Abstract

Opioid use disorder (OUD) impacts over 1.2 million people in the United States. This population suffers from multiple comorbidities which can result in the need for hospitalization. Managing opioid withdrawal in hospitalized patients is challenging. Assessment tools like the Clinical Opioid Withdrawal Scale (COWS) help healthcare providers determine appropriate interventions to alleviate withdrawal symptoms for these patients. This quality improvement project aimed to decrease the number of incidents of violent behaviors and/or patients leaving the hospital against medical advice (AMA) during opioid withdrawal and enhance nurses’ ability to perform the COWS assessment. Organizational data from a 402-bed acute care hospital demonstrated a need for an evidence-based intervention to screen patients for opioid withdrawal and treat its symptoms, which may contribute to violent behaviors and/or leaving AMA. Patients screening positive for OUD were offered treatment, including COWS assessment and interventions based on the COWS score. Frequencies and percentages are reported for numerical variables. A Fisher’s Exact test was conducted to determine any potential associations between COWS, AMA, and violent behavior. A two-tailed z test was performed to evaluate the significance of the COWS assessment in relation to AMA and violent behaviors. Descriptive statistics evaluated nurses’ ability to administer the COWS. There was no statistical significance between COWS, AMA, and violent behaviors which could be a result of low acceptance of treatment. Nurses performed and documented the COWS assessment correctly 82% of the time. Despite the lack of statistical significance, this project holds substantial clinical importance for highlighting the need to treat hospitalized patients for opioid withdrawal.

Author Details

Christine Aliory, DNP, APRN, AGCNS-BC, CURN, ONC

Sigma Membership

Non-member

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Quality Improvement

Research Approach

N/A

Keywords:

Clinical Opioids Withdrawal Scale, AMA, Opioid Withdrawal

Advisor

Dawn Rivas

Degree

DNP

Degree Grantor

Northern Arizona University

Degree Year

2025

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Proxy-submission

Full Text of Presentation

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