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Clinical Opioid Withdrawal Scale (COWS)

Implementation and Outcomes

Canamo, Lilian J. BSN, RN, PCCN; Tronco, Nicole B. MSN, RN, PCCN

doi: 10.1097/CNQ.0000000000000262
Original Articles

The opioid crisis has shown evidence worldwide and locally. There was no protocol to detect opioid withdrawal at this organization. The purpose of this project was to develop a nursing-driven opioid withdrawal management tool using the validated Clinical Opioid Withdrawal Scale (COWS) to address an increase in opioid-addicted patients. Evidence-based practice change was executed using the San Diego 8A's method for adult trauma step-down patients experiencing opioid withdrawal with the COWS tool affecting frequency of nursing attempts at managing opioid withdrawal over an 8-week period. Training was provided to 45 nurses on COWS use in opioid-positive patients exhibiting withdrawal symptoms. Nurses were tested and retested to establish reliability. Nursing management included communication with MDs, safe opioid use education, social work consultation, use of nonopioid pain relief, or other symptomatic medication management. Nursing withdrawal management: pre-COWS = 25%; post-COWS = 96%. There was a statistically significant increase in the percentage of patients evaluated correctly following COWS initiation (n = 28, χ2 = 29, P < .0001, 95% CI, 47.71-83.74). Data were collected on a matched cohort of symptomatic toxicology-positive patients before and after change (n = 28 pre-COWS and n = 28 post-COWS). Use of the COWS tool with corresponding interventions by trauma nurses is feasible and results in improved withdrawal management.

Trauma Progressive Care Unit, University of California: San Diego Health System.

Correspondence: Lilian J. Canamo, BSN, RN, PCCN, 5 West Trauma PCU, University of California: San Diego Health System, 200 W. Arbor Dr, San Diego, CA 92103 (

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

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