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Withdrawal Assessment Tool (WAT-1)

Withdrawal Assessment Tool (WAT-1) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Questionnaires


© 2007 L.S. Franck and M.A.Q. Curley. All rights reserved.
Reprinted with permission from: Franck LS, Harris S, Soetenga D, Amling J, Curley M. The withdrawal assessment tool (WAT-1):
Measuring iatrogenic withdrawal symptoms in pediatric critical care. Pediatr Crit Care Med 2008;9(6):573-580.
1Curley et al. State behavioral scale: A sedation assessment instrument for infants and young children supported on mechanical ventilation. Pediatr Crit Care Med 2006;7(2):107-114.
WITHDRAWAL ASSESSMENT TOOL VERSION 1 (WAT – 1)
© 2007 L.S. Franck and M.A.Q. Curley. All Rights reserved. Reproduced only by permission of Authors.

Patient Identifier

Date:

Time:



Information from patient record, previous 12 hours
Any loose/watery stools No = 0
Yes = 1

Any vomiting, retching, gagging No = 0
Yes = 1

Temperature > 37.8 °C No = 0
Yes = 1

2 minute pre-stimulus observation
State SBS1 < 0 or asleep/awake calm = 0
SBS1 > +1 or awake distressed = 1

Tremor None/mild = 0
Moderate/severe = 1
Any sweating No = 0
Yes = 1

Uncoordinated/repetitive movement None/mild = 0
Moderate/severe = 1
Yawning or sneezing None or 1 = 0
>2 = 1

1 minute stimulus observation
Startle to touch None/mild = 0
Moderate/severe = 1
Muscle tone Normal = 0
Increased = 1

Post-stimulus recovery
< 2 minutes = 0
Time to gain calm state (SBS1 < 0) 2 - 5 minutes = 1
> 5 minutes = 2

Total Score (0-12)

WITHDRAWAL ASSESSMENT TOOL (WAT – 1) INSTRUCTIONS
ξ Start WAT-1 scoring from the first day of weaning in patients who have received opioids +/or benzodiazepines by infusion or regular
dosing for prolonged periods (e.g., > 5 days). Continue twice daily scoring until 72 hours after the last dose.
ξ The Withdrawal Assessment Tool (WAT-1) should be completed along with the SBS1 at least once per 12-hour shift (e.g., at 08:00 and 20:00
± 2 hours). The progressive stimulus used in the SBS1 assessment provides a standard stimulus for observing signs of withdrawal.

Obtain information from the patient’s record (this can be done before or after the stimulus):
 Loose/watery stools: Score 1 if any loose or watery stools were documented in the past 12 hours; score 0 if none were noted.
 Vomiting, retching, gagging: Score 1 if any vomiting or spontaneous retching or gagging were documented in the past 12 hours;
score 0 if none were noted.
 Temperature > 37.8°C: Score 1 if the modal (most frequently occurring) temperature documented was greater than 37.8 °C in the
past 12 hours; score 0 if this was not the case.
2 minute pre-stimulus observation:
 State: Score 1 if awake and distress (SBS1 ≥ +1) observed during the 2 minutes prior to stimulus; score 0 if asleep or awake and
calm/cooperative (SBS1 ≤ 0).
 Tremor: Score 1 if moderate to severe tremor observed during the 2 minutes prior to stimulus; score 0 if no tremor (or only minor,
intermittent tremor).
 Sweating: Score 1 if any sweating during the 2 minutes prior to stimulus; score 0 if no sweating noted.
 Uncoordinated/repetitive movements: Score 1 if moderate to severe uncoordinated or repetitive movements such as head turning,
leg or arm flailing or torso arching observed during the 2 minutes prior to stimulus; score 0 if no (or only mild) uncoordinated or
repetitive movements.
 Yawning or sneezing: Score 1 if more than 1 yawn or sneeze observed during the 2 minutes prior to stimulus; score 0 if 0 to 1 yawn
or sneeze.
1 minute stimulus observation
 Startle to touch: Score 1 if moderate to severe startle occurs when touched during stimulus; score 0 if none (or mild).
 Muscle tone: Score 1 if tone increased during the stimulus; score 0 if normal.
Post-stimulus recovery:
 Time to gain calm state (SBS1 ≤ 0): Score 2 if it takes greater than 5 minutes following stimulus; score 1 if achieved within 2 to 5
minutes; score 0 if achieved in less than 2 minutes.
Sum the 11 numbers in the column for the total WAT-1 score (0-12).