COWS ASSESSMENT

Date and time: [Date, clock time]
Patient: [Name or ID, age]
Location: [Emergency department, inpatient unit, withdrawal management, clinic, or other]
Rated by: [Name, credentials]
Purpose: [Baseline, before a first buprenorphine dose, after a dose, taper check, or new symptoms]

OPIOID HISTORY
Last opioid: [Which opioid, route, and usual daily amount]
Time of last use: [Date and clock time; hours since]
Fentanyl exposure: [Known, possible, unlikely, or test result]
Current treatment: [Methadone or buprenorphine dose and time of the last dose, taper step, or none]
Other substances: [Alcohol, benzodiazepines, stimulants, or none]

VITALS
Pulse at rest: [Beats a minute after one minute still]
BP and temperature: [Readings]
Fluids: [Vomiting or diarrhea in the past day, and whether fluids stay down]

SIGN SCORES
Resting pulse: [Points]
Sweating: [Points]
Restlessness: [Points]
Pupil size: [Points]
Bone or joint aches: [Points]
Runny nose or tearing: [Points]
GI upset: [Points]
Tremor: [Points]
Yawning: [Points]
Anxiety or irritability: [Points]
Gooseflesh skin: [Points]
Total score: [0 to 48]
Severity: [No active withdrawal, mild, moderate, moderately severe, or severe]
Not counted: [Any sign left out because another cause explains it, or none]

TREATMENT GIVEN
Opioid treatment: [Drug, dose, route, and clock time; or none, and why]
Symptom relief: [Clonidine, loperamide, antiemetic, pain relief, or none]
Response: [Effect seen, or precipitated withdrawal suspected]

REASSESSMENT
Next COWS due: [Clock time and interval]
Call the prescriber if: [Score limit, a rise after a dose, vital sign limits, or heavy vomiting]
Naloxone: [Kit given and use taught, already has one, or declined]
Handover: [Who was told, and when]