Toolkits

These toolkits are resource collections that are designed to target a particular clinical issue within a particular setting. Each toolkit is made up of clinical and administrative forms and templates, clinical primers, and patient-directed documents, all grouped together for convenient access when needed.

ED Toolkit for Opioid Use Disorder

Withdrawal Management Services Toolkit


ED Toolkit for Opioid Use Disorder

The goal of the META:PHI ED Toolkit for Opioid Use Disorder is to provide the resources necessary for a prescriber in any emergency department in Ontario to initiate buprenorphine when appropriate, along with additional materials to support all ED staff in providing evidence-based care for patients with opioid use disorder.

This toolkit was inspired by the CA Bridge program.

Prescriber information

Prescriber Information
Buprenorphine Macrodosing Primer
Download PDF, 86kB
Prescriber Information
Methadone Initiation
Download PDF, 278kB
Prescriber Information
Buprenorphine Macrodosing Initiation
Download PDF, 542kB
Prescriber Information
Buprenorphine Quick-Start Guide
Download PDF, 614kB
Prescriber Information
Buprenorphine Reference Guide for ED Providers
Download PDF, 303kB
Prescriber Information
Buprenorphine FAQs
Download PDF, 158kB
Prescriber Information
Buprenorphine: Information for Community Providers
Download PDF, 59kB

Templates

ED
Methadone Initiation Order Set
Download PDF, 40kB
Templates
Methadone Prescription
Download PDF, 37kB
Templates
Substance Use Screening Questions
Download PDF, 120kB
Templates
ED Order Set for Opioid Withdrawal/Buprenorphine Initiation
Download PDF, 247kB
Templates
Clinical Opioid Withdrawal Scale (COWS)
Download PDF, 42kB
Templates
Buprenorphine Prescription after ED Initiation
Download PDF, 35kB
Templates
Buprenorphine Prescription for Home Start
Download PDF, 58kB
Templates
Buprenorphine Prescription for Microdose Start
Download PDF, 41kB
Templates
ED Discharge Summary/Referral to RAAM
Download PDF, 36kB

Administrative resources

Administrative Resources
Application to Add Buprenorphine to ED Formulary
Download PDF, 113kB
Administrative Resources
ED Naloxone Distribution Policy
Download PDF, 57kB
Administrative Resources
ED Naloxone Distribution Medical Directive
Download PDF, 43kB
Administrative Resources
ED Naloxone Kit Distribution Record
Download PDF, 45kB
Administrative Resources
Addressing Stigma
Download PDF, 109kB

Patient materials

Patient Materials
Suboxone Treatment: What to Know and Expect
Download PDF, 60kB
ED
Suboxone Microdosing Start Info
Download PDF, 124kB
Patient Materials
Suboxone Home Start Info
Download PDF, 118kB
Patient Materials
Naloxone Kit Insert
Download PDF, 163kB

Lead authors
Jennifer Wyman MD FCFP DABAM MPH
Larry Nijmeh MD CCFP (EM) FCFP
Elizabeth Shouldice MD MPH CCFP (EM) FCFP

Authors
Ruben Hummelen MD CCFP
Meldon Kahan MD CCFP FRCPC
Michelle Klaiman MD FRCPC DABAM
Helen Manohararaj MScN NP-PHC ENC (C)
Lisa Roth MD CCFP
Amit Shah MD CCFP (EM) FCFP
Anita Srivastava MD MSc CCFP

Reviewers
James Brokenshire MD CCFP (EM)
Calvin Chan MD CCFP
Katie Dunham BSc Hons BScN MN NP-PHC
Jonathan Gravel MD CCFP (EM)
Nour Khatib MD CCFP (EM)
Kate Lazier MD CCFP (EM) FCFP
James McGorman MD CCFP (EM)
Hasan Sheikh MD CCFP (EM)
Max Zworth MD PGY-1 (EM)


Withdrawal Management Services Toolkit

This toolkit was created for providers working in residential community-based withdrawal management services (WMS) to standardize care, improve documentation and information sharing, and provide quick access to relevant information. You can download the entire toolkit or the individual tools (see below).

Introduction to the WMS manual

Intake

Intake
Pre-arrival screening tool
Download PDF, 78kB
Intake
Client risk assessment on arrival
Download PDF, 62kB
Intake
Medical intake form
Download PDF, 106kB
General
Consent to release personal health information
Download PDF, 57kB

Treatment

Treatment
Clinical pathway for management of alcohol withdrawal
Download PDF, 483kB
Treatment
Order set for alcohol withdrawal
Download PDF, 101kB
Treatment
Clinical pathway for management of opioid withdrawal
Download PDF, 539kB
Treatment
Order set for opioid withdrawal
Download PDF, 100kB
Treatment
Declining opioid agonist therapy
Download PDF, 36kB
Treatment
Management of stimulant use
Download PDF, 61kB
Treatment
Management of benzodiazepine use
Download PDF, 68kB
Treatment
Management of cannabis use
Download PDF, 61kB
Treatment
Medical directive for point-of-care testing
Download PDF, 58kB
Treatment
Special considerations
Download PDF, 99kB

Emergency department

Emergency Department
Transfer from withdrawal management to emergency department
Download PDF, 60kB
Emergency Department
Transfer from emergency department to withdrawal management
Download PDF, 58kB

Discharge

Discharge
Gabapentin discharge information for primary care
Download PDF, 38kB
Discharge
Acamprosate discharge information for primary care
Download PDF, 38kB
Discharge
Depot buprenorphine discharge information for primary care
Download PDF, 61kB
Discharge
Discharge form
Download PDF, 58kB
Discharge
Naltrexone discharge information for primary care
Download PDF, 38kB
Discharge
Acknowledgment of tolerance loss
Download PDF, 37kB

Sample Policies

Sample Policies
Sample medication policy
Download PDF, 165kB
Sample Policies
Sample cannabis policy
Download PDF, 37kB
Sample Policies
Sample nicotine replacement therapy policy
Download PDF, 37kB

Scales

Scales
Subjective opioid withdrawal scale
Download PDF, 37kB
Scales
Level of agitation scale
Download PDF, 35kB
Point-of-Care Tools
Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) Scale
Download PDF, 39kB

Appendices

Appendices
Resources
Download PDF, 61kB
Appendices
References
Download PDF, 151kB

Authors
Katie Dunham BSc, BScN, MN, NP-PHC 
Mareena Mathew NP-Adult
Karan Cheema BScN, MN, NP-PHC
Melanie Vandewiel MN, NP-PHC
Laura Jones BSc, BScN, MN, NP-Adult 
Kristine Rivest BScInf, MScN, NP-PHC
Jared Bonis BscN, MScN, TITC-CT, NP-PHC
Meldon Kahan MD, CCFP, FRCPC
Jennifer Wyman MD, FCFP, DABAM, MPH

Reviewers
Rachel Alexander, Peer Advisor, META:PHI
Cassel Busse RN, PhD
Jarel Calumpang RN, BScN, MN
Christina Henry RN, BScN, BA
Nina Kovacic BA, MSW
Larry Nijmeh MD, CCFP(EM) FCFP
Robyn Nocilla BScN, MSc, NP-PHC
Rose Patterson BscN, MN, NP-PHC
Josh Richardson RP, RPN, PNC, BA-Hons
Rosanra (Rosie) Yoon MN, NP-Adult
Maria Zhang RPh, BScPhm, PharmD, MSc