How to Record a Withdrawal Scale (CIWA & COWS)

Log in to Olari with your own username and password. Have the client’s answers ready — both what you observe (like sweating or shaking) and what the client tells you (like nausea or anxiety).

Who can do this: Administrator, Full No Admin, Full No Billing, and Detox Monitor. (Read Only staff can look at withdrawal scores but cannot add them.) This is the same screen and the same access as recording vitals.

What a “withdrawal scale” is: A short list of questions that measures how strongly a client is going through withdrawal. Olari has two of them: CIWA (used for alcohol withdrawal) and COWS (used for opioid withdrawal). You score each question and then insert total at the bottom.

PART 1: Open the Withdrawal Scale

The withdrawal scale lives on the same screen as vitals — the Add Vitals + Withdrawal Scale window.

1. From the Client Census, click the client’s name to open their chart.
2. Open the client’s Vitals section, or find the Vitals task in the client’s task list.
3. Click the button to add a new entry:
   • Vitals tab select to Add, and the Vitals + Withdrawal Scale window open
   • Tasks tab locate Vitals and click to Complete and the Vitals + Withdrawal Scale window open

✓ What you should see: A list of scored questions, with a total at the bottom of the window.

PART 2: Pick the Right Scale — CIWA or COWS

1. Click the Withdrawal Scale tab at the top of that window.
   • Choose CIWA if the client is withdrawing from alcohol.
   • Choose COWS if the client is withdrawing from opioids (such as heroin, fentanyl, or prescription pain pills).

💡 Tip: If you are not sure which one to use, check the client’s Drug Use section or ask the nurse or clinician. Using the wrong scale gives a score that does not mean anything.

PART 3: Score Each Question

1. Go down the list one question at a time. For each one, pick the number that best matches what you see or what the client tells you. A higher number means a stronger symptom.
   • On CIWA (alcohol) you will score things like: nausea, tremor (shaking), sweats, anxiety, agitation, headache, feeling things that aren’t really there, and how aware the client is.
   • On COWS (opioids) you will score things like: resting pulse, sweating, restlessness, pupil size, bone aches, runny nose, watery eyes, upset stomach, tremor, yawning, and goosebumps.

💡 Tip: Score only what you actually see or are told. Do not round up or guess. If a symptom is not there, choose 0 — do not leave it blank, because a blank does not count toward the total.

✓ What you should see: The total score recorded on the Vitals screen.

PART 4: Read the Score and Save

Select the appropriate CIWA/COWS total range and input the total at the bottom. The total score tells you how severe the withdrawal is.

For CIWA:

• 0 – 5 = minimal withdrawal
• 6 - 10 = mild withdrawal
• 11 – 15 = moderate withdrawal
• 16 – 67 = severe withdrawal

COWS uses its own ranges. Read the severity Olari shows on the screen for the score, and follow your facility’s protocol for what each level means.

Notes: Add a short note in the Vitals Notes box if anything needs explaining (for example, “client refused temperature”).

Click Save.

⚠ Important: A high score can mean the client needs a nurse or clinician right away. Do not wait — follow your facility’s rule for when and who to call.

✓ What you should see: The assessment now appears in the client’s vitals/withdrawal history with the date, the time, and your name.

PART 5: Check or Fix an Assessment

1. Open the client’s Vitals section to see the list of past assessments, newest first.
2. To fix a mistake, open the entry and change the numbers, then Save again. If you cannot edit it, ask an Administrator.

If something goes wrong

• I don’t see the Withdrawal Scale tab. You may be on a view-only role, or you opened a tab that only shows vitals. Ask an Administrator to check your access.
• I picked the wrong scale (CIWA vs COWS). From dropdown menu above switch to the appropriate scale
• The Complete button is grey and won’t click. That task is assigned to a different role. This is normal — someone in that role will complete it.