Standing orders for ambulatory chemotherapy—As of July 11, 2012, chemo providers are prompted to select a pre-defined set of orders for intravenous access and line maintenance on completing the first orders an adult patient at an ambulatory MGH or DFCI location. The order sets are not available for inpatient or for pediatric patients. These access and flush orders, which are part of the nursing standing orders, are required for regulatory compliance, product bar coding, and electronic documentation of the chemo administration.
Orders in the set include IV fluids, insertion instructions, flush solutions, and related medications; each site has a different set. Orders from the set are flagged "AF" (access and flush) in the summary and detailed views.
The prompt to order occurs if the patient does not already have orders from the set, either active or pending activation. Clicking No when prompted to order access and flush defers the decision for a week; the prompt is triggered again when any provider writes ambulatory orders after seven (7) days
The AF orders must be activated, just like other chemotherapy-related orders. They are listed for activation as an Access and Flush session, separate from other chemo sessions (chemo-related session #1, chemotherapy session #2, and provider-activated chemotherapy session #3). AF orders expire 365 days after activation.
Instructions: Ordering from an Access and Flush set (MGH and DFCI ambulatory chemotherapy units only)
See also: Archive of What's New for DFCI Chemo Order Entry