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EMBED

Emergency Department-Initiated Buprenorphine for Opioid Use Disorder (EMBED)

Assess OUD, opioid withdrawal, and treatment readiness for ED-initiated buprenorphine.

OUD Present

YesNo

How ready is the patient to start treatment with Buprenorphine today?

Brief Negotiation Interview

YesNot ready for treatment

Assessed COWS Score

Withdrew Severity

None to Mild <8Mild to Moderate 8-12Moderate to severe

Is the patient pregnant?

YesNo

Do you have a waiver to prescribe Buprenorphine?

YesNo

Advice:

Please fill out required fields

Advice:

Hold in Ed

I have used the EMBED Buprenorphine Initiation decision support calculator to assess this patient for opioid use disorder, opioid withdrawal, and readiness for treatment. Using this calculator, I determined that this patient has:

(1) Opioid use disorder.
(2) A clinical opioid withdrawal scale of less than 8.
(3) Has expressed readiness to begin treatment with buprenorphine.

The patient will receive:

(1) Buprenorphine 4 mg once their COWS score is 8 or greater in the ED today.
(2) A prescription for naloxone.
(3) Referral to treatment.
(4) Education on opioid use disorder, naloxone use, this study, and instructions to return to the ED in 24 hours for their next dose of buprenorphine if they are unable to schedule an appointment with a buprenorphine prescriber tomorrow.

To view Orders, Prescriptions, Discharge Instructions and more, click on 'Next Steps.'

Advice:

Hold in Ed

I have used the EMBED Buprenorphine Initiation decision support calculator to assess this patient for opioid use disorder, opioid withdrawal, and readiness for treatment. Using this calculator, I determined that this patient has:

(1) Opioid use disorder.
(2) A clinical opioid withdrawal scale of less than 8.
(3) Has expressed readiness to begin treatment with buprenorphine.

The patient will receive:

(1) Buprenorphine 4 mg once their COWS score is 8 or greater in the ED today.
(2) A prescription for naloxone.
(3) Referral to treatment.
(4) Education on opioid use disorder, naloxone use, this study, and instructions to return to the ED in 24 hours for their next dose of buprenorphine if they are unable to schedule an appointment with a buprenorphine prescriber tomorrow.

To view Orders, Prescriptions, Discharge Instructions and more, click on 'Next Steps.'

Advice:

Start 4mg BUP (2x)

I have used the EMBED Buprenorphine Initiation decision support calculator to assess this patient for opioid use disorder, opioid withdrawal, and readiness for treatment. Using this calculator, I determined that this patient has:

(1) Opioid use disorder.
(2) A clinical opioid withdrawal scale of 8-12.
(3) Has expressed readiness to begin treatment with buprenorphine.

The patient will receive:

(1) Buprenorphine 4 mg in the ED today, be observed for at least 30 minutes, and given another 4mg dose if they have no side effects.
(2) Prescriptions for buprenorphine 16mg sublingual daily for 3 days and naloxone nasal spray.
(3) Referral to treatment.
(4) Education on opioid use disorder, naloxone use, this study and instructions to return to the emergency department in 24 hours for their next dose of buprenorphine if they are unable to schedule an appointment with a buprenorphine prescriber tomorrow.

To view Orders, Prescriptions, Discharge Instructions and more, click on 'Next Steps.'

Advice:

Start 8mg BUP

I have used the EMBED Buprenorphine Initiation decision support calculator to assess this patient for opioid use disorder, opioid withdrawal, and readiness for treatment. Using this calculator, I determined that this patient has:

(1) Opioid use disorder.
(2) A clinical opioid withdrawal scale of greater than 12.
(3) Has expressed readiness to begin treatment with buprenorphine.

The patient will receive:

(1) Buprenorphine 8 mg in the ED today and then be observed for at least 30 minutes to ensure no side effects to the medication.
(2) A prescription for buprenorphine 16mg sublingual daily for 3 days and for naloxone nasal spray.
(3) Referral to treatment.
(4) Education on opioid use disorder, naloxone use, this study, and instructions to return to the emergency department in 24 hours for their next dose of buprenorphine if they are unable to schedule an appointment with a buprenorphine prescriber tomorrow.

To view Orders, Prescriptions, Discharge Instructions and more, click on 'Next Steps.'

Advice:

BUP Rx for Home

I have used the EMBED Buprenorphine Initiation decision support calculator to assess this patient for opioid use disorder, opioid withdrawal, and readiness for treatment. Using this calculator, I determined that this patient has:

(1) Opioid use disorder.
(2) A clinical opioid withdrawal scale of less than 8.
(3) Has expressed readiness to begin treatment with buprenorphine.

The patient will receive:

(1) Instructions for home induction of buprenorphine.
(2) Prescriptions for buprenorphine 16mg sublingual daily for 3 days and naloxone spray.
(3) Referral to treatment.
(4) Education on opioid use disorder, naloxone use, this study and instructions to return to the emergency department in 24 hours for their next dose of buprenorphine if they are unable to schedule an appointment with a buprenorphine prescriber tomorrow.

To view Orders, Prescriptions, Discharge Instructions and more, click on 'Next Steps.'

Contact Us

info@alcoholwithdrawalcalc.com

Phoenix, AZ 85050

OUD Present
Ask the patient the following questions about his/her use of opioids in the past 12 months to determine a diagnosis. Select all that apply:

COWS Score for Opiate Withdrawal

This assessment quantifies the severity of opiate withdrawal. For each item, select the appropriate description of the patient’s signs or symptoms.

Resting Pulse Rate (BPM) Measure pulse rate after patient is sitting or lying down for 1 minute

≤80 ( +0 )81-100 ( +1)101-120 ( +2 )>120 ( +4 )

Sweating. Sweating not accounted for by room temperature or patient activity over the last 0.5 hours

No report of chills or flushing ( +0 )Subjective report of chills or flushing ( +1)Flushed or observable moistness on face ( +2 )Beads of sweat on brow or face ( +3 )Sweat streaming off face ( +4 )

Restlessness observation during assessment

Able to sit still ( +0 )Reports difficulty sitting still, but is able to do so ( +1)Frequent shifting or extraneous movements of legs/arms ( +3 )Unable to sit still for more than a few seconds ( +5)

Pupil size

Pupils pinned or normal size for room light ( +0 )Pupils possibly larger than normal for room light ( +1)Pupils moderately dilated ( +2 )Pupils so dilated that only the rim of the iris is visible ( +5)

Bone or joint aches If patient was having pain previously, only the additional component attributed to opiate withdrawal is scored

Not present ( +0 )Mild diffuse discomfort ( +1)Patient reports severe diffuse aching of joints/ muscles ( +2 )Patient is rubbing joints or muscles and is unable to sit still because of discomfort ( +4)

Runny nose or tearing Not accounted for by cold symptoms or allergies

Not present ( +0 )Nasal stuffiness or unusually moist eyes ( +1)Nose running or tearing ( +2 )Nose constantly running or tears streaming down cheeks ( +4)

GI Upset Over last 0.5 hours

No GI symptoms ( +0 )Stomach Cramps ( +1)Nausea or loose stool ( +2 )Vomiting or diarrhea ( +3)Multiple episodes of vomiting or diarrhea ( +5)

Tremor observation of outstretched hands

No tremor ( +0 )Tremor can be felt, but not observed ( +1)Slight tremor observable ( +2 )Gross tremor or muscle twitching ( +4)

Yawning observation during assessment

No yawning ( +0 )Yawning once or twice during assessment ( +1)Yawning three or more times during assessment ( +2 )Yawning several times/minute ( +4)

Anxiety or irritability

None ( +0 )Patient reports increasing irritability or anxiousness ( +1)Patient obviously irritable/anxious ( +2 )Patient so irritable or anxious that participation in the assessment is difficult ( +4)

Gooseflesh skin

Skin is smooth ( +0 )Piloerection of skin can be felt or hairs standing up on arms ( +3 )Prominent piloerection ( +5 )

points

points

No active withdrawal

points

Mild withdrawal

points

Moderate withdrawal

points

Moderately severe withdrawal

points

Severe withdrawal