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 Q&A session from an adolescent opioid use disorder (OUD) training program, discussing various aspects of patient care and management. Here’s a summary:<br /><br />**Hydration:** Juice is considered less hydrating than water due to its sugar content. IV hydration is generally used for very ill patients or those experiencing vomiting or diarrhea.<br /><br />**COWS scale assessment:** A baseline COWS (Clinical Opiate Withdrawal Scale) assessment is recommended upon admission, with reassessment every four hours until a certain threshold is reached to begin medication for opioid withdrawal.<br /><br />**Staff involvement:** Residents, along with nurses, use MD Calc for COWS scores on their phones. Hospitalists provide coverage for patients experiencing withdrawal symptoms during off-hours, with full phone coverage available 24/7.<br /><br />**Training and Education:** Residents receive training during noon conferences and are advised to contact addiction medicine for guidance in severe withdrawal situations.<br /><br />**Behavioral and Safety Concerns:** Violent behaviors in these patients are not typical, but 1:1 sitter arrangements may be preferred for overnight admissions. Communication strategies include showing interest and empathy, avoiding mirroring potentially harmful language from parents.<br /><br />**Treatment Refusal and Emergency Commitment:** In Connecticut, a licensed psychiatrist can involuntarily commit a patient refusing treatment for up to 15 days using a physician emergency certificate, following an assessment.<br /><br />**Medication Interactions:** Nicotine patches don't contraindicate the use of sublingual buprenorphine, but patients should avoid nicotine products shortly before or after taking it. Baseline EKGs aren't standard for buprenorphine initiation, but may be required if drug interactions risk QT prolongation.<br /><br />**Legal Protections:** Administering naloxone outside the hospital is protected under Good Samaritan Laws, and healthcare workers’ risk of fentanyl exposure is very low if universal precautions are followed.<br /><br />**Continuity of Care:** Local health centers and programs provide follow-up care and medication for discharged patients, with specialized programs available for young patients.<br /><br />This training provides comprehensive guidance for managing adolescent OUD in both clinical settings and emergency situations.

Keywords

adolescent OUD

hydration

COWS scale

staff involvement

training and education

behavioral concerns

treatment refusal

medication interactions

legal protections

continuity of care