Unique Plan Description: Admission Opiate Withdrawal COWS
Plan Selection Display: Admission Opiate Withdrawal COWS
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2025-06-10 07:45:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-06-25 08:38:16
Available at all facilities: No

Admission Opiate Withdrawal COWS
Admit/Discharge/Transfer
	Admit to Observation Status
		T;N
	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
			Comment: ICU_____   Psych______
	Admit to Psych - Involuntary
		T;N
	Admit to Psych - Voluntary
		T;N
	Transfer
		T;N, to ICU
		T;N, to Psych
Vital Signs
	Vital Signs
		T;N, TID, For COWS score 0-4
		T;N, Q6H, For COWS Score 5-12
		T;N, Q4H, For COWS score 13-24
		T;N, Q2H-Sch, For COWS score 25-36
Activity
	Activity-As Tolerated
		T;N
Diet
	Regular Diet
		T;N
	NPO
		T;N
	Diabetic Diet
		T;N
	Sodium Restricted Diet
		T;N
Laboratory
	CBC with Diff
		T;N, Routine, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Routine, spec type = Blood
	Magnesium Level
		T;N, Add On, spec type = Blood
	GGT
		T;N, Routine, spec type = Blood
	Phosphorus
		T;N, Stat, spec type = Blood
	Drug Screen DAU
		T;N, Routine, Urine Random, spec type = Urine
	Toxicology Screen DAU
		T;N, Routine, Urine Random, spec type = Urine
	Pregnancy Test Urine
		T;N, Routine, Routine, spec type = Urine
Medications
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	acetaminophen
		650 mg, Tab, By Mouth, Q4H, PRN discomfort
			Comment: and/or fever
	loperamide
		4 mg, Capsule, By Mouth, Once
			Comment: Do not exceed 16mg per day
		2 mg, Capsule, By Mouth, Once, PRN loose stools
			Comment: Do not exceed 16mg per day
	ondansetron
		4 mg, Injection, IV Push, Q6H, PRN nausea and/or vomiting
			Comment: Use if patient unable to take PO
		4 mg, Tablet-Disintegrating, By Mouth, Q6H, PRN nausea and/or vomiting
	cloNIDine
		0.1 mg, By Mouth, QID, PRN see comment
			Comment: For autonomic symptoms. Monitor blood pressure closely.
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		0.1 mg, By Mouth, QID, for see comment
			Comment: For autonomic symptoms. Monitor blood pressure closely.
	ondansetron
		4 mg, Injection, IV Push, Q6H, PRN nausea and/or vomiting
			Comment: Use if patient unable to take PO
		4 mg, Tablet-Disintegrating, By Mouth, Q6H, PRN nausea and/or vomiting
	cyclobenzaprine
		5 mg, Tab, By Mouth, TID, PRN muscle pain
	buprenorphine-naloxone 2 mg-0.5 mg sublingual tablet, disintegrating
		2 TAB, Tab, SUBLINGUAL, DAILY
		2 TAB, Tab, SUBLINGUAL, Once, PRN see comment, T;N+120
			Comment: May give 2 hours after the initial dose if withdrawal symptoms persist (maximum 12 mg/3 mg on the first day).
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		2 TAB, Tab, SUBLINGUAL, Once
		2 TAB, Tab, SUBLINGUAL, Once, PRN see comment, T;N+120
			Comment: May give 2 hours after the initial dose if withdrawal symptoms persist (maximum 12 mg/3 mg on the first day).
	methadone
		20 mg, By Mouth, Once
			Comment: For severe cases and if Suboxone is contraindicated) 20-30 mg PO initially (consult with a physician for specific dosing).
		30 mg, By Mouth, Once
			Comment: For severe cases and if Suboxone is contraindicated) 20-30 mg PO initially (consult with a physician for specific dosing).
	risperiDONE
		0.5 mg, Tab, By Mouth, TID, PRN agitation
	haloperidol
		2 mg, Tab, By Mouth, Q4H, PRN psychosis
			Comment: /agitation
		5 mg, Tab, By Mouth, Q4H, PRN psychosis
			Comment: /agitation
	haloperidol  Injectable
		2 mg, Injection, IM-Intramuscular, Q4H, PRN agitation
			Comment: for agitation
		5 mg, Injection, IM-Intramuscular, Q4H, PRN agitation
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	famotidine
		20 mg, Tab, By Mouth, BID, PRN dyspepsia
	folic acid
		1 mg, Tab, By Mouth, DAILY, duration: 30 Day(s)
	Vitamin B1
		100 mg, Tab, By Mouth, DAILY, duration: 5 Day(s)
		100 mg, Injection, IV Push, DAILY, duration: 5 Day(s)
	traZODone
		100 mg, Tab, By Mouth, QHS, PRN insomnia
	nicotine
		2 mg, Gum, By Mouth, Q1H, PRN smoking cessation
			Comment: <25 cigarettes/day; max 24 pieces/24 hours
		4 mg, Gum, By Mouth, Q1H, PRN smoking cessation
			Comment: >25 cigarettes/day; max 24 pieces/24 hours
Patient Care
	Resuscitation Status
		T;N, Full Code
		T;N, No Code
	Notify MD
		T;N, PCP if pulse >120, SBP <90, DBP >110; RR < 12 or shallow quality
		T;N, PCP if patient has seizures or hallucinations
	Neurological Assessment-Focused
		T;N, Q1H
	Fall Precautions
		T;N
	Cardiac Telemetry Monitoring
		T;N
	Seizure Precautions
		T;N
	Suicide Precautions
		T;N
Consults/Follow-up
	Consult Social Work
		T;N
	Consult Psychiatrist
		Reason for Referral: Opiate Withdrawal

nicotine 14 mg/24 hr Patch
Medications
	nicotine
		14 mg, Patch, TOPICAL, DAILY
	nicotine Patch Removal
		Patch Removal, Patch, TOPICAL, DAILY, T+1;0900
Patient Care
	Medication patch site check
		T;N+720, Q12H-Sch

nicotine 21 mg/24 hr Patch
Medications
	nicotine
		21 mg, Patch, TOPICAL, DAILY
	nicotine Patch Removal
		Patch Removal, Patch, TOPICAL, DAILY, T+1;0900
Patient Care
	Medication patch site check
		T;N+720, Q12H-Sch

nicotine 7 mg/24 hr Patch
Medications
	nicotine
		7 mg, Patch, TOPICAL, DAILY
	nicotine Patch Removal
		Patch Removal, Patch, TOPICAL, DAILY, T;N+1440
Patient Care
	Medication patch site check
		T;N+720, Q12H-Sch

Peripheral Lock - Access
Medications
	sodium chloride 0.9% flush injectable soln
		10 mL Syringe IV PUSH BID
		10 mL, Syringe, IV PUSH, Q5MIN, PRN, IV line flush
	lidocaine 1% injectable solution (MH/WH/FH)
		0.1 mL, IntraDermal, Q1H, PRN, see comment
			Comment: For IV start
	sodium chloride bacteriostatic 0.9% injectable soln
		0.1 mL, Injection, IntraDermal, Q1H, PRN, see comment
			Comment: For IV start, use if patient has lidocaine allergy.
	Sodium Chloride 0.9% IVPB Flush
		25 mL, IVPB, Q1H, PRN, IV line flush, 5 min(s)
			Comment: Use if medication not compatible with primary line or there is no primary line;  infuse 25mL.
Patient Care
	Peripheral Lock-Insert
		T;N

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase