process and outcome measures. All patients ready to wean off of DEX were included. Results: Results include a sample (N=48) of 33 low-, 12 moderate-, and three high-risk patients. Adherence was defined as correct algorithm use; violations include provider preference affecting incorrect weaning and clonidine use. The median adherence was 71%. Nurses’ documentation of heart rate, blood pressure and clinical assessment had a median of 100%. Weaning was well tolerated with low WS rates. Conclusions: There were promising results. Barriers were a small study team and inconsistent practice, addressed by added communication. Successes include nursing documentation and low rates of WS. A larger study team would increase reinforcement. Real time data collection would enhance determination of associations of process with outcomes. Findings suggest that practice change takes longer than 15 weeks.