7561E Management of Opioid Use Disorder in the Hospitalized Adolescent: Tips for the Pediatric Nurse-Q&A from 9-26

Q&A from 9-26

Pdf Summary

The document contains a series of questions and answers from an adolescent opioid use disorder (OUD) training session by Dr. Camenga on various topics related to patient management and protocols in a hospital setting. Here is a summary:<br /><br />**Hydration and IV Use**: Juice is less effective for hydration compared to water due to its sugar content. IV hydration is considered for very sick patients, usually in the case of vomiting or diarrhea, following standard pediatric indications.<br /><br />**COWS Scale Monitoring**: The Clinical Opiate Withdrawal Scale (COWS) is used to assess withdrawal symptoms every four hours until a specific score is reached, which determines when medication can start. This monitoring is primarily conducted by nursing staff and residents, the latter often using an app like MD Calc.<br /><br />**Patient Management Off-Shift**: Hospitalists provide coverage in withdrawal scenarios during off-hours, with 24-hour phone support available for guidance, particularly encouraged for severe withdrawal situations.<br /><br />**Risk and Behavioral Management**: While violent behavior is uncommon, having a 1:1 sitter is preferred for new admissions to manage any risk effectively. Communication with patients should be calm and unreactive, maintaining a focus on their specific experiences without using negatively loaded language.<br /><br />**Involuntary Treatment**: For adolescents refusing treatment, a 15-day involuntary commitment can be enacted in Connecticut following a psychiatrist's assessment.<br /><br />**Buprenorphine and Nicotine Use**: Nicotine patches are not a contraindication for buprenorphine, but the patient should avoid other nicotine products shortly before and after taking it. Baseline EKGs are not standard before buprenorphine but are occasionally required for patients at risk of QT prolongation.<br /><br />**Post-Discharge Follow-Up**: For monthly Sublocade injections, New Haven area patients can use local clinics and psychiatrists who provide injectable buprenorphine.<br /><br />**Safety Protocols**: Risk of fentanyl exposure to nurses is low with universal precautions. Naloxone administration outside the hospital is protected by Good Samaritan Laws, but EMS activation is advised.<br /><br />Overall, this training emphasizes careful monitoring, communication, and safety protocols in managing adolescent OUD.

Keywords

adolescent OUD

hydration

IV use

COWS scale

patient management

risk management

involuntary treatment

buprenorphine

nicotine use

safety protocols