1. Clinical Opiate Withdrawal Scale
COW SCALE

2. Audience
Undergraduate Nursing Students in a Community Rotation Course.
Clinical will take place in a Correctional setting.
Alongside an RN the student will perform assessments on inmate/patients that are detoxing from opiates using a Clinical opiate withdrawal scale.
Purpose of in-service to give insight on how to properly assess patients/inmates using the scale.

3. Objectives /Goals
Student will develop an awareness of the Clinical Opiate withdrawal scale and the importance of the tool. Cognitive domain of Applying.
Student will demonstrate and effectively apply clinical assessment skills while obtaining objective and subjective data as it pertains to scoring on the COW scale. Cognitive domain of remembering and applying.
Student will evaluate and measure the significance of numerical data obtained from the COW tool. Cognitive domain, remembering, applying and creating.

4. What is a COW scale?
COW scale is a clinical opiate withdrawal scale, that is used by health care professionals, this tool scores eleven common opiate withdrawal signs or symptoms.
The scale consists of objective and subjective data-if subjective assessments are not scored correctly, this can hinder the detox process or precipitate early withdrawal.
The summed scored of the 11 items is used for the induction of Detox Medications such as Suboxone, or other cocktail's that may be used for detox purposes

5. How to approach the process
Acknowledge all personal biases, use a non judgmental tone,
Practice having empathy.
Refrain from personal opinions; such as “well if you don't do drugs this wouldn’t be happening!”; “you deserve this your in jail”!

6. How to Explain process to inmates/patients

7. Sample Scale
Please note Physicians and Advanced Practice Nurses order the Medication for Detox.
Each facility may have different guidelines.
Optimal score to induct medication at the BCJ.

8. What does detox look like?

9. What's your observation?
Is the inmate/patient exhibiting an increase in restlessness and anxiety?
From your observation of his body language and symptoms does this inmate present as if he is ready for a Medical Detox?
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Student use of the clicker for this slide. A=yes B=No

10. Conclusion
Addiction to opiates remains to be a health disparity in the Correctional Setting. It is essential that Correctional Healthcare providers and nursing students understand the detox process and the tools used for assessment.
Teaching content incorporates IOM and QSEN standards of learning such as;
Patient centered care
Teamwork and Collaboration
Teaching safety by demonstrating and evaluating measures

11. References
Barnsteiner, J. (2011, September 30). Teaching the culture of safety. The online Journal of Issues in Nursing, 16(3).
Chavez, R. (2012). Standards for opioid treatment in the criminal justice system: implications for nurses. Journal of Addictions Nursing, 23,
Dolansky, M., & Moore, S. (2013, September 30). Quality and safety education for nurses (QSEN) The key is systems thinking. The Inline Journal of Issues in Nursing, 18(3).
Pickard, M. (2007). The new bloom’s taxonomy: an overview for family and consumer sciences. Journal of Family and Consumer Sciences Education, 25(1). Retrieved from