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lnstitute on Drug Abuse. CDH and KCJ will work together to build this screening tool into the Electronic Medical Records system (EMR) being used at KCJ. Inmates will be screened by nursing staff at intake, though if intake occurs after regular nursing hours, the TAPS tool is able to be completed by the inmate him/herself or KCJ deputy for NCM to review at next availability. lf an inmate screens positive for SUD, a urine sample may be requested from the inmate to confirm presence of illicit substance and ensure medical staff have as much information as possible regarding which specific substances the inmate has been using. With the urine sample, a rapid urine toxicology screen will be obtained in the jail, KCJ will be invoiced for the cost of the urine toxicology screen like how other routine lab tests are currently billed to KCJ by CDH on a monthly basis. Both parties can also look at other options for urine toxicology screening tools that are more cost effective and just as effective prior to implementation. lf inmates screen positive for OUD, NCM's will monitor for withdrawal symptoms using the Clinical Opiate Withdrawal Scale (COWS Scale). Once again, after regular nursing hours, KCJ deputies will need to utilize COWS screening until nursing arrives in the facility and call the on-call medical provider as needed. When inmates have COWS assessment scores of 10 or more, of course with inmate consent, buprenorphine treatment will be offered. NCM's or KCJ staff will contact the on-call CDH medical provider with prescriptive authority to obtain a prescription for buprenorphine administration. This access will be available 24171365, including holidays. This is a change from current practice at KCJ, as currently inmates withdraw from opioids completely, placing them at increased risk for potentially severe complications. CDH nursing will offer initial and periodic training to KCJ staff in utilizing the TAPS tool and COWS scale. During time of incarceration, CDH providers will also monitor clients and determine those who are appropriate and willing to switch medications to the Sublocade, long- acting injection. CDH will educate the client on the pros and cons of Sublocade and if determined that this is an appropriate alternative, provide the injections to the client based on the standards necessary relating to the use of it. Care coordination will consist of networking with local and regional agencies with capabilities to help inmates maintain their MOUD treatment upon release from custody This may include a wide arrcy of services including referrals to the Kittitas County Health Network, Comprehensive Mental Health, Community Health of Central Washington, Merit Resources, Kittitas Valley Healthcare, and FISH food bank, among others. Our NCMs will work diligently to develop and foster excellent working relationships with these community partners to ensure support for the inmate is maximized and risk for overdose, relapse, or recidivism will be drastically reduced. Care coordination duties will be shared by the two primary NCMs employed by CDH at KCJ. The purpose of implementing shared roles amongst nursing staff is to allow for enhanced and seamless coverage of all MOUD duties within KCJ. This will allow for Professi onal Services Agreem ent (rev . 09 I 24 120 1 8) Page 14 ol22