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Autotext Dot Phrases for Cerner EHR

All templates, "autotexts", procedure notes, and other documents on these pages are intended as examples only for educational purposes.  Your documentation in the medical record should always reflect precisely your specific interaction with an individual patient.  Do not merely copy and paste a prewritten note element into a patient's chart - "cloning" is unethical, unsafe, and potentially fradulent.

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ADM Buprenorphine Inpatient

Patient meets criteria for severe opiate use disorder by DSM 5 criteria. Risks/benefits/alternatives were discussed in detail and patient has made an informed decision to begin buprenorphine.

· Check HIV/HCV/HBV/LFTs/Utox/Preg test if not done

· If pregnant, obtain FHTs or NST as indicated

· Request an ADTS consult. Educated on harm reduction.

· Educate patient and RN that buprenorphine is a sublingual formulation and proper technique.

· Ensure patient has had NO opiates for at least 6 hours (short acting). Note, long acting opiates and methadone may take up to 36 hours for the initiation of withdrawal.

· Day 1: Check COWS when in withdrawal:

o if <8, reassess every 2 hours while awake until COWS >8

o Once >/= 8

§ administer 4mg of buprenorphine/naloxone and reassess COWS in 1.5 hours.

· COWS <8: reassess in 6 hours as needed

· COWS >/=8, dose again and then reassess every 6 hours as needed

o Can repeat COWS and dosing every 6 hours as needed

o Max dose day 1= 16mg total (average 8-12 mg)

· Day 2: Give total Day 1 dose on Day 2 as a once daily dose in the AM.

o May add an additional 2-4 mg as needed throughout the day

o Max dose day 2= 20mg total

· Day 3+: Give total Day 2 dose on Day 3 as a once daily dose in the AM unless divided dosing needed for pain/anxiety.

o Max dose 24mg


- May divide dosing as needed for pain/anxiety. May decrease dose as needed for any adverse effects.

- By 72 hours, ensure an x-waiver provider is involved in this case. Prior to 72 hours, any provider may begin buprenorphine.

** Caution: Expert consultation for any of the below: - In pregnancy, use buprenorphine mono-product - If methadone used in past week

- LFTs >5x ULN

- Surgery/Procedure in next 48 hours

- Severe acute pain (mild-mod pain can consider splitting dose to BID-q6) or adding a full agonist PRN (hydromorphone or fentanyl)

- recent use of other sedatives (benzodiazepines, barbiturates, z-drugs, opiates, EtOH) The following adjunctive medications can be used for symptom control: - acetaminophen 650mg q6 prn pain (as tolerated by LFTs). - clonidine 0.1-0.3 mg PO q6-8 hours prn vasomotor symptoms (hold if BP< 100/70 and NTE 1.2 mg/day). - hydroxyzine 25mg po q6 hours prn anxiety. - trazadone 50-100mg po qhs prn insomnia. - loperamide 4mg po initially, then 2 mg PRN each additional loose stool (NTE 16mg/24 hours).

- ondansetron 4mg po/SL/IV q6 hours prn nausea.

- melatonin 3mg po qhs prn insomnia.

On Discharge:

- Please provide enough Rx for patient to last until an appointment with a bup provider. Rx must come from a x-waivered provider. Appointment with bup provider should be within 1 week and max Rx given should be a 7 day supply.

- Provide discharge rx for nasal naloxone.

- Consider PEP for HIV if indicated.

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