Build Dosing Rules

1. Open the Chemo Builder and add or select a regimen or protocol.

2. Click the Definition tab; the Pediatric option must be checked.

3. Add or edit a chemo medication.

4. Select the dosing method, Pedi dosed by AUC (area under concentration over time curve).

5. Click R to the right of the dosing field to open the Dosing Rules Builder.

1. If needed, click the Formula Dosing tab (ALT+F).

2. Click to check Formula Dosing Rules.

3. If the formula should be applied only under a defined condition:

• Click to select a condition to complete "If the patient's ___ then use these rules."

• If the condition is not defined, click <new>. The Conditions tab opens automatically. See Defining Conditions, below.

If the patient does not meet the criteria set by this condition or the conditions for standard dosing, the chemo medication for which this rule applies will be omitted automatically when the provider writes the orders.  This includes medications that are preselected in the builder as required. The reason for omitting a required medication is applied automatically.

4. Click to select one of the following options:

• Dose All Patients the same—use that same formula for all patients, regardless of age, weight, BSA (body surface area), or GFR (glomerular filtration rate)

• Dose Patients depending on some condition—determine which formula to use based on the patient's age, weight, BSA, or GFR

5. Complete the selection:

• Dose All Patients the same:

• Click to select a formula to complete "Dose patient by ___"

• If the formula is not defined, click <new>. The Formulas tab opens automatically. See Defining Formulas, below.

• Dose Patients depending on a defined condition:

1. Select a condition

• Click to select a condition to complete "Use the patient's ___ to delineate dosing."

• If the condition is not defined, click <new>. The Conditions tab opens automatically. See Define Conditions, below.

2. For both the selected condition and its inverse:

• Click to select a formula.

• If the formula is not defined, click <new>. The Formulas tab opens automatically. See Defining Formulas, below.

6. Click Save (ALT+S). The dosing rules are displayed in the Rules section.

7. The rule must be completed before the regimen or protocol can be activated. If you will be completing the rule set later, click Yes (ALT+Y) when prompted to acknowledge the message if the rule set is not complete. To return to the rules builder, click No (ALT+N).

8. To exit the dosing rules builder, click Close (ALT+C).

1. Click the Standard Dosing tab (ALT+T).

2. Click to check Standard Dosing Rules.

3. Click to select a condition to complete "If the patient's ___ then use these rules."

4. If the condition is not defined, click <new>. The Conditions tab opens automatically. See Defining Conditions, below.

If the patient does not meet the criteria set by this condition or the conditions for formula dosing, the chemo medication for which this rule applies will be omitted automatically when the provider writes the orders. This includes medications that are preselected in the builder as required. The reason for omitting a required medication is applied automatically.

5. Click to select one of the following options:

• Dose All Patients the same—use the same standard dosing for all patients, regardless of age, weight, BSA, or GFR (glomerular filtration rate)

• Dose Patients depending on some condition—determine which standard dosing to use based on the patient's age, weight, BSA, or GFR

6. Complete the selection:

• Dose All Patients the same:

• Click to select a standard dose formula to complete "Dose patient by ___" (weight based or BSA based).

• When prompted, type the amount of the dose, then click OK.

• Dose Patients depending on a defined condition:

1. Select a condition:

• Click to select a condition to complete "Use the patient's ___ to delineate dosing."

• If the condition is not defined, click <new>. The Conditions tab opens automatically. See Define Conditions, below.

2. For both the selected condition and its inverse:

• Click to select a standard to complete "Dose patient by ___" (weight based or BSA based).

• When prompted, type the amount of the dose, then click OK.

7. Click Save (ALT+S). The dosing rules are displayed in the Rules section.

8. The rule must be completed before the regimen or protocol can be activated. If you will be completing the rule set later, click Yes (ALT+Y) when prompted to acknowledge the message if the rule set is not complete. To return to the rules builder, click No (ALT+N).

9. To exit the dosing rules builder, click Close (ALT+C).

• Click the Max Dosing tab (ALT+X).

• Previously defined maximum dosing rules for the selected chemo med are listed. To edit or delete, click to select a line.

• To delete a selected rule, click Remove.

• To write a new rule, click New.

• To edit a selected rule or write a new one:

1. Click to check all conditions that apply to the rule.

2. Type amount and select units from the drop-down lists. The maximum can be set per kg (weight), meters squared (BSA), or dose.

• Click Save/Update (ALT+U).

• If the rule set is complete, or if you will be completing the rule set later, click Save (ALT+S). The rule must be completed before the regimen or protocol can be activated. Click Yes (ALT+Y) if prompted to acknowledge the message that the rule set is not complete. To return to the rules builder, click No (ALT+N).

• To exit the dosing rules builder, click Close (ALT+C).

• The Conditions tab displays automatically when you select <new> from a condition drop-down list when building a dosing rule.

• If needed, click the Conditions tab (ALT+O).

• Previously defined conditions for the selected chemo med are listed. To edit or delete, click to select a line.

• To delete a selected condition, click Remove.

• To write a new condition, if the Condition Definer section is not visible, click New.

• To edit a selected condition or write a new one, construct the statement in the Condition Definer section:

1. Click to select a parameter to compare—age, weight, BSA (body surface area), or GFR (glomerular filtration rate).

2. Select the operator—greater than (>), great than or equal to (>=), less than (<), less than or equal to (<=).

3. Type the number that sets the limit for the condition.

4. For age or GFR, select the unit of measure—age in years or months, GFR in mL/min, mL/min/1.73 X m2, or mL/min/m2. Weight is limited to kilograms (kg), and BSA to square meters (m2).

5. By default, the builder automatically generates a condition to cover the opposite of the one you're building. Click to uncheck the option if you do not want to create the inverse condition automatically.

• Click Save/Update (ALT+U).

• If you selected <new> from a condition drop-down list while setting up standard or formula dosing, the dosing tab will display again, with the condition just saved selected.

• If the rule set is complete, or if you will be completing the rule set later, click Save (ALT+S). The rule must be completed before the regimen or protocol can be activated. Click Yes (ALT+Y) when prompted to acknowledge the message that the rule set is not complete. To return to the rules builder, click No (ALT+N).

• To exit the dosing rules builder, click Close (ALT+C).

• The Formulas tab displays automatically when you select <new> from a formula drop-down list when building a dosing rule.

• If needed, click the Formulas tab (ALT+R).

• Previously defined formulas for the selected chemo med are listed. To edit or delete, click to select a line.

• To delete a selected formula, click Remove.

• To write a new formula, if the Formula Definer section is not visible, click New.

• To edit a selected formula or write a new one, construct the statement in the Formula Definer section:

1. To begin with a system-defined formula, click to select from the Formulas you can use as templates.

• The system-defined formula can be used as is. To have other formulas added to the list, contact the Chemotherapy Order Entry team.

• You can edit a system-defined formula to build a new formula.

• If you edit a system-defined formula, you must provide a distinct name for the new formula.

2. If you are building a new formula, type the descriptive name.

3. Click the buttons (indicated below in bold) in sequence to lay out the formula.

• Formatting—parentheses ( ) and brackets [ ]
  Use these to contain operations that must be completed to first to complete the final calculation. Parentheses should be used for initial operations, braces to contain operations between the results of the parenthesized initial operations. Operations between parentheses are performed first, then operations between square braces, then finally, operations from left to right. There is no implicit order of precedence; variables will be multiplied or divided first only if contained within parentheses or braces. Otherwise, operations are performed left to right.

• Operators x: multiply; /: divide; +: add; - : subtract

• Variables:

• Target AUC

• GFR—when prompted, click to select units, then click Ok.

• Weight (kg)

• BSA(m2)

• Constant—when prompted, type the numerical value, then click Ok.

4. To change and item, double-click to select it, then click the button for the item to replace it.

• If parentheses () or braces [ ] are used, the builder displays a warning if an open ( or [ character or a close ) or ] character is not matched appropriately.

• Click Save/Update (ALT+U).

• If the rule set is complete, or if you will be completing the rule set later, click Save (ALT+S). The rule must be completed before the regimen or protocol can be activated. Click Yes (ALT+Y) when prompted to acknowledge the message that the rule set is not complete. To return to the rules builder, click No (ALT+N).

• To exit the dosing rules builder, click Close (ALT+C).

1. Click the Common tab (ALT+M).

2. Type the title to use in the audit and reporting for this rules set. Usually the name of the protocol or regimen and the medication name.

3. Click Save (ALT+S).

1. Click the Common tab (ALT+M).

2. Type the Target AUC (mg/ml/min).

3. Click Save (ALT+S).

1. Click the Common tab (ALT+M).

2. Type a GFR amount and select the GFR unit of measure from the drop-down list.

3.  Type a weight in kg.

4. Type a BSA in m2.

5. Type a date of birth.

6. Click Simulate.

The number and version of the current rule set displays at the top of the Dosing Rules Builder. The number for the rule set is generated automatically when the rule set is first saved. The version number is incremented from 1 each time the rule set is saved. In order to create a rule set and version number, the minimum required fields must be completed.

1. Click Save (ALT+S).

2. The rule must be completed before the regimen or protocol can be activated. Click Yes (ALT+Y) when prompted to acknowledge the message if the rule set is not complete. To return to the rules builder, click No (ALT+N).

3. To exit the dosing rules builder, click Close (ALT+C).

• Click Copy Rules to Clipboard (ALT+P).

• The copy includes the title from the Common tab, the date and time that the copy was made, the target AUC from the Common tab, all defined formulas (including the formula names), all defined conditions, and all defined formula, standard, and maximum dosing rule sets.

• This text can be pasted into any editable electronic document on the current device, including text documents, spreadsheets, and emails.

• To paste the content to a document, click to place the text cursor, then press CTRL+V. Many documents also include a paste from clipboard button . The Paste command is also often an option on the application Edit menu.

• Click Generate Test Package (ALT+G). When prompted, click Yes to open Excel and display the spreadsheet.

• This function exports sets of parameters necessary to test the dosing rules as built.

• The parameters include age, weight, BSA, and GFR. The combination of values needed to test each condition in the rule set is displayed in a single row of the spreadsheet.

• The final entry for each set of parameters is the dose expected when the protocol is tested with the values.

• Three (3) items are included in the spreadsheet for each condition used by the rules—one equal to the limit, one just less than, and one just greater than.

• If more than one parameter is used to set conditions in the rule set, each combination of parameters is listed. For example, if limit is defined for both age and GFR, the 3 possibilities for age (less than, equal, greater than the limit) are matched against each of the 3 possibilities for GFR (less than, equal, greater than), for a total of 9 scenarios.

• If not set by condition in the rules set, the testing spreadsheet uses defaults of age=9 years, BSA=1.07, weight=50 kg, and corrected GFR=65 mL/min/m2 x 1.73.  

• If the input is the same through all of the results above then it was not part of the protocol definition.

• The spreadsheet is saved automatically in a folder labeled AUC_TestPackages on the local hard drive of the device used for building the rule set (C:\AUC_TestPackages).

• The title of the spreadsheet includes the date generated, the rule set number, and the version number—for example, "2010.12.7 - Rule Set #403v3 Test Package.xls."