Cows Assessment Printable COWS Score for Opiate Withdrawal Quantifies severity of opiate withdrawal When to Use Pearls Pitfalls Why Use Resting Pulse Rate BPM Measure pulse rate after patient is sitting or lying down for 1 minute 80 0 81 100 1 101 120 2 gt 120 4 Sweating Sweating not accounted for by room temperature or patient activity over the last 0 5 hours
The Clinical Opiate Withdrawal Scale COWS Journal of Psychoactive Drugs 32 2 253 259 After completion scan form into patient record and provide a copy to the patient the patient was jogging just prior to assessment the increase would not add to the score 1 Resting pulse rate Measured after patient is sitting or lying for 1 minute Pulse rate 80 or below 0 Pulse rate 81 100 1 Pulse rate 101 120 2 Pulse rate greater than 120 4 bpm 2 GI upset Over last 189 hour No GI symptoms 0
Cows Assessment Printable
Cows Assessment Printable
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Source Wesson DR Ling W The Clinical Opiate Withdrawal Scale COWS Journal of Psychoactive Drugs 2003 35 2 253 9 doi 10 1080 02791072 2003 10400007 cows Clinical Opiate Withdrawal Scale To download more of this resource visit www insight qld edu au Interval 0 30 minutes 2 hours 4 hours Time Score Score Score
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Cows Assessment Printable
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Clinical Opiate Withdrawal Scale COWS Flow sheet for measuring symptoms for opiate withdrawals over a period of time For each item write in the number that best describes the patient s signs or symptom Rate on just the apparent relationship to opiate withdrawal
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COWS is not required prior to starting buprenorphine but it can help ensure the patient is ready for the first dose For each item write in the number that best describes the patient s signs or symptoms Rate only the apparent relationship to opiate withdrawal
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1 patient reports increasing irritability or anxiousness participation in the assessment is difficult 2 patient obviously irritable anxious Gooseflesh skin 0 skin is smooth 5 prominent piloerection 3 piloerection of skin can be felt arm hairs standing up
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Option 1 2mg max 16mg 24hr buprenorphine naloxone SL COWS 10 max 12mg 24hr Option 2 4mg buprenorphine naloxone SL Option 3 4mg buprenorphine naloxone SL PRN Determine Maintenance or Taper Plan for Patient Maintain on same dose received in 1st 24 hours Maintenance
https://ncbi.nlm.nih.gov/books/NBK143183/bin/annex10-fm3.pdf
Clinical Opiate Withdrawal Scale COWS For each item circle the number that best describes the patient s signs or symptom Rate on just the apparent relationship to opiate withdrawal For example if heart rate is increased because the patient was jogging just prior to assessment the increase pulse rate would not add to the score
The clinical opiate withdrawal scale COWS is a clinician administered pen and paper instrument that rates eleven common opiate withdrawal signs or symptoms The summed score of the eleven items can be used to assess a patient s level of opiate withdrawal and to make inferences about their level o The COWS is a clinician assessment instrument used to assess the signs and symptoms associated with opioid withdrawal in a patient presenting with substance abuse It is a valid and reliable instrument that can differentiate between patients suffering from mild opiate withdrawal and those without withdrawal
A patient s subjective assessment of severe withdrawal symptoms may be comparatively low when compared to objective assessment Therefore withdrawal should be assessed using the Clinical Opiate Withdrawal Score COWS as detailed below COWS Clinical Opiate Withdrawal Scale
