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.
Toolkit for Alcohol-Related Presentations to the Emergency Department
ED Toolkit for Opioid Use Disorder
RAAM Clinic Toolkit
Withdrawal Management Services Toolkit
Toolkit for Alcohol-Related Presentations to the Emergency Department
This toolkit was created for ED providers, including counsellors, nurses, nurse practitioners, peer support workers, pharmacists, physicians, and social workers. These tools address the effective treatment of alcohol withdrawal, management of other alcohol-related presentations, brief counselling interventions, initiation of anti-craving medications, and referral to community resources. The tools include evidence-informed recommendations, order sets, algorithms, sample prescriptions, and patient materials. You can download the entire toolkit or the individual tools (see below).
Introduction to the Toolkit for Alcohol-Related Presentations to the Emergency Department
Recommendations
Recommendations
Recommendations on the Management of Selected Alcohol-Related Presentations in the Emergency Department
Recommendations
Summary of Recommendations on the Management of Selected Alcohol-Related Presentations in the Emergency Department
Recommendations
Special Considerations for Alcohol-Related Presentations in the ED
Order Sets and Algorithms
Order Sets and Algorithms
ED Order Set for Alcohol Withdrawal
Order Sets and Algorithms
Choosing an Anti-Craving Medication
Order Sets and Algorithms
Approach to ED Patients With Alcohol-Related Presentations
Discharge
Discharge
Alcohol Withdrawal Management Prescription
Discharge
ED Naltrexone, Gabapentin, and Acamprosate Prescription
Discharge
Naltrexone Discharge Information for Primary Care
Discharge
Acamprosate Discharge Information for Primary Care
Discharge
Gabapentin Discharge Information for Primary Care
Patient-Facing Documents
Patient-Facing Documents
Substance Use Emergency Department Poster
Patient-Facing Documents
Emergency Department Patient Handout: Thinking About Drinking: Risky Drinking, Alcohol Use Disorder, and What You Can Do
Training
Training
CAMH Course: Introduction to the CIWA-Ar
Training
Clinical Institute Withdrawal Assessment for Alcohol Revised (CIWA-Ar) Training Tool
Training
Sample CIWA-Ar Video
Training
Brief Negotiated Interviews (BNI)
Training
Sample Brief Negotiated Interview Video
Authors
Robert Blackwell, Community Consultant
Bjug Borgundvaag MD PhD CCFP(EM)
Katie Dunham NP
Charlene Fraser, Community Consultant
Ruben Hummelen MD PhD CCFP
Meldon Kahan MD CCFP FRCPC
Kate Lazier MD CCFP(EM)
Robyn Nocilla BScN MSc NP-PHC
Kelly Shillington RN MScN ENC(C)
Ginette Thivierge RN, Community Consultant
Marcel Wagner RPh
Jennifer Wyman MD MPH
Reviewers
Chris Chan RPh
Janelle Hannon MSW RSW
Christina Henry BA BScN RN
Laura Jones NP
Michelle Klaiman MD FRCPC(EM)
Justin J. Koh MD MPH FRCPC
Bryan Marshall SSW, Community Consultant
Adam McInnis RN BScN MScCH MN-NP (student), Community Consultant
Patrick Nowak RN BScN
Lori Regenstreif MD CCFP(AM)
Julie Samson MD CCFP(EM)
Hasan Sheikh MD CCFP(EM)
Elizabeth Shouldice MD CCFP(AM)
Anita Srivastava MD MSc
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
Approach to Patients with Opioid Use Disorder in the ED
Prescriber Information
High-Dose Buprenorphine Initiation (“Macrodosing”) for ED Providers
Prescriber Information
Buprenorphine Macrodosing Initiation
Prescriber Information
Buprenorphine/Naloxone (Suboxone): Reference Guide for ED Providers
Prescriber Information
Buprenorphine FAQs
Prescriber Information
Buprenorphine/Naloxone (Suboxone): Information for Community Providers
Prescriber Information
Starting Methadone in the ED
Templates
ED
Methadone Initiation Order Set
Templates
ED Methadone Prescription
Templates
Substance Use Screening Questions
Templates
Opioid Withdrawal/Buprenorphine Initiation Order Set
Templates
Clinical Opioid Withdrawal Scale (COWS)
Templates
Buprenorphine Prescription after ED Initiation
Templates
Home Start Buprenorphine Prescription
Templates
Microdosing Buprenorphine Prescription
Templates
ED Discharge Summary/Referral to RAAM
Administrative resources
Administrative Resources
Pharmacy & Therapeutics Committee: Request for Addition of Buprenorphine/Naloxone to Drug Formulary
Administrative Resources
Naloxone Kit Distribution: Policy
Administrative Resources
Naloxone Kit Distribution: Emergency Department Medical Directive
Administrative Resources
ED Naloxone Kit Distribution Record
Administrative Resources
Addressing Stigma
Patient materials
Patient Materials
Suboxone Treatment: What to Know and Expect
ED
Starting Suboxone (Buprenorphine) With Microdosing
Patient Materials
Starting Suboxone (Buprenorphine) at Home
Patient Materials
Naloxone Kit Insert: Responding to an Overdose in a Toxic Drug Supply
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)
This toolkit was created to support RAAM clinic leads (managers, directors, medical directors, etc.) in the implementation and operationalization of the RAAM clinic model in their communities. You can download the entire toolkit or the individual tools (see below).
Section 1 – Introduction
Section 1
RAAM Clinic Toolkit Introduction
Section 2 – Introduction to META:PHI
Section 2
Introduction to META:PHI
Section 3 – Introduction to the RAAM Clinic Model: FAQ
Section 3
Introduction to the RAAM Clinic Model: FAQ
Section 4 – Starting a RAAM Clinic
Section 4
Starting a RAAM Clinic
Section 4
RAAM Clinic Implementation Checklist
Section 5 – RAAM Clinic Human Resources
Section 5
RAAM Clinic Human Resources
Section 6 – Clinic Supplies
Section 6
Clinic Supplies
Section 7 – RAAM Clinic Quality Targets
Section 7
RAAM Clinic Quality Targets
Section 8 – Data Collection and Reporting
Section 8
Data Collection and Reporting
Section 8
Ontario Perception of Care Tool for Mental Health and Addictions (OPOC-MHA)
Section 8
RAAM Clinic Client Survey
Section 9 – Resources Specific to First Clinical Visit
Section 9
Resources Specific to First Clinical Visit
Section 9
RAAM Clinic Client Consent and Waiver for Electronic Communication
Section 9
RAAM Clinic Client Consent to Service
Section 9
RAAM Clinic Flyer: Virtual Help for Substance Use
Section 9
RAAM Clinic HIV Serology Lab Requisition
Section 9
RAAM Clinic Intake Form
Section 9
RAAM Clinic Standard Intake Lab Requisition
Section 9
RAAM Clinic Referral Template
Section 9
RAAM Clinic Client Consent to Obtain and Release Information
Section 9
RAAM Clinic Client Rights and Responsibilities
Section 9
RAAM Clinic Client Handout: What to Expect in a First Appointment
Section 9
RAAM Clinic Client Form
Section 10 – General Clinical Resources
Section 10
General Clinical Resources
Section 10
Adult ADHD Self-Report Scale (ASRS-v1.1)
Section 10
Columbia-Suicide Severity Rating Scale (C-SSRS)
Section 10
Generalized Anxiety Disorder (GAD-7) Scale
Section 10
GAIN Short Screener (GAIN-SS)
Section 10
Goal-Setting Form
Section 10
Mood Disorder Questionnaire (MDQ)
Section 10
Sample Methadone Carry Agreement
Section 10
Opioid Use Disorder Follow-Up Visit Form
Section 10
PTSD Checklist for DSM-5 (PCL-5)
Section 10
Patient Health Questionnaire (PHQ-9)
Section 10
Quality of Life Scale (QoLS)
Section 10
Road to Recovery: R2AR Patient-Reported Outcomes Measurement
Section 10
Sweating Hallucinations Orientation Tremor Scale (SHOT)
Section 10
Substance Use Disorder (Non-Opioid) Follow-Up Visit Form
Treatment
Order set for alcohol withdrawal
Treatment
Order set for opioid withdrawal
Point-of-Care Tools
Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) Scale
Templates
Clinical Opioid Withdrawal Scale (COWS)
Section 11 – Transition Planning
Section 11
Transition Planning
Section 11
Consultation Letter for Transferring Substance Use Disorder Care to Primary Care
Section 12 – Clinical and Administrative Policies
Section 12
Clinical and Administrative Policies
Section 12
Medical Directive: Management of Alcohol Withdrawal
Section 12
Medical Directive: Naloxone Administration Policy
Section 12
Medical Directive: Point-of-Care Urine Testing
Section 13 – Educational and Mentorship Resources
Section 13
Educational and Mentorship Resources
Authors
Victoria Burke, Community Consultant
Katie Dunham, Nurse Practitioner Lead, Stonehenge Therapeutic Community RAAM; Nursing Educator,
META:PHI, Women’s College Hospital
Ashley Flemming, Community Consultant
Kate Hardy, Administrative Director, META:PHI, Women’s College Hospital
Pia Heikkinen, North Western Ontario Regional RAAM Coordinator, St. Joseph’s Care Group
Meldon Kahan, Medical Director, META:PHI, Women’s College Hospital
Michael Roach, Clinical Manager, Regional Outpatient Addictions Services, Health Sciences North
Stephanie Rochon, Holmes House Manager, Norfolk General Hospital
Philip Wong, Director, Nursing Services, Addiction Services Central Ontario
Jennifer Wyman, Clinical Programs Lead, META:PHI; Medical Director, Substance Use Service, Women’s College Hospital
Reviewers
Greg Carfagnini, MD CCFP(AM)
Caryn Green, MD CCFP, Division Head, Addiction Medicine, Lakeridge Health
Brian Irving, RP, RCS, CACII
Mary LaBine, Director of Clinical Services, CMHA Hastings Prince Edward Addictions & Mental Health Services
Tonya Muchano, RAAM Coordinator, Thunder Bay and Greenstone
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 toolkit
Intake
Intake
Pre-arrival screening tool
Intake
Client risk assessment on arrival
Intake
Medical intake form
General
Consent to release personal health information
Treatment
Treatment
Clinical pathway for management of alcohol withdrawal
Treatment
Order set for alcohol withdrawal
Treatment
Clinical pathway for management of opioid withdrawal
Treatment
Order set for opioid withdrawal
Treatment
Declining opioid agonist therapy
Treatment
Management of stimulant use
Treatment
Management of benzodiazepine use
Treatment
Management of cannabis use
Treatment
Medical Directive: Point of Care Testing
Treatment
Special considerations
Emergency department
Emergency Department
When to Transfer to the Emergency Department
Emergency Department
Emergency Department to WMS Transfer Checklist
Discharge
Discharge
Buprenorphine/Naloxone Discharge Information for Primary Care
Discharge
Acknowledgment of tolerance loss
Discharge
Naltrexone discharge information for primary care
Discharge
Acamprosate discharge information for primary care
Discharge
Gabapentin discharge information for primary care
Discharge
Buprenorphine Extended-Release Injection Discharge Information for Primary Care
Sample Policies
Sample Policies
Sample medication policy
Sample Policies
Sample cannabis policy
Sample Policies
Sample nicotine replacement therapy policy
Scales
Scales
Subjective opioid withdrawal scale
Scales
Level of agitation scale
Point-of-Care Tools
Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) Scale
Appendices
Appendices
Withdrawal management services toolkit: Resources
Appendices
Withdrawal management services toolkit: References
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
