Withdrawal Management
The Withdrawal Management tab provides a structured clinical framework for identifying, monitoring, and treating inmates experiencing acute substance withdrawal at intake and throughout their incarceration. Using validated assessment tools such as the CIWA-Ar and COWS scales, medical staff can document withdrawal severity in real time, trigger medication-assisted treatment protocols, and meet the constitutional standard of care for one of corrections’ highest-risk medical populations.
Validated Withdrawal Scales
Built-in CIWA-Ar (alcohol) and COWS (opioid) assessment scales with automatic severity scoring and protocol triggers.
Real-Time Monitoring Schedule
Automated monitoring schedules (q1h, q4h, q8h) generate nurse task reminders based on current withdrawal severity level.
MAT Protocol Integration
Medication-Assisted Treatment (MAT) orders are linked directly to the withdrawal episode, with dosing triggered by CIWA/COWS threshold scores.
Emergency Escalation Alerts
Critical CIWA/COWS scores automatically alert the on-call provider and document whether emergency transfer was initiated.
Step-by-Step: Withdrawal Monitoring & Treatment
Initiate a Withdrawal Episode
From the inmate’s medical record, click the Withdrawal Management tab (Tab 9). Click New Withdrawal Episode and select the Substance Type (Alcohol, Opioids, Benzodiazepines, Stimulants, or Polysubstance). Document the inmate’s reported Last Use Date/Time and Quantity Used to calculate the expected withdrawal onset window.
Select and Configure the Assessment Scale
The system pre-selects the appropriate validated assessment tool based on substance type: CIWA-Ar for alcohol/benzodiazepines and COWS for opioids. Set the initial Monitoring Frequency and assign the Responsible Nurse. The system will generate scheduled assessment reminders according to your facility’s withdrawal protocol.
Complete Assessment Scores
Click Record Assessment when due. The CIWA-Ar form guides the nurse through all 10 clinical items (nausea, tremor, diaphoresis, agitation, anxiety, headache, perceptual disturbances, orientation, paroxysmal sweats, and tactile disturbances) with numeric scoring. The COWS form scores 11 items including pulse rate, GI upset, restlessness, and pupil size. The total score is calculated automatically and classified as Mild, Moderate, Severe, or Critical.
Trigger Protocol-Based Treatment
When a CIWA-Ar or COWS score exceeds a configured threshold, the system displays the appropriate Standing Order Set for the provider to review and activate. For alcohol withdrawal, this typically includes benzodiazepine dosing per CIWA score band. Activated orders are automatically sent to the MAR for the nurse to administer.
Respond to Critical Scores & Escalate
A CIWA-Ar score of 15+ or COWS score of 25+ automatically generates a Critical Alert to the on-call provider. The nurse must document the provider’s response, any immediate interventions ordered, and whether an Emergency Medical Transfer was initiated. All escalation actions are time-stamped and create a complete legal record of the care provided.
Monitor Trends with the Score Graph
The Assessment Trend Graph displays all CIWA/COWS scores for the current episode on a timeline, showing whether the inmate is improving, plateauing, or deteriorating. This visual aid supports clinical decision-making and provides instant context during provider rounds or shift handoffs.
Close the Episode and Transition to MAT Enrollment
When withdrawal has resolved, click Close Episode and document the resolution status. If the inmate is a candidate for ongoing Medication-Assisted Treatment (buprenorphine, methadone, naltrexone), click Enroll in MAT Program to transition from the acute withdrawal episode into the facility’s long-term substance use disorder treatment program.
Create a New Medical Record
Click New Screening in the module toolbar. Complete the medical form:
- Inmate — search by name or booking number.
- Visit Type — Intake Screening, Sick Call, Scheduled Follow-Up, or Emergency.
- Priority — Routine, Urgent, or Emergent; Emergent pages on-call provider immediately.
- Chief Complaint / Findings — document symptoms, vitals, and objective observations.
- Provider — assign the clinician or nurse conducting the visit.
- Disposition — Treat and Return, Infirmary Admission, Hospital Transfer, or No Action.
- Add any Prescriptions, Follow-Up Date, or Restrictions.
- Click Save Record. Alerts fire automatically if vital signs are out of range.
💡 Pro Tips
- Never rely solely on an inmate’s self-report of substance use — document visible signs and symptoms at each CIWA/COWS assessment to build an objective clinical record that withstands legal scrutiny.
- Activate the q1h Monitoring setting for any inmate with a CIWA-Ar score above 8 at intake — alcohol withdrawal can escalate to life-threatening delirium tremens within hours and is one of the leading causes of in-custody deaths nationally.
- Use the MAT Enrollment handoff at episode close to maintain continuity of care — abruptly stopping MAT at booking and failing to re-enroll is a leading source of Eighth Amendment deliberate indifference lawsuits in jails.
Mobile View — Withdrawal Management
FortressDMS is fully responsive. Officers can access the Withdrawal Management on a phone or tablet directly from the field — no app install required.
Tab view with data rows
Scrolled / detail view