NEONATAL CLINICAL PRACTICE GUIDELINE
|
|
- Hollie Atkinson
- 6 years ago
- Views:
Transcription
1 NEONATAL CLINICAL PRACTICE GUIDELINE Title: Neonatal Substance Exposure: Assessment and Clinical Management Approval Date: February 2018 Approved by: Neonatal Patient Care Teams, HSC & SBH Child Health Standards Committee Women s Health Maternal Newborn Committee Women s Health Standards Committee Pages: 1 of 15 Supercedes: HSC: PURPOSE AND INTENT 1.1 To identify infants who may be at risk for Neonatal Abstinence Syndrome (NAS) and assess their symptoms using a standardized objective scoring tool. 1.2 To outline the steps for infant management and monitoring. Note: All recommendations are approximate guidelines only and practitioners must take in to account individual patient characteristics and situation. Concerns regarding appropriate treatment must be discussed with the attending neonatologist. 2.0 PRACTICE OUTCOME 2.1 Infants experiencing NAS will have their symptoms managed safely with minimize interruption in the maternal-newborn bonding process. 3.0 DEFINITIONS 3.1 Neonatal Abstinence Syndrome (NAS): The physiologic response of infants who are withdrawing from addictive drugs or substances they were exposed to in utero. 3.2 Neonatal Substance Exposure (NSE): When the neonate has been exposed to substances in utero that may not cause withdrawal symptoms, but may cause adverse neurological symptoms or have other effects on their development. 3.3 Healthcare Provider: refers to Pediatrician, Family Physician or Midwife who is responsible for routine infant care. 4.0 GUIDELINES 4.1 Identify infants at risk for NAS who are born to mothers with known or suspected use of addictive drugs, substances or alcohol during their pregnancy, and especially but not exclusively within 72 hours prior to delivery. See Appendix A for lists of potential drugs that may cause withdrawal in the infant. 4.2 Document known maternal drug or substance use or suspicious events or behaviors in the infant s health record and initiate social work consult. 4.3 Provide routine care to the infant and admit to the postpartum unit with the mother unless the baby has other health issues that require neonatal intensive care. See Appendix B for an algorithm for the process for infants at risk on the post-partum unit. 4.4 Upon admission, initiate assessment using either the Finnegan Neonatal Abstinence Score Short Form (see Appendix C) or The Modified Finnegan Neonatal Abstinence Score (see Appendix D). Determine frequency of scoring based on the criteria outlined below. Refer to the back of the form for descriptions of scoring criteria. 4.5 For the first 2 hours of life observe for clinical features and symptoms of NAS. (see Appendix E)
2 2 of At 2 hours of age calculate NAS Score use the sum of values for all symptoms observed since birth to determine ongoing frequency of scoring: 7 or less score every 4 hours 8 or higher score every 2 hours AND notify healthcare provider. 4.7 For newborns who remain on the mother-baby unit, communicate the baby s status to the charge nurse in the NICU once a shift with the following categories: Green: scores are less than 5 Amber: Scores are 5-7 Red: Scores are 8 or higher and baby may meet admission criteria (see below). 4.8 Discontinue scoring when scores are 7 or less for 72 hours AND the infant is on no medication. Maintain infant with mother on postpartum unit for at least 7 days if exposure is to methadone or other long acting opioids. 4.9 Admit baby to NICU if three successive scores are 8 or higher or two successive scores are 12 or higher. (Call the NICU and admit baby directly). In NICU score using the long form Modified Finnegan Neonatal Abstinence Score Call physician or in-house healthcare provider immediately if infant exhibits myoclonic jerking while awake or exhibits convulsions or seizures at any time Determine nature of pharmacologic intervention and management based on the type of drug or substance exposure as outlined in Appendix F. and according to scores: Consider pharmacologic support if scores are or average 8 or higher for 3 consecutive intervals Provide pharmacologic support if scores are or average 12 or higher for 2 consecutive intervals Select medications in the same class as the causative agent. Titrate dose to achieve treatment goals but do not increase faster than the time it takes to achieve or get close to steady state, to avoid drug accumulation and undesirable effects that may delay infant discharge Morphine is the first line treatment for infants withdrawing from methadone or suboxone/subutex. Symptoms presenting in the first 72 hours may be related to benzodiazepines or antidepressents the mother has been prescribed to treat comorbidities. In these cases, consider phenobarbital as the first medication When scores are less than 8 for at least 48 hours follow drug weaning process outlined in APPENDIX G. See also APPENDIX H for algorithms for medication escalation and weaning For infants started on Phenobarbital to manage withdrawal from Methadone and antidepressants or Benzodiazepines, consider weaning the Phenobarbital first, within the first 10 days when the benzodiazepine/antidepressant withdrawal has finished For infants greater than 3 weeks of age, use 11 as the treatment threshold score rather than 8 and manage medication adjustments accordingly, to accommodate for natural changes in sleep wake patterns with age Provide a calm, quiet environment, facilitate skin to skin / kangaroo care. Decrease sensory stimulation and provide swaddling support when infant is in bed using safe swaddling. Bathing may be too stimulating, so provide bundle bath or waterless bath whenever possible Encourage frequent breastfeeding or provision of expressed breast milk to ensure high caloric needs are met. Consider hypercaloric formula or supplements to breast milk, and IV fluids and electrolytes as indicated Facilitate appropriate follow up after discharge with Public Health Nurse and within 1 week with Pediatrician.
3 3 of REFERENCES 5.1 Backes, CH., Backes, C.R., Gardner, D., Nankervis, C.A., Giannone, P.J. & Cordero, L. (2012) Neonatal abstinencs syndrome: transitioning methadone-treated infants from an inpatient to an outpatient setting. Journal of Perinatology, 32, Bio, L.L. & Poon, C.Y. (2011). Update on the pharmacologica management of neonatal abstinence syndrome. Journal of Perinatology. 31, Casper, T & Arbour, N. (2014). Evidence-based nurse-driven interventions for the care of newborns with neonatal abstinence syndrome. Advances in Neonatal Care, 14(6), Dow, K., Ordean, A., Murphy-Oikonen, J., Pereira, J., Koren, G., Roukema, H., Selby, P. & Turner, R. (2012). Neonatal abstinence syndrome clinical practice guidelines for Ontario. Journal of Popular Therapies in Clinical Pharmacology, 19(3), e488-e Gomez-Pomar, E., Christian, A., Devlin, L., Ibonia, K.T., Concina, V.A., Bada, H. & Westgate, P.M. (2017). Analysis of the factors that influence the Finnegan neonatal Abstinence Scoring System. Journal of Perinatology, 37, Hall, E.S. et al. (2015). Implementation of a neonatal abstinence syndrome weaning protocol: A multicenter cohort study. Pediatrics. 136(4), e803-e Hamilton Health Sciences Centre (2012). Neonatal Abstinence Syndrome (NAS): Identification, Assessment, Management of, in the High Risk Newborn. Clinical Practice Guideline. 5.8 Holmes, A.P., Schmidlin, H.N. & Kurzum, E.N. (2017). Breastfeeding considerations for mothers of infants with neonatal abstinence syndrome. Pharmacotherapy, 37(7), Homes, A.V., Atwood, E.C., Whalen, B., Beliveau, J., Jarvis, J., Matulis, J.C. & Ralston, S.L. (2016). Rooming-in to treat neonatal abstinences syndrome: Improves family-centered care at lower cost. Pediatrics, 137(6), e Maguire, D., Cline, G.J., Parnell, L. & Tai, C-Y. (2013). Validation of the Finnegan Neonatal Abstinences Syndrome Tool- Short Form. Advances in Neonatal Care. 13(6), McQueen, K. & Murphy-Oikonen, J.M. (2016). Neonatal abstinence syndrome. New England Journal of Medicine. 375, NSW Department of Health (2010). Neonatal abstinence syndrome guidelines. Obtained from Ohio Children s Hospital Neonatal Research Consortium (2013) Enteral Morphine or Methadone Protocol for Neonatal Abstinence Syndrome (NAS) from Maternal Exposure Queensland Maternity and Neonatal Clinical Guidelines Program (2015). Neonatal abstinence syndrome. Obtained from Raffaeli, G., Cavallaro, G., Allegaert, K., Wildschut, E.D., Fumagalli, M., Agosti, M., Tibboel, D. & Mosca, F. (2017). Neonatal abstinence syndrome: Update on diagnostic and therapeutic strategies. Pharmacotherapy, 37(7), Sutter, M.B., Leeman, L. & His, A. (2014). Neonatal opioid withdrawal syndrome. Obstetrics and Gynecology Clinics of North America, 41, Zimmermann-Baer, U., Notzli, U, Rentsch, K & Bucher, H.U. (2010). Finnegan neonatal abstinences scoring system: normal values for first 3 days and weeks 5-6 in non-addicted
4 4 of 15 infants. Addictions, 105, PRIMARY AUTHORS 6.1 Fabiana Postolow, Neonatologist 6.2 Lisa Merrill, Neonatal Patient Care Manager 6.3 Jarrid McKitrick, Child Health Pharmacy Manager 6.4 Cathy Sabiston, NICU Pharmacist
5 5 of 15 APPENDIX A Potential Drugs of Abuse Table 1: Drugs when used within 72 hours before birth place infant at risk for NAS Opioids Central Nervous System Depressants Hallucinogens Methadone Alcohol Inhalants ( sniff ): Morphine Barbiturates Solvents Codeine Benzodiazepines (eg. Valium) Aerosols Heroin Glue Hydromorphone (Dilaudid) Gasoline Meperidine (Demerol) Paint thinner Oxycodone (Percodan) Nail polish Pentazocine (Talwin) Fentanyl Buprenorphine/Naloxone (Suboxone) Buprenorphine (Subutex) Table 2: Drugs that may cause adverse neurological symptoms but not withdrawal symptoms Central Nervous Central Nervous Hallucinogens Other System Stimulants System Depressants Caffeine Cocaine Methamphetamine Marijuana Hashish Nitrites Nitrous Oxide Nicotine (in large quantities) Crystal meth speed Methylphenidate (Ritalin) Phenylpropanolamine
6 6 of 15 APPENDIX B
7 Score Title: 7 of 15 APPENDIX C Finnegan Neonatal Abstinence Scale Short Form Directions: Score infant every 3-4 hours on all items, adding the total score. Score 0 if not present. Choose only one item from crying, sleeps, tremors and respiratory rate to score (if not 0 ). NAS Signs AM PM COMMENTS Mild/Early Signs Crying: unable to console in 5 min 2 or cries 25-50% of the time Crying: unable to console > 5 min 3 or cries > 50% of the time Sleeps < 1 hour after feeding 3 Sleeps < 2 hours after feeding 2 Sleeps < 3 hours after feeding 1 Increased muscle tone 2 Moderate/Progressing Signs Mild tremors, undisturbed 3 Moderate-severe tremors, 4 undisturbed Respiratory rate > 60/min 1 Respiratory rate > 60/min with 2 retractions Sweating 1 Excessive sucking 1 Score (range 0 16) Average Daily Score Initials of Scorer 1 TOTAL SCORE Initials of Scorer 2 (optional) This scale was derived from the Modified Finnegan Neonatal Abstinence Scale (Finnegan & Kaltenbaach, 1992). Recommend: If the infant scores meet treatment criteria (see #4.9), switch to the full Neonatal Abstinence Scoring to capture the full range of additional withdrawal signs.
8 8 of 15 APPENDIX D
9 9 of 15 APPENDIX E Clinical Feature & Symptoms of NAS Clinical presentation of neonatal drug withdrawal is dependent upon the drug(s), timing and amount of the last maternal use, maternal and infant metabolism and excretion, and other less definable factors. W I T H D R A W A L Wakefullness Irritability Tremulousness, Temperature Instability, Tachypnea Hyperactivity, High-pitched Cry, Hyperacusia (sensitivity to sound), Hyper-reflexia, Hypertonia Diarrhea, Diaphoresis, Disorganized Suck Rub marks, Respiratory Distress, Rhinorrhea Apnea, Autonomic Dysfunction Weight Loss Apathy, Alkalosis, Acidosis, Appetite Increased or Decreased Lacrimation (tears), Lassitude (weariness) Neurologic Excitability Gastrointestinal Dysfunction Autonomic Signs Tremors Poor feeding Sweating Irritability Uncoordinated and constant Nasal stuffiness Increased Wakefulness sucking Fever High pitched cry Vomiting Mottling Increased muscle tone Diarrhea (leads to diaper Temperature instability Hyperactive deep tendon dermatitis) reflexes Dehydration Exaggerated moro reflex Poor weight gain Seizures Frequent yawning and sneezing
10 10 of 15 APPENDIX F Recommended Medication Management for Infants with NAS Select medication based on drug or substance neonate withdrawing from: Morphine is the initial drug of choice for opioid withdrawal. Use in cases where mother dependent on opioid due to: (i) (ii) (iii) illicit drug use treatment for addiction chronic pain Examples Buprenorphine (Suboxone, Subutex) Codeine (includes Tylenol #1, #2, #3 and 222 s) Fentanyl Heroin Hydromorphone (Dilaudid) Meperidine (Demerol) Methadone Morphine Oxycodone (OxyNeo, Percocet and Percodan) Pentazocine (Talwin) Phenobarbital should be the initial medication chosen for: (i) (ii) (iii) medical management of non-opioid withdrawal in cases were maternal drug(s) used are unknown there is polysubstance exposure Alcohol intoxication Amphetamines Benzodiazepines (Alprazolam, Clonazepam, Diazepam, Lorazepam, Temazepam) Inhalants: Solvents, aerosols (gasoline, glue, paint thinner) Antidepressants: SNRI: Venlafaxine (Effexor), SSRI: Citalopram (Celexa), Fluoxetine (Prozac), Sertraline (Zoloft)
11 11 of 15 Morphine-First line treatment for opioid withdrawal PO/ NG/ OG Dosing Information Load: milligrams/kg/dose q2h and PRN until symptoms controlled *Maximum of 3 initial loads with a maximum total dose of 1 milligram/kg/24h Maintenance dosing recommendations: (escalate to next step only if needed and only after giving a load) Step 1: 0.05 milligrams/kg/dose q4h Step 2: 0.1 milligrams/kg/dose q4 h Step 3: 0.15 milligrams/kg/dose q4 h Step 4: 0.2 milligrams/kg/dose q4 h In the first 24 hours of treatment: If infant s symptoms are controlled following 1 load then start maintenance at 0.05 milligrams/kg/dose q4h. If infant s symptoms are not controlled and the infant requires more than 1 load then start maintenance dose of 0.1milligram/kg/dose q4h. **Do not increase the maintenance past Step 2 in the first 24 hours. **Maximum oral dose (including loading doses) = 2 milligrams/kg/day Monitoring, Additional Information Establish continuous cardiorespiratory monitoring Note: risk of respiratory depression with doses greater than or equal to 1 milligram/kg/24h, especially in combination with other sedatives (e.g. phenobarbital, lorazepam) If the infant has a large emesis within 5-10 minutes of receiving the Morphine dose, repeat the dose. Note: to reduce the risk of the infant vomiting please give the dose before a feed and ensure the infant is not overfed. Clonidine- Second line treatment for opioid withdrawal in addition to Morphine. Add Clonidine when Morphine maintenance dose has reached 0.15milligrams/kg/dose q4h and three consecutive scores greater than 8 or two greater than 12. PO/ NG/ OG Dosing Information Maintenance: (escalate to next step only if needed and following 24 hours of a dose increase) Step 1: Start at 1 microgram/kg/dose q6h Step 2: (increase after 24 hours on Step 1): 1.5 micrograms/kg/dose q6h Step 3: (Increase after 24 hours on Step 2): 2 micrograms/kg/dose q6h Maximum daily dose: 8 micrograms/kg/24 hours Monitoring, Additional Information Monitor BP prior to dose and 1hr post dose: for the first 2 doses when therapy is initiated for 2 doses following each dosage increase
12 12 of 15 Phenobarbital- First choice for polysubstance exposure treatment Third line treatment for opioid withdrawal in addition to Morphine and Clonidine if NAS scores remain above the treatment threshold. PO/ NG/ OG Dosing Information Load: 20 milligrams/kg/dose (may administer as 10 milligrams/kg/dose X 2 doses given over 2 consecutive feeds) Maintenance: milligrams/kg/24h divided BID or TID start 12 hours after load Monitoring, Additional Information If patient sedated, consider obtaining a serum phenobarbital level. If patient receiving a dose of greater than 5mg/kg/day for longer than 1 week, consider obtaining a serum phenobarbital level. Lorazepam-Additional option for symptom management when infant not responding to other 3 recommended medications. PO/ NG/ OG Dosing Information 0.05 milligrams/kg/dose q4h PRN (Range milligrams/kg/dose q4h PRN) Monitoring, Additional Information
13 13 of 15 APPENDIX G Medication Weaning Protocol Once NAS scores have consistently been below 8 for hours, begin weaning. Please note ONLY ONE CHANGE per 48 hour until Morphine dose reaches 0.05 milligrams/kg/dose q4h Morphine: PO/NG/OG First step 0.15 milligrams/kg/dose q4h Do not change dosing Second step 0.12 milligrams/kg/dose q4h interval unless as indicated Third step 0.1 milligrams/kg/dose q4h in fifth step. Fourth step 0.08 milligrams/kg/dose q4h Notes: Fifth Step 0.05 milligrams/kg/dose q4h q6h q8h q 12h x 48 hours stop Follow step decreases as indicated or until the dose reaches a minimum volume of 0.1mL (of a 1mg/mL solution) then change the dosing interval to prevent the need for further dilution of the medication. If infant does not tolerate weaning: Consult pharmacist to adjust weaning schedule; Provide extra dose of Morphine (equal to the current maintenance dose) and then: 1. Continue with current maintenance dosing schedule OR 2. Go back to previous step of weaning protocol maintenance dose. If infant is sensitive to weaning or is not tolerating weaning well (i.e. scores are increasing) then consider weaning by 10% over a longer length of time (i.e. one change q72hours) If infant is receiving Morphine only for NAS treatment at 0.05 milligrams/kg/dose q4h consider weaning every 24 hours, if tolerated. Once infant reaches 0.05 milligrams/kg/dose q8h and after consultation with social work and family, consider possibility of discharge home on medication to complete weaning course of treatment. o Note: Slower weaning dose may be considered for all infant s discharged to community. Clonidine: PO/NG/OG Once Morphine dose reaches 0.05 milligrams/kg/dose q4h then: Decrease Clonidine by 0.5 micrograms/kg/dose q48hours until dose reaches 1 microgram/kg/dose q6h x 48 hrs then lengthen interval to 1 microgram/kg/dose q8h x 24 hours then discontinue. Note: If weaning is well tolerated then consider alternate weaning doses of Morphine and Clonidine q48hours (i.e. one change q24hours). If receiving Clonidine only then consider one change in weaning dose q24hours. Note: Monitor BP q6h x 48 hours once clonidine discontinued to monitor for rebound hypertension. Phenobarbital: PO/NG/OG Initiate weaning of Phenobarbital 24 hours after Clonidine is discontinued. If maintenance dose is 7.5 milligrams/kg/day BID or TID then decrease dose to 5 milligrams/kg/day BID for 5-7days. If maintenance dose is 5 milligrams/kg/day BID then decrease dose to 2.5 milligrams/kg/day once per day for 5-7days then discontinue.
14 14 of 15 APPENDIX H Algorithms for Medication Escalation and Weaning
15 15 of 15
Opioid Use Disorder in Pregnancy. Neonatal Abstinence Syndrome
Opioid Use Disorder in Pregnancy Neonatal Abstinence Syndrome Opioid Use Disorder and Pregnancy Cont. 4.6 million women (or 3.8 percent) ages 18 and older misused prescription drugs in 2013. One-third
More informationObjectives. Care of the Neonate with Prenatal Opioid Exposure. What is Neonatal Abstinence Syndrome (NAS)? Increasing Incidence of NAS 8/27/2016
Care of the Neonate with Prenatal Opioid Exposure Heather Pratt Chavez, MD Ann Winegardner, MD Objectives Review the latest population data on neonates with prenatal opioid exposure Describe the acute
More informationNeonatal Drug Withdrawal
History Neonatal Drug Withdrawal Katherine Wang, MD, FAAP Avera McKennan Children s Hospital NICU Morphine has been used for pain for many years Congenital morphinism was not recognized as an entity until
More informationLori A. Shook, MD Division of Neonatology Kentucky Children s Hospital University of Kentucky Medical Center
Lori A. Shook, MD Division of Neonatology Kentucky Children s Hospital University of Kentucky Medical Center NSDUH, 2012 National Survey on Drug Use and Health: 2012 Substance abuse: Public Health Problem
More informationCare of the Neonate with Prenatal Opioid Exposure. Objectives. What is Neonatal Abstinence Syndrome (NAS)/ Neonatal Opiate Withdrawal Syndrome?
Care of the Neonate with Prenatal Opioid Exposure Heather Pratt Chavez, MD Ann Winegardner, MD Objectives Review the latest population data on neonates with prenatal opioid exposure Describe the acute
More informationWales Neonatal Network Guideline
Guideline on the Management of Neonatal Abstinence Syndrome Introduction Neonatal Abstinence Syndrome (NAS) is a constellation of symptoms and signs occurring in a baby as a result of withdrawal from physically
More informationThe Long-Term Outcomes of Infants with Neonatal Abstinence Syndrome
Neonatal Nursing Education Brief: The Long-Term Outcomes of Infants with Neonatal Abstinence Syndrome https://www.seattlechildrens.org/healthcareprofessionals/education/continuing-medical-nursing-education/neonatalnursing-education-briefs/
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Kraft WK, Adeniyi-Jones SC, Chervoneva I, et al. Buprenorphine
More informationSupersedes Date None and Management Guidelines. Originating Dept. NICU Document Owner Dir., NICU Document applies to: NCH Required Not Required
Effective Date 12/13/16 Neonatal Abstinence Syndrome (NAS) Date Approved 12/13/16 Guideline Pharmacologic Protocol Supersedes Date None and Management Guidelines Originating Dept. NICU Document Owner Dir.,
More informationClinical Management of Neonatal Abstinence Syndrome. Tricia L. Romesberg, DNP, MSN, ARNP, CNNP
Clinical Management of Neonatal Abstinence Syndrome Tricia L. Romesberg, DNP, MSN, ARNP, CNNP Timeline Incidence of NAS Healthcare Cost and Utilization Project (HCUP), 1999-2013 State Inpatient Databases
More informationNeonatal Abstinence Syndrome
5 Neonatal Abstinence Syndrome Amy P. Holmes, PharmD Introduction Neonatal abstinence syndrome (NAS) is recognized as the effect of intrauterine exposure to substances that can cause physical dependence.
More informationIN-PATIENT PEDIATRIC REHABILITATION
IN-PATIENT PEDIATRIC REHABILITATION Neonatal Abstinence Syndrome Program Carissa H. Snelling, MS, OTR/L, BCP Erika Herzer, PT, DPT, PCS, CBIS April 2017 CHARACTERISTICS OF NAS Drug(s) Opioids Cocaine Benzodiazepines
More informationNeonatal Abstinence: It s No Child s Play!
Neonatal Abstinence: It s No Child s Play! Claudia Summa BScPhm Pharmacy Resident Wednesday, March 28, 2007 Objectives To present a case of neonatal abstinence syndrome (NAS) To discuss the incidence,
More informationNeonatal Abstinence Syndrome:
Neonatal Abstinence Syndrome: Rethinking Our Approach Matthew Grossman, M.D. Assistant Professor of Pediatrics Yale School of Medicine Quality and Safety Officer Yale-New Haven Children s Hospital Patrick,
More informationObjectives. Common Drugs leading to NAS. Differential Diagnosis. Clinical Features of NAS. Assessing Neonatal Abstinence in the Newborn Nursery
Objectives Assessing Neonatal Abstinence in the Newborn Nursery WAPC Annual Meeting 2012 Elizabeth Goetz MD Mary Rolloff PhD, RN, CNE At the conclusion of this session participants will be able to: Understand
More informationNeonatal abstinence syndrome
PedsCases Podcast Scripts This is a text version of a podcast from Pedscases.com on the Neonatal Abstinence Syndrome. These podcasts are designed to give medical students an overview of key topics in pediatrics.
More informationNeonatal Abstinence Syndrome (NAS)
Neonatal Abstinence Syndrome (NAS) Dhara D. Shah, PharmD PGY-1 Pharmacy Practice Resident January 31, 2018 Program for HealthTrust Members Disclosures This program may contain the mention of drugs or brands
More informationRunning head: NEONATAL ABSTINENCE SYNDROME 1
Running head: NEONATAL ABSTINENCE SYNDROME 1 Nursing Treatment of Neonatal Abstinence Syndrome Ferris State University Kelly Geraghty, Tracy James, Kristen Lintjer, Sara Potes, Rikki Zissler NEONATAL ABSTINENCE
More informationMaternal-fetal Opiate Medical Home (MOMH) Jocelyn Davis DNP,CNM, RN, CEFMM Karen Frantz BSN, RNC
Maternal-fetal Opiate Medical Home (MOMH) Jocelyn Davis DNP,CNM, RN, CEFMM Karen Frantz BSN, RNC Objectives 1. Discuss the effects of opiate addiction on mothers and infants. 2. Discuss a Medical Home
More informationObjectives. Nothing to Disclose No Conflicts of Interest
April 22, 2014 PCSS-MAT Webinar Lori Devlin, DO, MHA Assistant Professor- Department of Pediatrics University of Louisville School of Medicine Nothing to Disclose No Conflicts of Interest Objectives Define
More informationConsequences and Treatment of Opioid Abuse During Pregnancy. Katie Ellis, PharmD March 12, 2018
Consequences and Treatment of Opioid Abuse During Pregnancy Katie Ellis, PharmD March 12, 2018 Disclosure I have nothing to disclose. Objectives At the completion of this activity, the pharmacist will
More informationNursing Care of the NAS Infant. Lori Markham MSN, MBA, ARNP, NNP-BC
Nursing Care of the NAS Infant Lori Markham MSN, MBA, ARNP, NNP-BC Objectives Define neonatal abstinence syndrome Recognize the clinical presentation Identify non-pharmacologic and pharmacologic caregiver
More informationOpioid Use in Pregnant Women and Prenatal Care. Murray F Dweck MD, FACOG Medical Director/OBGYN Florida Department of Health -Brevard
Opioid Use in Pregnant Women and Prenatal Care Murray F Dweck MD, FACOG Medical Director/OBGYN Florida Department of Health -Brevard Objectives Summarize contextual and co-morbid factors observed among
More informationNeonatal Intensive Care Unit Clinical Guideline. Abstinence and Withdrawal in Neonates. Background
Neonatal Intensive Care Unit Clinical Guideline Abstinence and Withdrawal in Neonates Background (NAS) is a combination of behavioural and physiological signs and symptoms that occur in newborn babies
More informationNeonatal Abstinence Syndrome Epidemiology, diagnosis, management and prevention
Neonatal Abstinence Syndrome Epidemiology, diagnosis, management and prevention Cynthia Thomas, DO,MPH Northeast Regional Health Office Tennessee Department of Health Disclosure Statement of Financial
More informationNeonatal Abstinence Syndrome Questions & Answers Webinar #1 (February 9, 2012) Webinar #2 (March 30, 3012)
Neonatal bstinence Syndrome Questions & nswers Webinar #1 (February 9, 2012) Webinar #2 (March 30, 3012) For more information and to download a copy of the NS Clinical Practice Guidelines, please visit
More informationOutcomes of Infants with Neonatal Abstinence Syndrome
Outcomes of Infants with Neonatal Abstinence Syndrome Caroline O. Chua, MD, FAAP Medical Director, Division of Neonatology Director, Neonatal Follow Up Clinic Nemours Children s Hospital Orlando, Florida
More informationMAT IN PREGNANCY KAYLA LIFE STAGE 1: ADOLESCENCE LIFE STAGE 2: EARLY ADULTHOOD. family History of addiction. addiction to oral opioids
MAT IN PREGNANCY R. COREY WALLER MD, MS PRINCIPAL, HEALTH MANAGEMENT ASSOCIATES FACULTY, INSTITUTE FOR HEALTHCARE INNOVATION (IHI) CHAIR, LEGISLATIVE ADVOCACY COMMITTEE, ASAM KAYLA LIFE STAGE 1: ADOLESCENCE
More informationPROJECT DOVE. Improving Maternal and Neonatal Health Through Safer Opioid Prescribing MODULE 3
PROJECT DOVE Improving Maternal and Neonatal Health Through Safer Opioid Prescribing MODULE 3 Partners Support Bureau of Justice Assistance, Department of Justice Grant # PM-BX-Koo4 Treatment Plan MODULE
More informationProduct Labeling to Communicate Benefits and Risks of Treatment for Opioid Use Disorder in Pregnant Women. Hendrée E. Jones, PhD
1 The National Academies of Sciences, Engineering and Medicine Regulatory Strategies of address prescription opioidrelated harms 4 th of November, 2016 Washington DC Product Labeling to Communicate Benefits
More informationNAS / NOWS: Description. Disclosures: I will discuss off-label uses of medications I have no financial disclosures. Objectives
Opioid-exposed Newborns and Their Families the Vermont Approach Anne Johnston, MD Neonatal Perinatal Medicine Associate Professor of Pediatrics University of Vermont Disclosures: I will discuss off-label
More informationRelationships Relationships
PRENATAL OPIATE EXPOSURE IMPACT ON EARLY CHILDHOOD LEARNING AND BEHAVIOR Ira J. Chasnoff, MD NTI Upstream www.ntiupstream.com Children grow and develop in the context of Attachment: Basic Concept Attachment:
More informationA System of Care Surrounding the Drug Exposed Neonate. Disclosures. Objectives 11/17/2015. I have no financial disclosures
A System of Care Surrounding the Drug Exposed Neonate Sean Loudin MD Disclosures I have no financial disclosures Objectives Discuss the epidemiology of Neonatal Abstinence Syndrome (NAS) both nationally
More informationHOPE. Considerations. Considerations ISING. Safe Opioid Prescribing Guidelines for ACUTE Non-Malignant Pain
Due to the high level of prescription drug use and abuse in Lake County, these guidelines have been developed to standardize prescribing habits and limit risk of unintended harm when prescribing opioid
More informationClinical Policy: Neonatal Abstinence Syndrome Guidelines Reference Number: CP.MP.86 Effective Date: 10/13
Clinical Policy: Reference Number: CP.MP.86 Effective Date: 10/13 Last Review Date: 10/17 See Important Reminder at the end of this policy for important regulatory and legal information. Revision Log Description
More informationNEONATAL ABSTINENCE SYNDROME. Michael Donnelly, D.O., PGY-2 Lake Cumberland Regional Hospital Somerset, KY
NEONATAL ABSTINENCE SYNDROME Michael Donnelly, D.O., PGY-2 Lake Cumberland Regional Hospital Somerset, KY Disclosures I have no financial disclosures to discuss Objectives Discuss the history of Neonatal
More informationOpioid use in pregnancy and Neonatal Abstinence Syndrome
Opioid use in pregnancy and Neonatal Abstinence Syndrome Morissa Ladinsky, MD Assoc. Professor of Pediatrics Division of General Pediatrics and Adolescent Medicine UAB Objectives 1. Understand the magnitude,
More informationA New approach to NAS: home in 6 days
+ A New approach to NAS: home in 6 days Lisa Grisham, NNP-BC Moe Kane, NNP-BC Banner University Medical Center - Tucson University of Arizona, College of Medicine Department of Pediatrics Division of Neonatology
More informationPresented by DCF SunCoast Region: Kyle Teague, Melissa Worthen, Christina Cuoco, Nina Romeu, Dekesha Seay
Presented by DCF SunCoast Region: Kyle Teague, Melissa Worthen, Christina Cuoco, Nina Romeu, Dekesha Seay Overview/Learning Objectives What is Addiction Medication Assisted Treatment Discuss facts about
More informationNeonatal Abstinence Syndrome
Neonatal Abstinence Syndrome Linda Wallen, M.D. Clinical Professor of Pediatrics Univ of Washington/ Seattle Children s Hospital Many slides courtesy of Christine Gleason, MD I do not have any conflict
More information4/19/2017. Neonatal Abstinence Syndrome. Disclosures. Objectives. Kara Kuhn-Riordon, MD UC Davis Medical Center. I have no financial disclosures
Neonatal Abstinence Syndrome Kara Kuhn-Riordon, MD UC Davis Medical Center Disclosures I have no financial disclosures Objectives Identify the substances associated with neonatal abstinence syndrome (NAS)
More informationThe Substance Exposed Newborn Alphabet Soup
The Substance Exposed Newborn Alphabet Soup SEN, NAS, NOWS, OUD, SUD & MAT Sara Park MD Chief Medical Officer Comprehensive Medical and Dental Program Department of Child Safety CAP conference, July 2017
More information9/19/13. Postpartum Counseling for Women in MAT. Katie Clark MSPH, CSAC. A little about Katie. Definitions. MAT: Medication-Assisted Treatment
Postpartum Counseling for Women in MAT Katie Clark MSPH, CSAC A little about Katie SUD and PH crossroads BA Health Arts and Sciences Goddard College MSPH MCH UNC Project Lazarus, Yale, CHER Solutions LLC
More informationDonor human milk may decrease severe gastrointestinal distress in infants with neonatal abstinence syndrome.
Research Article http://www.alliedacademies.org/pregnancy-and-neonatal-medicine/ Donor human milk may decrease severe gastrointestinal distress in infants with neonatal abstinence syndrome. Catherine Alexander,
More informationNEONATAL ABSTINENCE SYNDROME (NAS) AKA NEWBORN DRUG WITHDRAWAL:THE NEWARK EXPERIENCE
NEONATAL ABSTINENCE SYNDROME (NAS) AKA NEWBORN DRUG WITHDRAWAL:THE NEWARK EXPERIENCE Salma Ali MD, Debra Brendel RN, BSN, MSN and Ona Fofah MD Division of Neonatology and Newborn Medicine Department of
More informationAdvancing the Care of Pregnant and Parenting Women with Opioid Use Disorder and their Infants: A Foundation for Clinical Guidance
Advancing the Care of Pregnant and Parenting Women with Opioid Use Disorder and their Infants: A Foundation for Clinical Guidance Karol Kaltenbach, PhD Emeritus Professor of Pediatrics Sidney Kimmel Medical
More informationCARD TOBACCO: Cigarettes, E- Cigarettes, Cigars, Tobacco Pipe, Chewing Tobacco, Snuff
CARD 1 1. TOBACCO: Cigarettes, E- Cigarettes, Cigars, Tobacco Pipe, Chewing Tobacco, Snuff 2. ALCOHOL: Beer, Wine, Liquor 3. MARIJUANA: Grass, Pot, Hashish, Hash, Hash Oil, Weed, Ganja, Marijuana Edibles
More informationMethadone Maintenance
Methadone Maintenance A Practical Guide to Pharmacotherapy Methadone/Buprenorphine 101 Workshop, April 1, 2017 Ron Joe, MD, DABAM Objectives I. Pharmacology Of Methadone II. Practical Application of Pharmacology
More informationEmergent Issues Affecting Early Intervention/ Early Childhood. Workforce Development for Inclusion in Early Childhood November 4, 2017 Washington, DC
Emergent Issues Affecting Early Intervention/ Early Childhood Workforce Development for Inclusion in Early Childhood November 4, 2017 Washington, DC Conversation Points Changing Demographics Emergent Trends
More informationNOWS The Time Caring for the Infant with Neonatal Opiate Withdrawal Syndrome
NOWS The Time Caring for the Infant with Neonatal Opiate Withdrawal Syndrome Meghan Howell, MD FAAP Assistant Professor of Pediatrics Clinical Director, Tulane NICU Graduate Clinic Tulane University School
More informationOhio Perinatal Quality Collaborative
Ohio Perinatal Quality Collaborative Neonatal Abstinence Syndrome Project Presented by Michele Walsh MD Neonatal Lead Physician December 2017 Disclosure I have no financial or other conflicts of interest.
More informationJoint Trust Guideline for the Management of Neonatal Abstinence Syndrome
Management of Neonatal Abstinence Syndrome A clinical guideline recommended for use In: Neonatal Intensive Care Unit, Post natal wards By: For: Key words: Written by: Supported by: Approved by: Paediatric
More informationNeonatal Abstinence: The epidemic Its Impact on All of Us
Neonatal Abstinence: The epidemic Its Impact on All of Us Michelle Bode MD, MPH Neonatologist Crouse Hospital Assistant Professor Pediatrics SUNY Upstate Objectives & Disclosure Statement 1) The participant
More informationSUBSTANCE EXPOSED INFANTS PRESENTED BY ECOLE J. BARROW-BROOKS M.ED & DARLENE D. OWENS MBA, LBSW, CADC, ADS
SUBSTANCE EXPOSED INFANTS PRESENTED BY ECOLE J. BARROW-BROOKS M.ED & DARLENE D. OWENS MBA, LBSW, CADC, ADS 1 SUBSTANCE-EXPOSED INFANTS Refers to infants exposed to alcohol and or other substances ingested
More informationMedication Assisted Treatment. MAT Opioid dependence/addiction Opioid treatment programs OTP Regulation of OTP Office Based Treatment
Medication Assisted Treatment MAT Opioid dependence/addiction Opioid treatment programs OTP Regulation of OTP Office Based Treatment Opioid Drugs Opium Morphine Heroin Codeine Oxycodone Roxycodone Oxycontin
More informationNeonatal Abstinence Syndrome
Neonatal Abstinence Syndrome TAMARA HARVANKO RN, BAN HIGH RISK OB CARE COORDINATOR CASE MANAGEMENT HENNEPIN COUNTY MEDICAL CENTER TAMARA.HARVANKO@HCMED.ORG 612-873-6552 https://www.youtube.com/watch?v=tk2hoyupkvi
More informationNEONATAL ABSTINENCE SYNDROME
NEONATAL ABSTINENCE SYNDROME P Kocherlakota MD Division of Neonatology Department of Pediatrics Maria Fareri children's Hospital at West Chester Medical Center New York Medical College, Valhalla, NY DISCLOSURES
More informationNeonatal Abstinence Syndrome:
Neonatal Abstinence Syndrome: Reconsidering the Standard Approach Matthew Grossman, M.D. Assistant Professor of Pediatrics Yale School of Medicine Quality and Safety Officer Yale-New Haven Children s Hospital
More informationThe Opioid-Exposed Woman
The Opioid-Exposed Woman Management Considerations for Labor and Delivery Jane Sublette, MS, RN, CNM, WHNP-BC Fairview Ridges Hospital Objectives Describe opioid-associated risks to the mother and fetus
More information10/15/2018. The Tiniest Victims of the Opioid Crisis Tara Sundem, RN, NNP-BC, MS
The Tiniest Victims of the Opioid Crisis Tara Sundem, RN, NNP-BC, MS What is Neonatal Abstinence Syndrome (NAS)? What causes NAS? Signs and Symptoms of NAS? Treatment of NAS? Follow up for babies with
More informationPain management. Coleman Palliative Care Conference: February 2016 Josh Baru MD Stacie Levine MD
Pain management Coleman Palliative Care Conference: February 2016 Josh Baru MD Stacie Levine MD Case #1 61 yo man with history of Stage 3 colon cancer, s/p resection and adjuvant chemotherapy with FOLFOX
More informationModule II Opioids 101 Opiate Opioid
BUPRENORPHINE TREATMENT: A TRAINING FOR MULTIDISCIPLINARY ADDICTION PROFESSIONALS Module II Opioids 101 Module II Goals of the Module This module reviews the following:! Opioid addiction and the brain!
More informationEAT, SLEEP, CONSOLE The Yale Method of assessment and treatment of neonates during withdrawal from opiates
EAT, SLEEP, CONSOLE The Yale Method of assessment and treatment of neonates during withdrawal from opiates NICOLE DUNCAN BSN, RN, CPN MAY 2018 Pediatric Educator, MultiCare Health System DISCLAIMER I have
More informationPRACTICE GUIDELINES WOMEN S HEALTH PROGRAM
C Title: NEWBORN: HYPOGLYCEMIA IN NEONATES BORN AT 35+0 WEEKS GESTATION AND GREATER: DIAGNOSIS AND MANAGEMENT IN THE FIRST 72 HOURS Authorization Section Head, Neonatology, Program Director, Women s Health
More informationToxicology aspects of SUDI. Dr Stephen Morley STH
Toxicology aspects of SUDI Dr Stephen Morley STH Epidemiology of SUDI toxicology Neonatal-placental transfer Breast milk 3 rd person administration Association between illicit drug use in pregnancy and
More informationSubstitution Therapy for Opioid Use Disorder The Role of Suboxone
Substitution Therapy for Opioid Use Disorder The Role of Suboxone Methadone/Buprenorphine 101 Workshop, December 10, 2016 Leslie Lappalainen, MD, CCFP, dip ABAM Prepared by Mandy Manak, MD, ABAM, CCSAM
More informationJohann Hari. Truths 2/29/2016. From the street to the NICU. Treatment works
From the street to the NICU Richard Christensen, PA, CAS Johann Hari Treatment works Truths Disconnect with pregnant women seeking treatment Disconnect between community and science Medication is not a
More informationTreating Women for Opioid Use Disorder during Pregnancy: Methadone and Buprenorphine as a Part of a Complete Care Approach
Treating Women for Opioid Use Disorder during Pregnancy: Methadone and Buprenorphine as a Part of a Complete Care Approach Hendrée E. Jones, PhD Executive Director, UNC Horizons Professor, Department of
More informationTHE OPIOID DEPENDENT MOTHER AND NEWBORN - AN UPDATE
THE OPIOID DEPENDENT MOTHER AND NEWBORN - AN UPDATE THE 6 TH ANNUAL IVEY SYMPOSIUM Ron Abrahams, Claudette Chase, Judy Desmoulin, Mel Kahan, David Knoppert, Gideon Koren, Laura Lyons, Alice Ordean, Henry
More informationMethadone and Pregnancy
Methadone and Pregnancy Methadone/Buprenorphine 101 Workshop, April 1, 2017 Charissa Patricelli, MD, CCFP, ABAM Clinical Associate Professor, Dept. of Family Practice UBC American Board of Addiction Medicine
More information10/17/2013. Stephen R. Kandall, MD, FAAP opiate is derived directly from the opium poppy, e.g. opium, morphine
Kandall, S. Substance and Shadow: Women and Addiction in the United States. Harvard U. Press, Cambridge, MA 1996 (Paperback 2001). Finnegan, LP and Kandall, S.R. Maternal and Neonatal Effects of Alcohol
More informationADDICTION IN PREGNANCY
ADDICTION IN PREGNANCY R. Corey Waller MD, MS, DFASAM Sr. Medical Director, Education and Policy The National Center for Complex Health and Social Needs DISCLOSURES No relevant disclosures OBJECTIVES The
More informationMaternal Substance Abuse: Challenges & Opportunities for Perinatal Nurses Catherine H. Ivory, PhD, RNC-OB October, 2015
Maternal Substance Abuse: Challenges & Opportunities for Perinatal Nurses Catherine H. Ivory, PhD, RNC-OB October, 2015 Objectives Discuss the current scope of maternal substance use and abuse List examples
More informationSummary of Changes: References/content updated to reflect most current standards of practice.
Alaska Native Medical Center: Mother Baby Unit Guideline: Neonatal Hypoglycemia Subject: Neonatal Hypoglycemia REVISION DATE: Jan 2015,12/2011, 02/2009, 11, 2007, 07/2007,04/2001, 04/1999 REPLACES: NSY:
More informationNeonatal Abstinence Syndrome: An Evidence- Based Review for the Family Nurse Practitioner
Southern Adventist Univeristy KnowledgeExchange@Southern Graduate Research Projects Nursing 8-2014 Neonatal Abstinence Syndrome: An - Based Review for the Family Nurse Practitioner Kindra Romer Follow
More informationMethamphetamine Abuse During Pregnancy
Methamphetamine Abuse During Pregnancy Robert Davis, MD / r.w.davismd@gmail.com ❶ Statistics ❷ Pregnancy Concerns ❸ Postpartum Concerns ❹ Basic Science ❺ Best Practice Guidelines ❻ Withdrawal ❼ Recovery
More informationEffects of Prenatal Illicit Drug. Use on Infant and Child
Effects of Prenatal Illicit Drug Use on Infant and Child Development Andrew Hsi, MD, MPH Larry Leeman, MD, MPH Family Medicine MCH Grand Rounds 6 July 2011 Objectives for Presentation At the end of this
More informationInequalities in health and their effect on the newborn
Inequalities in health and their effect on the newborn Dr Kathryn Johnson Leeds Neonatal Service Leeds Teaching Hospitals NHS Trust Consultant Neonatologist Research lead Neonatal Abstinence Syndrome Covered
More informationNon-Pharmacologic Treatment for Infants with Neonatal Abstinence Syndrome (NAS)
University of Vermont ScholarWorks @ UVM Family Medicine Block Clerkship, Student Projects College of Medicine 2014 Non-Pharmacologic Treatment for Infants with Neonatal Abstinence Syndrome (NAS) Michael
More informationTalking with your doctor
SUBOXONE (buprenorphine and naloxone) Sublingual Film (CIII) Talking with your doctor Opioid dependence can be treated. Talking with your healthcare team keeps them aware of your situation so they may
More informationPlease review the following slides prior to class. Information from these slides will be used to answer patient cases. Come prepared!
Please review the following slides prior to class Information from these slides will be used to answer patient cases. Come prepared! Alcohol and Opiate Dependence Reference Slides Substances of Abuse A
More informationThe Role of Opioid Overdoses in Confirmed Maternal Deaths,
The Role of Opioid Overdoses in Confirmed Maternal Deaths, 2012-2015 Introduction The Department of State Health Services (DSHS) conducted an analysis of maternal deaths resulting from drug overdoses from
More informationFederal Trafficking Penalties (As of January 1, 1996)
APPENDIX 3 Federal Penalties and Sanctions for Illegal Trafficking and Possession of a Controlled Substance Federal Trafficking Penalties (As of January 1, 1996) Controlled Substances Act Schedule* 1st
More informationOMT FOR THE NAS INFANT. Eren Ural OGME II
OMT FOR THE NAS INFANT Eren Ural OGME II Objectives: 1. Review the signs and symptoms monitored for diagnosing Neonatal Abstinence Syndrome 2. Understand current medical management for Neonatal Abstinence
More informationSTARSHIP WITHDRAWAL OF ANALGESIA AND SEDATION
STARSHIP WITHDRAWAL OF ANALGESIA AND SEDATION Patients receiving analgesia and/or sedation for longer than 5-7 days may suffer withdrawal if these drugs are suddenly stopped. To prevent this happening
More informationThe Substance Exposed Newborn Standards of Care
The Substance Exposed Newborn Standards of Care Sara Park MD Chief Medical Officer Comprehensive Medical and Dental Program Department of Child Safety CAP conference, July 2017 Disclosures I have no financial
More informationEFFECTS OF PRENATAL EXPOSURES. Thomas J. Schreiner M.D. CAPT., USPHS White Earth Health Center
EFFECTS OF PRENATAL EXPOSURES Thomas J. Schreiner M.D. CAPT., USPHS White Earth Health Center I have nothing to disclose. DISCLOSURES DISCLAIMER Any views or opinions expressed are mine and are do not
More informationBrief Pain Surveys. Developed by: Betty R. Ferrell, PhD, FAAN and Margo McCaffery RN, MSN, FAAN
Brief Pain Surveys Pain Assessment/Behavior Survey Pain/Gender Survey Brief Cancer Pain Information Survey Pain Addiction Survey Brief Pharmacology Survey Test Questions Developed by: Betty R. Ferrell,
More informationThe Substance Exposed Newborn Alphabet Soup
The Substance Exposed Newborn Alphabet Soup SEN, NAS, NOWS, OUD, SUD & MAT Sara Park MD Chief Medical Officer Comprehensive Medical and Dental Program Department of Child Safety CAP conference, July 2017
More informationAnnual Reports Questionnaire (ARQ) Part III: Extent, patterns and trends in drug use
Annual Reports Questionnaire (ARQ) Part III: Extent, patterns and trends in drug use Report of the Government of: Reporting Year: Completed on (date): Please return completed questionnaire to: arq@unodc.org
More informationNIDA Quick Screen V1.0F1
NIDA Quick Screen V1.0F1 Name:... Sex ( ) F ( ) M Age... Interviewer... Date.../.../... Introduction (Please read to patient) Hi, I m, nice to meet you. If it s okay with you, I d like to ask you a few
More informationSUBOXONE (buprenorphine and naloxone) sublingual film (CIII) IMPORTANT SAFETY INFORMATION
SUBOXONE (buprenorphine and naloxone) sublingual film (CIII) IMPORTANT SAFETY INFORMATION What is the most important information I should know about SUBOXONE Film? Keep SUBOXONE Film in a secure place
More informationNeonatal Abstinence Syndrome (NAS)
Neonatal Abstinence Syndrome (NAS) Jodi Jackson, MD Neonatologist Children's Mercy Hospital Associate Professor of Pediatrics University of Missouri-Kansas City School of Medicine Medical director NICU
More informationOpioids in Pregnancy. Beyond to Baby GENERAL INFO
Opioids in Pregnancy and Beyond to Baby by Marcia W. VanVleet, MD, MPH Medical Director, Newborn Service Team, Women and Infants Hospital, and Assistant Professor of Pediatrics, Brown Alpert Medical School,
More informationOpioids. Sergio Hernandez, MD
Opioids Sergio Hernandez, MD Required Slide Disclosures 1. SIGNIFICANT FINANCIAL INTERESTS NO SIGNIFICANT FINANCIAL, GENERAL, OR OBLIGATION INTERESTS TO REPORT 2. GENERAL AND OBLIGATION INTERESTS All general
More informationLumbar Fusion. Reference Guide for PACU CLINICAL PATHWAY. All patient variances to the pathway are to be circled and addressed in the progress notes.
Reference Guide for PACU Lumbar Fusion CLINICAL PATHWAY All patient variances to the pathway are to be circled and addressed in the progress notes. This Clinical Pathway is intended to assist in clinical
More informationOB Well Baby Nursery Admission (Term) [ ] For specialty focused order sets for your patient, refer to: General
OB Well Baby Nursery Admission (Term) [3040000234] For specialty focused order sets for your patient, refer to: 3040000424 Neonatal Circumcision Order Set 3040000522 Neonatal Herpes Viral Order Set 3040000524
More informationSCID-I Version 2.0 (for DSM-IV) Non-Alcohol Use Disorders
SCID-I Version 2.0 (for DSM-IV) Non-Alcohol Use Disorders *NON-ALCOHOL SUBSTANCE USE DISORDERS* (LIFETIME DEPENDENCE AND ABUSE) Now I am going to ask you about your use of drugs or medicines. SHOW DRUG
More informationMichael O Neil, Pharm.D. Professor and Vice-Chair, Department of Pharmacy Practice Drug Diversion, Substance Abuse, and Pain Management Consultant
Michael O Neil, Pharm.D. Professor and Vice-Chair, Department of Pharmacy Practice Drug Diversion, Substance Abuse, and Pain Management Consultant South College School of Pharmacy Knoxville, TN (304) 546-7746
More information1/29/2013. Schedule II Controlled Substances: Basics and Beyond. Controlled Substances. Controlled Substances, Schedule I
chedule II Controlled ubstances: Basics and Beyond James L. Besier, Ph.D., R.Ph., FAHP Adjunct Associate Professor College of Nursing Adjunct Assistant Professor James L. Winkle College of Pharmacy University
More information