THE RECOVERY CENTER
|Date |time |Standing Order-set for Suboxone/Subutex Induction and Maintenance |Action Taken | |
|Ordered | | |Signature | |
| | | Complete level of care (LOC) assessment | | |
| | | Admit to appropriate LOC | | |
| | | Initial medication-assisted treatment evaluation with MD | | |
| | | Buprenorphine consent procedure with clinician | | |
| | | Lab: CBC, hepatic function panel, urine drug screen, bHcG (females), hepatitis | | |
| | |panel, +/- HIV | | |
| | | Check prescription drug monitoring program (PDMP) website | | |
| | |Suboxone Induction Orders | |
| | |Day One | | |
| | |COWS scale prior to dosing | | |
| | |Administer _____mg. buprenorphine sublingually | | |
| | |Return to treatment group or observation with RN | | |
| | |In 0.5-2 hours, repeat COWS. If score increased or adverse symptoms develop, call MD. | | |
| | |If COWS less than or equal to initial scale, may administer additional _____mg, or send | | |
| | |patient home. | | |
| | |Patient may take additional buprenorphine as directed by MD, up to total daily dose on | | |
| | |Day 1 of _____mg | | |
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| | |Day Two | | |
| | |Patient returns for appointment with MD as indicated for follow-up and dose adjustment if| | |
| | |needed. | | |
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| | |Special instructions: | | |
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| | |MD Signature:_________________________ Date:_______________ | | |
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| | |RN/Clinician | |
| | |Signature: ______________________________Date:_____________ | |
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Patient Label
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