The administration of sedative drugs at the end of life raises both clinical and ethical challenges. This article details the evolution of sedation decision-making practices at a 14-bedded UK hospice over the course of 5 years through an initial review and two follow-up audits. Key areas, such as documented consideration of hydration status and discussion with family members, have been improved following the implementation of a checklist of decision-making prompts, demonstrating how practice can be improved and sustained over time.