Hospital-initiated Extended-release Injectable Buprenorphine Using a Novel Reallocation Initiative From an Outpatient Addiction Medicine Clinic.

OBJECTIVES: Novel strategies for initiation and continuation of buprenorphine are critical, especially during a pandemic when traditional opioid use disorder treatment pathways may be disrupted. We describe an innovative outpatient to inpatient reallocation initiative for extended-release buprenorphine (XR-BUP) designed to repurpose an expensive medication for use in hospitalized patients facing treatment barriers upon discharge and pilot the feasibility of XR-BUP use in the inpatient setting. METHODS: We collaborated with our institution's inpatient pharmacy and a New Jersey Medicaid managed care organization to create an alternate pathway to make XR-BUP available to hospitalized patients insured by the same payor. In this process, XR-BUP doses were deidentified and transferred to the inpatient controlled substance inventory for administration to hospitalized patients at no charge by our Addiction Medicine Consult Service after a period of sublingual buprenorphine stabilization. Our reallocation pathway bypassed several existing XR-BUP regulatory barriers to allow for inpatient administration. RESULTS: To date, we have transferred approximately 85 XR-BUP 300 mg doses to the inpatient controlled substance inventory. This equates to a cost savings of nearly $145,000. CONCLUSIONS: Reallocation of XR-BUP from an outpatient to inpatient setting increased postdischarge buprenorphine treatment access while also reducing health care costs by repurposing an expensive medication that would otherwise go to waste. Use of reallocated XR-BUP in the inpatient setting may pave the way for addition of XR-BUP to the hospital's formulary to minimize treatment gaps after discharge.

The ethics of theatre nurse practice under the microscope.

Perioperative practice is a multidisciplinary environment. In some theatres, student nurse allocations are at last becoming longer, although some theatres still only get a brief visit from student nurses who wish to watch an operation all the way through. Furthermore, practically all operating departments have trainee operating department practitioners (tODPs). Diploma and degree level tODPs are now beginning to produce higher academic levels of coursework and many warrant recognition. We should remember that these 'learners' are potentially the theatre practitioners of the future and we should encourage them, not only within the perioperative environment but also towards their academic achievements. Qualified nurses and operating department practitioners (ODPs) now have access to various multi-disciplinary post-registration/gradate courses, which not only build upon theoretical knowledge, but also enhance practical skills. Individuals work long and hard to achieve high level academic pieces of coursework. Unfortunately after courses finish many assignments are packed away, collect dust and get forgotten, instead of the authors being brave enough to submit them for consideration for publication. This new series offers all practitioners the chance to share with others their work within this speciality. Whether you are a nurse or an ODP undertaking, or having recently completed a course, tODP or student nurse (but preferably a member of NATN) the possibility to share your experiences or coursework with other perioperative practitioners is available to you in these articles. It has always been so, but this new series is dedicated to you all and to the hard work you put into your coursework.