Clinical Opiate Withdrawal Scale (Cows) Template printable pdf download

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. 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.

Patient’s Name:___________________________

Date: ______________

Enter scores at time zero, 30min after first dose, 2 h after first dose, etc.

Times:

______

Resting Pulse Rate: (record beats per minute)

Measured after patient is sitting or lying for one minute

0 pulse rate 80 or below

1 pulse rate 81-100

2 pulse rate 101-120

4 pulse rate greater than 120

Sweating: over past ½ hour not accounted for by room

temperature or patient activity.

0 no report of chills or flushing

1 subjective report of chills or flushing

2 flushed or observable moistness on face

3 beads of sweat on brow or face

4 sweat streaming off face

Restlessness Observation during assessment

0 able to sit still

1 reports difficulty sitting still, but is able to do so

3 frequent shifting or extraneous movements of legs/arms

5 Unable to sit still for more than a few seconds

Pupil size

0 pupils pinned or normal size for room light

1 pupils possibly larger than normal for room light

2 pupils moderately dilated

5 pupils so dilated that only the rim of the iris is visible

Bone or Joint aches If patient was having pain

previously, only the additional component attributed

to opiates withdrawal is scored

0 not present

1 mild diffuse discomfort

2 patient reports severe diffuse aching of joints/ muscles

4 patient is rubbing joints or muscles and is unable to sit

still because of discomfort

Runny nose or tearing Not accounted for by cold

symptoms or allergies

0 not present

1 nasal stuffiness or unusually moist eyes

2 nose running or tearing

4 nose constantly running or tears streaming down cheeks

Clinical Opiate Withdrawal Scale (Cows) Template

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