Alison Enimpah

Implementation of the Clinical Opiate Withdrawal Scale for Use with Hospitalized Inpatients

Background: The opioid epidemic is reaching massive proportions, thereby putting pressure on the health care system to prioritize comprehensive care of the patient with a substance use disorder. This care continuum includes periods of hospitalization for acute withdrawal management. However, clinical opioid withdrawal symptoms might be obscured due to inadequate knowledge or assessment skills, which could lead to poorer outcomes for the patient. Introducing a standardized tool can help determine the presence and severity of acute withdrawal and facilitate communication between providers about necessary interventions during an inpatient visit. 

Methods: A pre- and post- survey will evaluate nursing perception of care of the individual with an opioid use disorder. In addition, pre- and post- electronic health data (length of stay, number of comfort or treatment medications ordered, number of consults ordered) will be compared for improvements in the care of patients in withdrawal. Intervention: The Clinical Opioid Withdrawal Scale (COWS) was implemented in adult inpatient units within an academic medical center via the electronic medical record (EHR). This was done in collaboration with nursing informatics and supported by educational content created and distributed to bedside nurses. Results: A change in nursing perception of opioid use, care and communication was not able to be identified likely due to insufficient participation. The implementation of the COWS within the EHR resulted in an increase in the total number of patients being assessed compared to pen and paper form use. However, the number of patients hospitalized specifically with an opioid use disorder decreased limiting statistical analysis of changes in care. 

Conclusions: The Clinical Opioid Withdrawal Scale has shown to be useful in the inpatient setting as a tool that provides quantitative measurement that facilitates communication for improved care to the patient in opioid withdrawal. The tool is helpful when it is readily available, can be well understood and quickly administered by the nurses and providers who are using it, and is easily interpreted and communicated through the continuum of care, including the inpatient setting.

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