{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T04:10:13Z","timestamp":1777435813402,"version":"3.51.4"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2018,5,1]],"date-time":"2018-05-01T00:00:00Z","timestamp":1525132800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:sec>\n            <jats:title>Introduction:<\/jats:title>\n            <jats:p>Methadone and lorazepam prescribing discrepancies for the use of iatrogenic withdrawal were observed among providers. A standardized pharmacist-managed methadone and lorazepam taper protocol was implemented at a pediatric tertiary care facility with the aim to reduce the length of taper for patients with iatrogenic withdrawal.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>A multidisciplinary team of nurses, pharmacists, and physicians reviewed the current literature, then developed and implemented a standardized withdrawal taper protocol. Outcomes were compared with a retrospective control group using past prescribing practices. The primary endpoint was the length of methadone and\/or lorazepam taper. Secondary endpoints included evaluation for significant differences between the control and standardized protocol groups regarding additional breakthrough withdrawal medications, pediatric intensive care unit (PICU) and hospital length of stay. We also evaluated provider satisfaction with the protocol.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>The standardized protocol group included 25 patients who received methadone and\/or lorazepam taper. A retrospective control group contained 24 patients. Median methadone taper length before protocol implementation was 9.5 days with an interquartile range (IQR) of 5.5\u201314.5 days; after protocol implementation, it was 6.0 (IQR, 3.0\u20139.0) days (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.0145). Median lorazepam taper length before protocol implementation was 13.0 (IQR, 8.0\u201318.0) days; after protocol implementation, it was 6.0 (4.0\u20137.0) days (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.0006). A statistical difference between PICU length of stay, hospital length of stay, or the number of additional medications for breakthrough withdrawal was not found.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>The use of a standardized withdrawal protocol resulted in shorter taper duration for both the methadone and lorazepam groups. There was no difference in PICU or hospital length of stay.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/pq9.0000000000000079","type":"journal-article","created":{"date-parts":[[2019,6,11]],"date-time":"2019-06-11T20:48:49Z","timestamp":1560286129000},"page":"e079","source":"Crossref","is-referenced-by-count":8,"title":["Shortened Taper Duration after Implementation of a Standardized Protocol for Iatrogenic Benzodiazepine and Opioid Withdrawal in Pediatric Patients: Results of a Cohort Study"],"prefix":"10.1097","volume":"3","author":[{"given":"Jane M.","family":"Vipond","sequence":"first","affiliation":[{"name":"Department of Pharmaceutical Services, Sanford USD Medical Center, Sioux Falls, S.Dak."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy L.","family":"Heiberger","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Services, Sanford USD Medical Center, Sioux Falls, S.Dak."},{"name":"Department of Pharmacy Practice, South Dakota State University College of Pharmacy and Allied Health Professions, Brookings, S.Dak."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul A.","family":"Thompson","sequence":"additional","affiliation":[{"name":"University of South Dakota, Sanford School of Medicine, Vermillion, S.Dak."},{"name":"Departments of Pediatrics and Internal Medicine, Sanford USD Medical Center, Sioux Falls, S.Dak."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jody N.","family":"Huber","sequence":"additional","affiliation":[{"name":"University of South Dakota, Sanford School of Medicine, Vermillion, S.Dak."},{"name":"Department of Pediatrics, Sanford Children\u2019s Hospital, Sioux Falls, S.Dak."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R1-20230930","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.pain.2011.10.003","article-title":"Validity and generalizability of the Withdrawal Assessment Tool-1 (WAT-1) for monitoring iatrogenic withdrawal syndrome in pediatric patients.","volume":"153","author":"Franck","year":"2012","journal-title":"Pain"},{"key":"R2-20230930","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1097\/00003246-199405000-00009","article-title":"Prospective study on the occurrence of withdrawal in critically ill children who receive fentanyl by continuous infusion.","volume":"22","author":"Katz","year":"1994","journal-title":"Crit Care Med"},{"key":"R3-20230930","doi-asserted-by":"crossref","first-page":"e86","DOI":"10.1097\/PCC.0000000000001054","article-title":"Withdrawal Assessment Tool-1 monitoring in PICU: a multicenter study on iatrogenic withdrawal syndrome.","volume":"18","author":"Amigoni","year":"2017","journal-title":"Pediatr Crit Care Med"},{"key":"R4-20230930","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1097\/PCC.0000000000000306","article-title":"Risk factors associated with iatrogenic opioid and benzodiazepine withdrawal in critically ill pediatric patients: a systematic review and conceptual model.","volume":"16","author":"Best","year":"2015","journal-title":"Pediatr Crit Care Med"},{"key":"R5-20230930","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1097\/ADM.0000000000000197","article-title":"Opioid and benzodiazepine withdrawal syndrome in PICU patients: which risk factors matter?","volume":"10","author":"da Silva","year":"2016","journal-title":"J Addict Med"},{"key":"R6-20230930","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.medin.2012.02.009","article-title":"Withdrawal syndrome in the pediatric intensive care unit. 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