Clinical Opiate Withdrawal Scale (Cows) Template (Page 2 of 2) in pdf

Clinical Opiate Withdrawal Scale (Cows) Template Page 2

COWS / Flow-sheet format for measuring symptoms over a period of time

GI Upset: over last ½ hour

0 no GI symptoms

1 stomach cramps

2 nausea or loose stool

3 vomiting or diarrhea

5 Multiple episodes of diarrhea or vomiting

Tremor observation of outstretched hands

0 No tremor

1 tremor can be felt, but not observed

2 slight tremor observable

4 gross tremor or muscle twitching

Yawning Observation during assessment

0 no yawning

1 yawning once or twice during assessment

2 yawning three or more times during assessment

4 yawning several times/minute

Anxiety or Irritability

0 none

1 patient reports increasing irritability or anxiousness

2 patient obviously irritable anxious

4 patient so irritable or anxious that participation in the

assessment is difficult

Gooseflesh skin

0 skin is smooth

3 piloerrection of skin can be felt or hairs standing up on

arms

5 prominent piloerrection

Total scores

with observer’s initials

Score:

5-12 = mild;

13-24 = moderate;

25-36 = moderately severe;

more than 36 = severe withdrawal

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Clinical Opiate Withdrawal Scale (Cows) Template Page 2