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Related Experiment Video

Updated: Sep 10, 2025

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A Quality Improvement Pilot to Implement an Inpatient Opioid Withdrawal Screening Pathway.

Cherie Avants1, Carolyn Huffman2, Rachel Graham3

  • 1Cherie Avants, DNP, APRN, NP, PMGT-BC, AP-PMN, Atrium Health Wake Forest Baptist, Winston Salem, North Carolina, and Duke University School of Nursing, Durham, North Carolina.

Journal of Addictions Nursing
|August 27, 2025
PubMed
Summary
This summary is machine-generated.

Quality improvement methods significantly increased inpatient screening for opioid withdrawal using the Clinical Opioid Withdrawal Scale (COWS). This initiative reduced hospital stays and discharges against medical advice, improving patient care.

Keywords:
Clinical Opioid Withdrawal Scale (COWS)Nurse-Driven ScreeningOpioid Withdrawal

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Area of Science:

  • Healthcare Quality Improvement
  • Clinical Practice Guidelines
  • Patient Outcomes

Background:

  • Opioid withdrawal screening in hospitals often relies on subjective measures.
  • The Clinical Opioid Withdrawal Scale (COWS) is validated but underutilized in inpatient settings.
  • Improving inpatient opioid withdrawal management is crucial for patient safety and effective treatment.

Purpose of the Study:

  • To enhance inpatient screening for opioid withdrawal symptoms.
  • To increase the use of the Clinical Opioid Withdrawal Scale (COWS) in hospitals.
  • To improve outcomes for patients at risk of opioid withdrawal during hospitalization.

Main Methods:

  • A pre-post test design utilizing Plan-Do-Study-Act cycles.
  • Phase I: A 2-week educational program for nurses and providers on opioid withdrawal and COWS.
  • Phase II: A 12-week implementation of an Opioid Withdrawal Screening Pathway with COWS assessments and audits.

Main Results:

  • Significant increase in illicit drug use screening rates and COWS assessments.
  • High completion rates for educational programs.
  • Significant reductions in discharge against medical advice rates and average length of stay.

Conclusions:

  • Implementation of an education program and screening pathway improved opioid use screening.
  • Increased utilization of COWS assessments in the healthcare organization.
  • Quality improvement initiatives can effectively enhance inpatient opioid withdrawal management.