Disturbance to Archaeology Site in Canal Flats



PHYSICIAN/ NURSE PRACTITIONER ORDERS FOR OPIATE WITHDRAWAL

FAX TO MARY BASIL HOUSE – 778-517-5609

Monitor withdrawal symptoms BID and PRN using the Clinical Opiate Withdrawal Scales (COWS)

COWS 5-12 = Mild Withdrawal (Use Symptomatic Protocol only)

COWS 13-24 = Moderate Withdrawal (Use Symptomatic and Clonidine Protocols)

COWS 25-36 = Moderately Severe Withdrawal (may need to add Valium)

COWS greater than 26 = Severe Withdrawal

1. Symptomatic Protocol (COWS = 5-12)

Multivitamin 1 Tab PO daily

DimenhydRINATE 50mg to 100 mg PO every 4 hours PRN for nausea and vomiting

Acetaminophen 325mg to 650 mg PO Q4-6 hour PRN for headache or mild pain (max 4g/24 hrs)

Ibuprofen 200mg to 400 mg PO QID PRN for pain/ headache

Ranitidine 150mg PO BID PRN for heartburn

Calcium 333mg/Magnesium 1-2 tabs PO PRN for mild muscle cramping (max. of 3 tabs/24hr)

Sennosides 8.6mg PO BID PRN for constipation

Lomperamide 4 mg PO x 1 dose then 2 mg PO after each loose bowel movement, to

maximum 16 mg/24 hour PRN for diarrhea

Chloral Hydrate 500mg to 1500 mg PO HS PRN for sleep deprivation x 3 nights. Avoid with renal failure (GFR less than 48ml/min) or hepatic compromise. Take with fruit juice.

Symptomatic Protocol should be fairly rigid and non-negotiable to prevent drug seeking behaviour.

The on-judgemental attitudes of staff will lessen with anxiety and stress the client will be experiencing.

2. Clonidine Protocol

• Start Clonidine for Moderate withdrawal symptoms (COWS 13-24)

• Clonidine 0.1-0.2 mg PO QID x 4 days (withhold dose if diastolic BP less than 60 mm Hg)

THEN

• Clonidine 0.025-0.05 mg PO QID x 2 days (withhold dose if diastolic BP less than 60 mm Hg)

• Assess patient for severity of opiate withdrawal prior to each dose of Clonidine using the Clinical Opiate Withdrawal Scale

• Check BP before each dose

• Monitor for S&S of sympathetic nervous system depression (resulting from overdose) such as bradycardia, miosis, hallucinations, hypotension, hypothermia, mild drowsiness to coma, hyporeflexia, seizures, dysrhythmias, respiratory depression, apnea, pallor.

3. For Moderately Severe to Severe withdrawal symptoms, (COWS greater than 36 or score greater than or equal to 10 with evident agitation and the maximum tolerated Clonidine has been given) then …

Valium 10-20 mg PO prn may be given at the nurse’s discretion (Risk: Resp. Depression)

4. CURRENT MEDICATIONS: Prescriptions required for all medications during stay, please prescribe these on Physicians/NP orders, see page 2.

Physician / NP Signature:_______________________________________Date:_____________________________________

After Hours Contact Number:___________________________________ Office/Clinic Phone:__________________________

PHYSICIAN/ NP ORDER

Name:

Allergies:

|Prohibited |Correct Term |Prohibited |Correct Term |Prohibited |Correct Term |

|Abbreviations | |Abbreviations | |Abbreviations | |

|U, IU, u or iu |UNIT |D/C |Discharge or |< or > |Less than or greater |

| | | |discontinue | |than |

|QD or qd |DAILY |cc |ml |Trailing zero (3.0 |NEVER use zero after |

| | | | |mg) |decimal |

|QOD or qod |Every other day |i/g |mcg |Lack of leading zero |ALWAYS use zero before |

| | | | | |decimal |

|Drug name substitution|Write generic drug |@ |at |OS, OD, OU |Left eye, right eye, |

| |name | | | |both eyes |

|Date |Time |Orders |

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All medication orders require a name, dose, route, frequency, duration and signature

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Affix Client Label

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