Write a Chemo Medication Order

1. Add or edit an order set to open the Orders For This Session scratch pad. See Building Regimens and Protocols.

2. Click Chemo (ALT+H).

3. Click Add (ALT+A), or select an order from the list, then click Edit (ALT+E).

Only chemotherapeutic or chemo-related medications should be added via this form. Dosing methods and scheduling on the Chemo form are set up for chemo and medications that are administered like chemo. To add a different kind of drug, cancel out of this form, click Previous to move to a non-chemo folder, and edit the folder list. See Adding Orders to a Non-Chemo Folder .

You can change the administration route and other parameters for a completed medication order by clicking Change (ALT+H). To change the drug itself, delete or discontinue the order, and write another order for the new medication.

1. Select the drug and delivery route

   1. Type all or part of the name of the medication in the Med name field. For patient-controlled analgesia, you can type "PCA" without selecting a route.

   2. Select an administration method from the Route list to narrow the list of results. (Multiple routes—for example, PO/PR—are not allowed.)

   3. Click Search (ALT+S).

2. Select from the search results, then click OK (ALT+O).

   The initial medication search is based on the parameters you entered for the med name and route (if any) AND the age group of the selected patient. Definitions for age groups in medication ordering. Dosing, frequency of administration, pharmacy-recommended dose instructions, and other information may differ based on the age group.

   • Expanding or changing the search: Click to select another age group option: Adult, Pediatric, or Neonate. The search begins automatically.

   • If you did not get a result you expected, the med name entry may be misspelled. Click the Sounds like search checkbox to see if that helps. The search begins automatically.

   • Choosing a medication:

   1. Click to select a medication/route combination.

   Chemotherapeutics that can be administered in non-oncology treatments are available through this medications order form. Scroll down the search results list and select a "non-chemo use" option to order either cytoxan and methotrexate, for example.

   2. Click OK (ENTER).

   • If you selected the incorrect drug, click Cancel (ALT+C), then start again.

3. For certain med/route combinations, specify type as prompted

   • If you chose IV as a route when the options are bolus, continuous infusion, or both together, the IV Type window opens. Click to select an option, then click OK (ALT+O).

   • If a sliding scale is defined for a continuous infusion medication, the Type window opens. Click an option, then click OK (AL:T+O). If you select Sliding Scale, click to select a blank or pre-filled scale, then click Ok.

1. Select the units for dosing (measure).

2. Select the method for dosing (dosed by). For AUC dosing, select either the Cockroft-Gault or Jelliffe formula, then type the upper and lower limits for the target the provider must choose.

3. Type the amount of the standard dose based on the units you selected.

4. Select a value or Other for the frequency.

5. If weight-based, BSA-based, or AUC dosing should not be recalculated when the orders are activated for use, type the reason for this in the Do not Recalc Reason field. (For a description of dose recalculation at activation, see Recalculation of Dosing in the Overview of Activating Chemo Orders.

6. Type instructions as needed.

7. To note the maximum amount to be administered, type in the Cap total dose at field (ALT+T).

8. To note the maximum BSA (body-surface area) to be used in BSA-dependent dosing, type in the Cap BSA at field (ALT+B).

9. As needed for bolus IV, continuous IV, or intrathoracic infusions, type a number and units for the duration in the Infuse over field—for example, 2 h to infuse over two hours.

1. Click Scheduled days/doses (ALT+H).

2. Click Doses (ALT+S) or Days (ALT+Y).

• For doses, type the number to administer and the time to start.

• For days, type numbers separated by commas (,) to designate days of the cycle. Use negative numbers for days prior to a defining event—for example, a bone marrow transplant. To indicate a number of consecutive days, type the first and last day of the range, separated by a colon (:).

3. Click OK (ALT+O) to return to the medications form.

1. If you haven't already, click Dose Modifications on the chemo medication order form. The Dose Modifications list opens.

2. Click Add (ALT+A) to enter new modifications; click a line then Edit (ALT+E) to change parameters for an existing modification.

3. Click Modify by percent (ALT+M) or Modify by dose (ALT+B).
   If you have set up pediatric age, weight, or age/weight dependent dosing, or plan to do so for this medication, you can only define Dose Modifications by percent.

4. Complete the selection as follows:

• Percent—Type a number (1 through 99) to indicate the amount of change, then click Decrease percentage (ALT+E) if the dose should be lowered. If the new dose should be based on the previous dose given rather than the standard dose, click the checkbox to Calculate based on current dose (not standard dose) (ALT+A). If the total dose for this modification should not be recalculated based on the patient's BSA on activation of the order, click Decrease dose by __% (recalc based on actual dose; results in fixed dose).

This is the percentage of the change in dose, not the final amount to administer. For example, to increase the dose to 120%, type 20; to decrease the dose to 75%, type 25 and click the Decrease checkbox.

 CAUTION—The pharmacy order interface does not accept doses that equal zero (0). Do not decrease a dose by 100%.

The fixed total dose modification is available for pediatric treatments only. This calculates a total dose that is not automatically recalculated against the patient's BSA on activation. The reason for Do Not Recalculate is provided automatically when a provider orders this dose modification. On activation of these orders, recalculated dosing that would increase the total dose is ignored because the dose is capped. If recalculating the dose on activation would decrease the dose by more than 5%, the orders with the higher fixed dose must be approved before they can be activated. See Defining Approval and Authorization for more information on recalculating weight-based dosing at activation.

• Dose—Type the appropriate value, then select the frequency. If this amount is a change rather than the actual dose to be given, click the Change by specified amount checkbox, and if the amount should go down, click Decrease.

This amount can be defined as either the actual dose to be given, or an amount by which to change the actual dose. For example, if you enter 25 and select a frequency, the administration dosing is set at 25 (with whatever units are appropriate for the selected medication. If you enter 25 and click the Change checkbox, the dosing increases by this amount—from the standard dose of 100, for example, to 125. If you enter 25 and check both Change and Decrease, the administration changes from the standard 100 to 75.

5. Type the reason for modifying the dosing.

6. Click OK (ALT+O).

7. To remove an option, click its line, then click Delete (ALT+D).

1. Write the order for the applicable chemo medication, selecting AUC as the dosed by parameter.

2. Complete the form, selecting the AUC formula, and typing a single value for the Target AUC.

3. Click Dose modifications (ALT+M). The Dose Modifications window opens.

4. Click Add (ALT+A) to enter new modifications; click a line then Edit (ALT+E) to change parameters for an existing modification.

5. Type a Target AUC and the clinical reason for changing the value during treatment.

6. Click OK (ALT+O).

7. Repeat the process for additional modifications to the target AUC. Click OK (ALT+O) when all of the options are listed in the Dose Modifications window.

8. Click OK (ALT+O) to complete the chemo medication order.

1. If you haven't already, click Dose Modifications on the chemo medication order form. The Dose Modifications list opens.

2. The Dose Modifications list displays all modifications for the selected medication.

• Click Add (ALT+A) to enter new modifications.

• Click a line, then click Edit (ALT+E) to change modification parameters.

• Click a line, then click Delete (ALT+D) to remove the modification entirely. To "undelete" before closing, click Restore (ALT+R).

1. If you haven't already, click Body Weight Options on the Chemo Medication form.

2. Click to select a single option for calculating the total dose.

3. For dosing based on a dosing weight (entered by the provider when ordering), click to check Frame Size if needed. When Frame Size is checked, the provider is required to select an option: Small, Medium, or Large.

4. For calculations dependent on percentages—the final two options—type the cutoff values for percentage as needed.

1. Click to check Enhanced Ordering Features on the Chemo medication order form.

2. Click the checkbox to select Allow Non-RN Activation.

3. Click OK (ALT+O).

4. Complete the order.

• See Overview of Activating Chemotherapy Orders.

1. Click to check Enhanced Ordering Features on the Chemo medication order form.

2. Click the checkbox to select PO Investigational Chemotherapy.

3. Click OK (ALT+O).

4. Complete the order.

• Prescription-writing capability is also dependent on the ordering site.

• See also: Writing Prescriptions For Oral Investigational Chemotherapy

1. Click (Adult) Age Dependent Dose on the chemo medication order form. The Age Dependent Dosing window opens.

2. Type the age that defines the upper limit of the younger range.

Zero is the lower end of this range; all ages less than (but not equal to) to number of years entered are included in the younger range. The older age range begins with the number you entered.

3. Type the dose for the younger age range.

4. Type the dose for the older age range.

The units for dosing are defined in the main Chemo Med Order.

5. Click OK (ALT+O) to return to the medications form.

1. Click the option for (Adult) Weight Dependent Dose on the chemo medication order form. The Adult Weight Dependent Dosing window opens.

2. Type the upper limit (in kg) for each range in the weight fields, followed by the applicable dose and frequency. For Other frequency, type a description when prompted, then click OK.

The upper limit plus one becomes the lower limit for the next range in the sequence.

3. Click OK (ALT+O).

1. Click to check Enhanced Ordering Features on the Chemo medication order form.

2. Click the checkbox to select (Adult) PO Dose Options.

3. Click OK (ALT+O).

4. Complete the order.

• See Adjusting Dosing of PO Chemo Meds.

See .

1. If you haven't already, click Mix-In... on the Chemo Medication Orders form.
   Fluids and Additives for mix-in are only available for IV routes.

2. Select an option from the Fluid drop-down list as the primary diluent. For Other, type a description when prompted, then click OK.

3. Type the amount of fluid needed.

4. Select the appropriate unit of measure. For Other, type a description when prompted, then click OK.
   Weight-based amounts are calculated automatically when the order is written.

5. For each one needed, select from an Additive drop-down list.

• For Other, type a description when prompted, then click OK.

• Up to eight (8) additives are allowed.

6. Type the amount of each additive needed.

7. Select the appropriate unit of measure for each additive. For Other, type a description when prompted, then click OK.

8. Click OK (ALT+O).

This option is not available if you have defined Dose Modifications by a fixed amount, rather than as a percentage. Delete the fixed amounts dose modifications to reactivate this option. See Changing Dose Modifications.

1. Click (Pedi) Age Dependent Dose on the chemo medication order form.

2. Type the age that defines the upper limit of the youngest range in the Age column of line 1. The value is automatically carried down to complete the first half of the next and last ranges: "Greater than or equal to"

3. Select the units for the age: Year or Month.

4. Type the dose for the defined age range.

5. Select units to dose by: Meters squared (BSA), Kilograms (weight), or Fixed Dose (not weight-dependent).

6. Select a Frequency for the defined age range. For Other, type a description when prompted, then click OK.

7. For lines 2 through 5 as needed, type the upper limit of the next range to be defined in the Age column for that line. Complete each line as described above.

8. Complete line 6 as described above. This defines the lower limit of the upper age range. Any age above the one defined fits into this range.

The minimum requirement for age dependent dosing is two (2) sequential ranges, so you must complete at least the first and last lines.

9. Click OK (ALT+O) to return to the medications form.

The Age Dependent Dosing as defined is displayed on the right of the medication order form, above the Instructions field. Check the phrasing to be sure you got what you intended.

This option is not available if you have defined Dose Modifications by a fixed amount, rather than as a percentage. Delete the fixed amounts dose modifications to reactivate this option. See Changing Dose Modifications.

1. Click (Pedi) Weight/BSA Dependent Dose on the chemo medication order form. The Pedi Weight Dependent Dosing window opens.

2. Click either BSA (meters squared) or Kilograms (weight) to set units for the ranges.

3. Type the upper limit (in units as set in previous step) of the lowest weight or BSA in the weight column of line 1. The upper limit plus one becomes the lower limit for the next range in the sequence.

4. Type the dose for the defined range.

5. Select units to dose by: Meters squared (BSA), Kilograms (weight), or Fixed Dose (not weight-dependent).

6. Select a Frequency for the defined range. For Other, type a description when prompted, then click OK.

7. For lines 2 through 5 as needed, type the upper limit of the next range to be defined in the Weight column for that line. Complete each line as described above.

8. Complete line 6 as described above. This defines the lower limit of the upper age range. Any age above the one defined fits into this range.

The minimum requirement for weight dependent dosing is two (2) sequential ranges, so you must complete at least the first and last lines.

9. Click OK (ALT+O).

1. Click (Pedi) Age/Weight/BSA Dependent Dose on the chemo medication order form.

2. Click an option to define the requirements for dosing:

• Age only: if the patient is under the defined age, use the first dosing option; otherwise use the second. Only the age definition fields are active for this selection.

• Weight only: if the patient is under the defined weight, use the first dosing option; otherwise use the second. Only the weight definition fields are active for this selection.

• Age AND Weight: if the patient meets BOTH requirements, use the first dosing option; otherwise use the second.

• Age OR Weight: if the patient meets ONE or BOTH requirements, use the first dosing option; otherwise use the second.

3. In the If patient age line:

• Select the limiting operation for the age portion of the requirement: Less Than, Less Than or Equal To, Greater Than, Greater Than or Equal To

• Type age that defines the limit, then select Year or Month for the age units.

4. In the If patient weight line:

• Select the limiting operation for the weight portion of the requirement: Less Than, Less Than or Equal To, Greater Than, Greater Than or Equal To

• Type weight that defines the limit, then select Kilograms (weight) or Meters squared (BSA) for the weight units.

5. In the Give line:

• Type the amount of the dose.

• Select the Dose by units and Frequency. For Other frequency, type a description when prompted, then click OK.

The Give dosing is applied automatically when the clinician writes the order, if the patient MEETS the criteria as set.

6. In the Otherwise give line:

• Type the amount of the dose.

• Select the Dose by units and Frequency. For Other frequency, type a description when prompted, then click OK.

The Otherwise give dosing is applied automatically when the clinician writes the order, if the patient DOES NOT MEET the criteria as set.

7. Click OK (ALT+O).