Community: Hospital Emergency Department
Medication: Buprenorphine
ED MAR Intake and Assessment
Watch an experienced IL provider describe the intake and assessment protocols and patient materials that are used where he works.
Hospital Emergency Department
Intake & Assessment
Triage Nurse
Assess patient’s chief complaint and perform a NIDA Quick Screen
non-acute complication, positive screen
acute complication linked to substance abuse
MAR Provider / Nurse
Examine patient, evaluate for medical emergencies, and decide if hospital admission required
if high DAST-10
if not admitted
MAR Provider / Nurse
Assess withdrawal with COWS and complete a UDS.
Use motivational interviewing to assess the patients’ goals related to substance use and readiness to change.
If patient is interested, begin buprenorphine initiation following the CA Bridge Hospital Quick Start
Resources
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ED MAR Initiation
Watch an experienced IL provider describe the initiation protocols and patient materials that are used where she works.
Hospital Emergency Department
Initiation
Start
MAR Provider
When COWS > 8, administer 4-8 mg buprenorphine and monitor.
If concerned about fentanyl, begin with 2 mg dose, repeating every 30 min, while monitoring closely for precipitated withdrawal.
After 1 hr
MAR Provider
If COWS improves, administer 8 mg dose and discharge.
(see next step)
If COWS doesn’t improve (suggesting fentanyl exposure), administer 4 mg dose, repeating every 30 min, while monitoring closely for precipitated withdrawal (max = 16 mg).
Discharge
ED Nurse
Discharge patient with a short-term (3 to 7 days) script of 8 mg buprenorphine twice-a-day along with naloxone 4mg/actuation.
Educate patient on how to use medications.
ED MAR Warm Handoff
Watch an experienced IL provider describe the warm handoff protocols and patient materials that are used where she works.
Hospital Emergency Department
Warm Handoff
During ED Initiation
Recovery Coach / Patient
When paged for bedside consult, use a handout to educate patient on how to take buprenorphine.
After second dose, return to determine if patient is amenable to continuing treatment.
Before Discharge
If possible, schedule next-day (or soonest) appointment at an in-system MAR clinic in patient’s neighborhood. If not possible, schedule next-day (or soonest) appointment at an out-of-system MAR clinic and obtain patient’s release of information.
Address barriers (travel, insurance, etc.) to attending after-care appointment.
Next Day
Recovery Coach
Remind patient of appointment. Check later to determine if patient attended and note in chart.
Patient / Outpatient MAR Provider
If no-show, attempt to reengage patient to attend an appointment.
Address barriers again.
Resources
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