How to use the COWS Assessment
Observe the patient.
You, the clinician, will be using the COWS Assessment to evaluate a patient’s state of withdrawal. You will do so by observing the following:
- Resting Pulse Rate (beats per minute; to be measured after patients sit or lie down for 1 minute)
- Sweating (over the past ½ hour not accounted for by room temperature or patient activity)
- Restlessness (observation during the assessment)
- Pupil size
- Bone or joint aches (if patient was having pain previously, only the additional component attributed to opiates withdrawal is scored)
- Runny nose or tearing (not accounted for by cold -symptoms or allergies)
- GI Upset (over last ½ hour)
- Tremor (observation of outstretched hands)
- Yawning (observation during the assessment)
- Anxiety or irritability
- Gooseflesh skin
It is recommended that you monitor them with this assessment three to four times a day
Pick your answers based on your observations and calculate the COWS score.
You just need to pick one answer for each item. Each answer has a score assigned to it. After picking answers for all items, you need to get the total score.
This assessment has score ranges so you know which severity level your patient falls under:
- 5-12 = Mild
- 13-24 = Moderate
- 25-36 = Moderately severe
- 37+ = Severe withdrawal
Determine what goes into your rehabilitation plan for them.
After you totaled the scores and have seen which severity designation your patient falls under, you can create a care plan and see what goes into it in order to help your patient work through their opioid withdrawal and come out of it in good health. For improved client results and practice efficiency, utilize this care plan template.
One thing that may be included in your treatment plan is the use of buprenorphine, which is considered as an opioid partial agonist that’s used to help treat opioid use disorder. The patient may benefit from this since it can help with fighting withdrawal symptoms and opioid cravings because it diminishes the effects of physical dependency.
Of course, the inclusion of buprenorphine in your plan depends on the level of severity of the patient’s withdrawal. It’s only recommended if their scores fall under Mild or Moderate. If they fall under Moderately Severe or Severe Withdrawal, then you might want to hold off on including this to be on the safe side because buprenorphine has opioid effects.
