Degree Name

Master of Science in Nursing (MSN)

Document Type

Limited Access


School of Nursing



Date of Original Version



The opioid epidemic is a significant concern for the United States. Forty-eight and a half million Americans have either used illicit drugs such as heroin or have misused prescription opioid drugs. The exponential rise in opioid use increases the risk of opioid withdrawal, thus making opioid withdrawal assessment a top priority, especially for hospitalized individuals. The Clinical Opiate Withdrawal scale (COWS) is highly recommended to assess opioid withdrawal in hospitalized individuals and is well supported by the American Society of Addiction Medicine National Practice guideline and the World Health Organization. Despite the availability of reliable opioid withdrawal assessment scales, improper use and underuse of these scales are reported. Nurses education on the use of the COWS could address this gap. The purpose of this quality improvement project was to determine the effectiveness of an educational intervention concentrating on the COWS to improve critical care nurse’s knowledge and confidence in scale use. The quality improvement project utilized a pre-test, educational intervention and a posttest design. Twenty-eight out of the possible 60 critical care nurses participated in the quality improvement session. The mean scores on the pretest and post-test were 41.2 % and 83.5%, respectively. This showed a percentage increase in knowledge of 42.3. Furthermore, participants reported higher level of confidence in their ability to utilize the COWS. Receipt of COWS education could promote proper use of the scale. The advanced practice nurse can assist in establishing and implementing educational programs that focus on the importance of opioid withdrawal assessment through evidence-based practice.


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