CIWA, COWS scale, and drug courts
CIWA scale - answer used by nurses to assess risk and severity of *alcohol* withdrawal
CIWA- Scale assess for these common withdrawal symptoms - answer-
nausea/vomiting
- tremors
- anxiety
- agitation
- paroxysmal sweats
- orientation and clouding of sensorium
- tactile disturbances
- auditory disturbances
- visual disturbances
- headache
CIWA procedure - answer1. Assess and rate each of the 10 criteria of the CIWA scale.
Each criterion is rated on a scale from 0 to 7, except for "Orientation and clouding of
sensorium" which is rated on scale 0 to 4. Add up the scores for all ten criteria. This is
the total CIWA-Ar score for the patient at that time. Prophylactic medication should be
started for any patient with a total CIWA-Ar score of 8 or greater (ie. start on withdrawal
medication). If started on scheduled medication, additional PRN medication should be
given for a total CIWA-Ar score of 15 or greater.
2. Document vitals and CIWA-Ar assessment on the Withdrawal Assessment Sheet.
Document administration of PRN medications on the assessment sheet as well.
3. The CIWA-Ar scale is the most sensitive tool for assessment of the patient
experiencing alcohol withdrawal. Nursing assessment is vitally important. Early
intervention for CIWA-Ar score of 8 or greater provides the best means to prevent the
progression of withdrawal.
when to perform vitals for CIWA - answerb. If initial score greater or equal to 8 repeat
q1h x 8 hrs, then if stable q2h x 8 hrs, then if stable q4h.
c. If initial score < 8, assess q4h x 72 hrs. If score < 8 for 72 hrs, d/c assessment. If
score greater or equal 8 at any time, go to above
Indications for PRN medication CIWA: - answera. Total CIWA-AR score 8 or higher if
ordered PRN only (Symptom-triggered method).
b. Total CIWA-Ar score 15 or higher if on Scheduled medication. (Scheduled + prn
method)
, Consider transfer to ICU for any of the following: Total score above 35, q1h assess. x
more than 8hrs required, more than 4 mg/hr lorazepam x 3hr or 20 mg/hr diazepam x
3hr required, or resp. distress
Scale for Scoring CIWA - answer0 - 9: absent or minimal withdrawal
10 - 19: mild to moderate withdrawal
more than 20: severe withdrawal
COWS Scale - answerClinical Opiate Withdrawal Scale
CIWA - answerClinical Institute Withdrawal Assessment
COWS scale
for buprenorphine/ naloxone induction: - answer- enter scores at time zero
- 1-2hrs after the first dose
- and at additional time that buprenorphine/naloxone is given
COWS scale
components assessed: - answer- resting pulse (measured after patient is sitting/lying for
1 minute)
- sweating (over past 1/2 hour not accounted for by room temperature or patient activity)
- restlessness
- pupil size
- bone or joint aches
- runny nose or tearing (not accounted for by colds/allergies)
- GI upset (over past 1/2 hr)
- tremor (observation of outstretched hand).
- yawning
- anxiety or irritability
CIWA scale - answer used by nurses to assess risk and severity of *alcohol* withdrawal
CIWA- Scale assess for these common withdrawal symptoms - answer-
nausea/vomiting
- tremors
- anxiety
- agitation
- paroxysmal sweats
- orientation and clouding of sensorium
- tactile disturbances
- auditory disturbances
- visual disturbances
- headache
CIWA procedure - answer1. Assess and rate each of the 10 criteria of the CIWA scale.
Each criterion is rated on a scale from 0 to 7, except for "Orientation and clouding of
sensorium" which is rated on scale 0 to 4. Add up the scores for all ten criteria. This is
the total CIWA-Ar score for the patient at that time. Prophylactic medication should be
started for any patient with a total CIWA-Ar score of 8 or greater (ie. start on withdrawal
medication). If started on scheduled medication, additional PRN medication should be
given for a total CIWA-Ar score of 15 or greater.
2. Document vitals and CIWA-Ar assessment on the Withdrawal Assessment Sheet.
Document administration of PRN medications on the assessment sheet as well.
3. The CIWA-Ar scale is the most sensitive tool for assessment of the patient
experiencing alcohol withdrawal. Nursing assessment is vitally important. Early
intervention for CIWA-Ar score of 8 or greater provides the best means to prevent the
progression of withdrawal.
when to perform vitals for CIWA - answerb. If initial score greater or equal to 8 repeat
q1h x 8 hrs, then if stable q2h x 8 hrs, then if stable q4h.
c. If initial score < 8, assess q4h x 72 hrs. If score < 8 for 72 hrs, d/c assessment. If
score greater or equal 8 at any time, go to above
Indications for PRN medication CIWA: - answera. Total CIWA-AR score 8 or higher if
ordered PRN only (Symptom-triggered method).
b. Total CIWA-Ar score 15 or higher if on Scheduled medication. (Scheduled + prn
method)
, Consider transfer to ICU for any of the following: Total score above 35, q1h assess. x
more than 8hrs required, more than 4 mg/hr lorazepam x 3hr or 20 mg/hr diazepam x
3hr required, or resp. distress
Scale for Scoring CIWA - answer0 - 9: absent or minimal withdrawal
10 - 19: mild to moderate withdrawal
more than 20: severe withdrawal
COWS Scale - answerClinical Opiate Withdrawal Scale
CIWA - answerClinical Institute Withdrawal Assessment
COWS scale
for buprenorphine/ naloxone induction: - answer- enter scores at time zero
- 1-2hrs after the first dose
- and at additional time that buprenorphine/naloxone is given
COWS scale
components assessed: - answer- resting pulse (measured after patient is sitting/lying for
1 minute)
- sweating (over past 1/2 hour not accounted for by room temperature or patient activity)
- restlessness
- pupil size
- bone or joint aches
- runny nose or tearing (not accounted for by colds/allergies)
- GI upset (over past 1/2 hr)
- tremor (observation of outstretched hand).
- yawning
- anxiety or irritability
