Build a Chemo Regimen or Protocol

1. Click Tools (ALT+L).

2. Click Build Chemotherapy Regimens/Protocols (ALT+P).

1. Click the Chemo Maintenance folder.

2. Click the Regimen folder inside Chemo Maintenance.

3. Click Add (ALT+A).

4. Press TAB and type the name.

5. Press ENTER or click OK (ALT+O). The red regimen folder appears in the list, named as you have entered.

6. Sign to save your work.

1. Click the Chemo Maintenance folder.

2. Click the Protocols folder inside Chemo Maintenance.

Protocols are not associated with diagnoses the way regimens are.

3. Click Add (ALT+A).

4. Press TAB and type the QACT number.

5. Press ENTER or click OK (ALT+O). The purple protocol folder appears in the list, numbered as you have entered.

6. Sign to save your work.

The bottom section of the builder now includes several tabs for entering more information on the regimen or protocol. Click the fields in each tab listed below to complete the required information.

1. To prevent editing of scheduled days for a protocol, click to uncheck the Allow day edit checkbox on the Protocol tab.

2. Description

   • Type any relevant information in the free-text field. This includes how and when the regimen or protocol is used, what population it applies to, and what drugs are involved.

   • For clarity, write complete sentences with proper capitalization and punctuation.

3. Definition

   • Inactive—prevents ordering from this protocol or regimen. Do not check Inactive if using the Test option (below).

   • Blind Study—For protocols, if applicable.

   • Test—marks this regimen or protocol for testing. This function does all of the following:

   • Adds "Test" to the beginning of the regimen/protocol folder name, flagging it as a non-usable item.

   • Allows the regimen or protocol to appear in the live version of Provider Order Entry without Activation.

   • Allows the regimen or protocol to appear in the live version of Provider Order Entry without being moved from the Maintenance folder.

   • Day 0—reckoned as the first day of treatment. Otherwise, the first day is designated as Day 1.

   • Lifespan—the interval after which an episode of treatment (cycle, week, phase, or weekly) expires. Set this equal to the cycle length or 30 days, whichever is shorter.

   • Pediatric—flags the treatment as designated for (but not restricted to) pediatric populations.

   • Episodes of Treatment—the player defaults to cycle. Cycles are numbered. Adult treatments auto-increment sequentially in the player; clinicians must enter a number for pediatric treatments. Click one of the following to change to a different description of an episode of treatment:

   • Weeks—may be used for adults or pediatric patients. Weeks are numbered, following the same rules for adult and pediatric treatments as cycles.

   • Ordered Weekly—pediatric regimens or protocols only. Not numbered.

   • Phase—pediatric regimens or protocols only. Phases are not numbered.

   • Allow Regimen Ordering—This is a Therapeutic protocol that gives the ordering clinician the option to order from a standard regimen.

   • This tab is time-stamped on signing when it is created, edited, and activated, as well as when ordering from previous is not allowed. Time stamps include a description of the action, the name of the signer, and the date and time signed.

4. Diagnosis—Regimens only

   • Click the Diagnosis folder and check for diagnosis; add if needed.

   • Select an item from the Diagnosis List, then click Select>>> to add the diagnosis to the Regimen Diagnosis list. You can add as many diagnoses as applicable.

   • To remove a diagnosis from the regimen, select it in the Regimen List and click <<<Deselect.

5. Physician Instructions

   • Physician instructions are specific to the ordering provider. Include notes that are relevant to the provider's understanding of the treatment—for example, No dose modifications included, IBW/ABW used, or Do not recalculate doses cycle to cycle. Include definitions of arms if applicable.

   • Do not reiterate the course of treatment here. For clarity, write complete sentences with proper capitalization and punctuation.

6. Maintenance Description

   • The maintenance description is presented to the ordering provider whenever he or she orders chemotherapy for a patient who is currently on an older version of a regimen or protocol. This information helps the provider decide whether to switch to the newest version of the treatment or remain with the older version.

   • If this is the first version—that is, a completely new treatment—type "This is a new regimen/protocol." Otherwise, describe the changes included in this version. For clarity, write complete sentences with proper capitalization and punctuation.

7. Sign Off

   Record of electronic sign-off for this version of the selected regimen or protocol. Includes Maintenance, Physician, Pharmacist, and Nurse. At present, this process is not required for activation. A paper copy of the regimen or protocol must be printed, signed off, and stored as required by standard operating procedure.

8. Sign to save your work.

1. In the chemotherapy builder, click the Diagnosis folder.

2. Click Add (ALT+A).

3. Press TAB and type the name and a description.

4. Click OK (ALT+O).

5. Sign to save your work.

Notes on diagnoses:

• Diagnoses are listed in alphabetical order by name. These are the options for selection on the diagnoses tab for each regimen.

• Diagnoses are automatically typed as oncology. Diagnoses for non-oncology use must be changed (see below).

• Once a regimen is activated, it is stored in the applicable diagnosis folder or folders, as well as the Regimens folder.

• Physicians ordering a chemotherapy regimen must select a diagnosis first. This limits the regimen options to those that apply to the given diagnosis.

• See below for mapping indications to the new diagnosis. Indications for treatment are required for most chemotherapy regimens and protocols written for adults. Indications include curative versus non-curative intent for solid tumors, or adjuvant/neoadjuvant/curative intent versus palliative/metastatic for hematological malignancies. The provider must update the indication when ordering chemotherapy after 60 days.

1. In the chemotherapy builder, click to select the appropriate regimen (red), protocol (purple), or yellow folder (inside a regimen or protocol) in the Chemo Maintenance folder.

2. Click Add (ALT+A).

3. Click Branch Point.

4. Press TAB and type the name and a description.

5. If needed, change the Branch Name, from the default of Randomization, to Cohort or Select one:.

6. Click OK (ALT+O).

7. Sign to save your work.

Branch points can only hold yellow folders. Order sets can be added to yellow folders.

1. In the chemotherapy builder, click to select the appropriate regimen (red), protocol (purple), or branch folder (inside a regimen or protocol) in the Chemo Maintenance folder.

2. Click Add (ALT+A).

3. Click Folder.

4. Press TAB and type the name and a description.

5. Click OK (ALT+O).

6. Cycle length—In the tab for the folder, type the cycle length, the number of days required for this step of the treatment, including any subsequent days when no therapy should be administered.

7. Confirm Previous—For a subfolder within a branch point, click the Confirm Previous checkbox if the orders in the folder are only intended for use in a single treatment episode. When this box is checked and the ordering clinician clicks Yes when prompted to reuse previous orders, the folders inside the branch point are all offered in a drop-down list. The clinician must select a folder to continue.

8. Last Folder—If this is the final subfolder for the regimen or protocol, click the Last Folder check box. Check Last Folder for single-subfolder regimens and protocols also.

9. Sign to save your work.

Yellow folders can hold branch points, other yellow folders, and order sets.

1. Click to select the yellow folder you're adding a set to. In the chemotherapy builder, click the appropriate regimen (red), protocol (purple), or branch folder (inside a regimen or protocol) in the Chemo Maintenance folder.

2. Click Add (ALT+A).

3. Click Order Set; type a name and description.

4. Click OK (ALT+O).

5. The Orders For This Session scratch pad opens. See next point, adding orders to order sets.

1. Add the order set to open the Orders For This Session scratch pad. To add or edit orders in an existing set, click the green order set folder, then click Edit (ALT+E).

2. Click the appropriate button in the Add New Order section.

3. Click Add (ALT+A) or an order button to open the order form.

4. Complete the form and click OK (ALT+O).

• Complete only required fields. Information can be added or changed when the set is used to write orders.

• For links to step-by-step instructions for each type of order, see Writing Orders.

• Depending on the order, you may be prompted to include other orders. See Overview of Consequent Orders.

5. Repeat the process for additional orders of that type, then click Close (ALT+C).

6. Add orders of different types as needed for the set.

7. Click Sign (ALT+S).

8. Type your signing key, and then click OK (ALT+O) to save the orders and return to the builder.

9. Sign to save your work.

Once you complete the session that pulls in all of the orders for a set, you may want to review the orders and make adjustments or deletions. In addition, when you have a lot of orders in a set, it's a good idea to arrange the orders and create headings to distinguish different types or uses.

• To view details of an order, click its line, then click Zoom (ALT+Z). Click Close (ALT+C) to return to the builder.

• To change or add an order, or remove an order from the list, click its line, then click Edit (ALT+E). The Orders For This Session scratch pad opens, listing every order in the set. Click the line for the order, then click Edit (ALT+E). See Editing Orders.

• To move lines, click one to select it, then click Up (ALT+U) or Down (ALT+D).

• To create sections with headings, select the line that will be the first in the section, then click Insert Text (ALT+I). When prompted, type the heading in the field provided, then click OK (ALT+O).

1. Click Sign (ALT+S).

2. Type your signing key, and then press ENTER or click OK (ALT+O).

The builder closes when you sign. To continue working, reopen the builder and select a folder.

1. Click Build Chemotherapy Regimens/Protocols (ALT+P).

2. Click the Chemo Maintenance folder.

3. Click the Regimen or Protocol folder inside Chemo Maintenance. Regimens or protocols are listed alphabetically.

4. Click the folder for the regimen or protocol you want.

1. Click to select the regimen or protocol in Chemo Maintenance.

2. Click the Definition tab.

3. Click Test. This function does all of the following:

• Adds "Test" to the beginning of the regimen/protocol folder name, flagging it as a non-usable item.

• Allows the regimen or protocol to appear in the live/production version of Provider Order Entry without activation.

4. Sign to save your work.

A paper copy of the regimen or protocol must be printed, signed off, and stored as required by standard operating procedure.

1. Click to select the regimen or protocol in Chemo Maintenance.

2. Click Print (ALT+N).

3. When prompted, click to select an option:

• Hard copy—generate a paper copy to the default printer

• Word—export a text copy to Word; can be edited and saved as a document

• PDF—export a text copy to PDF; cannot be edited, can be saved

4. Click OK (ALT+O).

1. In the Chemo Maintenance folder, click the folder for the regimen or protocol to be activated.

2. Click the Maintenance Description tab. Type a clear, brief description of the changes made, for the ordering providers to see.

3. Click Activate (ALT+V).

4. Type your signing key, then click OK (ALT+O).

5. When prompted, review the Maintenance Description. If it is acceptable, click Yes (ALT+Y); otherwise, click No (ALT+N) and repeat from step 2.

6. When prompted, determine whether to prevent ordering from previous edits. You should require ordering based on the standard if you have made significant changes.

• Click Yes—Entire Template when there are changes to the chemo medication orders to require that all new orders be written starting with the standard regimen/protocol.

• Click Yes—Non-Chemo Only when there are changes to the non-chemo medication orders to require that only new non-chemo orders be written starting with the standard regimen/protocol; ordering from previous for chemo agents is still allowed.

• Click No (ALT+N) to allow ordering based on previous edits to the standard.

7. Click OK (ALT+O) to acknowledge the message that the activation is complete.

If the regimen or protocol being activated is an edit of an existing live regimen or protocol:

• The current active version is time-stamped and moved to the appropriate Archive folder. Archived folders cannot be used by clinicians or activated.

• If the current version is "on hold" the new version remains on hold. Resume the active/live folder to allow clinicians to use it for orders. See Resuming Regimens and Protocols On Hold..

• The definition tab is time-stamped "Stopped Previous" if you do not allow ordering from previous, and time-stamped "Stopped Non Chemo Previous" if you limit ordering from previous to chemo agents (because non-chemo meds have been changed significantly).

• If you do not allow ordering from previous, or limit ordering from previous to chemo agents (because non-chemo meds have been changed significantly), on writing the next set of orders in the treatment clinicians will get a message explaining that the regimen/protocol has been edited.

1. Click the Regimen or Protocols folder, then click the folder inside for the specific regimen or protocol to be held.

2. Click the Maintenance Description tab. Type a clear, brief description of the changes made, for the ordering providers to see.

3. Click Hold (ALT+H).

4. When prompted, type the reason the treatment is on hold.

5. Click OK ALT+O).

6. Type your signing key, then click OK (ALT+O).

• A clinician selecting an "on hold" regimen or protocol is presented with the reason entered by the builder. For patients on regimens, ancillary protocols, or ancillary/therapeutic protocols, the clinician can select an alternate treatment regimen.

• Builders can edit "on hold" folders. The "on hold" status is retained when the maintenance version is activated.

• Resume the active/live folder to allow clinicians to use it for orders. See Resuming Regimens and Protocols On Hold.

1. Click the Regimen or Protocols folder, then click the folder inside for the specific regimen or protocol to be resumed.

2. Click Resume (ALT+M).

3. Type your signing key, then click OK (ALT+O).

1. Click the Regimen or Protocols folder, then click the folder inside for the specific regimen or protocol to be updated.

2. Click Edit (ALT+E). A duplicate of the selected folder is created in the appropriate Chemo Maintenance folder.

3. Click OK (ALT+O) to acknowledge the message displayed.

4. Make changes, additions, and deletions as needed to the new version in the Maintenance folder. When all changes are complete, activate the new version.

1. Click to select the folder you want to copy.

2. Click Copy (ALT+O).

• You can copy any folder in Chemo Maintenance, Regimens, or Protocols—a regimen, protocol, branch point, yellow folder, or order set.

• All of the folders and orders within the original are included in the copy.

• Copies are labeled "Copy of" followed by the name of the original. Only the highest level folder of the copy is labeled this way.

• Regimens or protocols copied from live are placed alphabetically (in the Cs for Copy) in the appropriate Maintenance folder.

• Branch points, yellow folders, and order sets are placed at the bottom of the same level as the original.

3. When prompted. CLICK OK.

DO NOT PRESS ENTER; this creates an error.

4. For regimens or protocols copied from live to maintenance, click Exit to complete the process of registering the copy to maintenance.

Exit the builder to allow the copy to reload as a maintenance folder. Failure to reload causes errors in the system.

5. Update the copy for use:

• To move a folder into a different folder, see Moving Folders (Edit the Path).

• To change the top to bottom order of folders within a folder, see Reorganizing Folders.

• To change the name, see Renaming Folders.

You can rename any folder—a regimen, protocol, branch point, yellow folder, or order set.

1. Click the folder to view its tabs below.

2. Click the first (leftmost) tab.

3. Click and drag over the name to highlight the words in blue, then type a new name.

4. Press TAB to complete the change.

5. Sign to save your work.

1. Click to select the folder to move.

2. Click Edit Path (ALT+H).

The Edit Path button is active only when a moveable folder is selected.

3. The Select Chemo Folder Parent Path window opens. Click to select a destination folder in the bottom pane, New Folder Parent.

Only regimen folders (red), protocol folders (purple), or container folders (yellow) can serve as destinations.

4. Click OK(ALT+O).

5. When prompted, type your signing key, then click OK (ALT+O).

When the process is complete, the moved folder is displayed in it's new location. This may take a moment.

1. Click to select the folder to move.

2. Click Up (ALT+U) or Down (ALT+D). It may take a moment for the moved folder to appear in it's new location.

1. Click to select the folder to delete.

2. Click Delete (ALT+D). The folder is "crossed out" with a red X: .

To undo this action, click Restore (ALT+R).

3. Click OK (ALT+O).

4. Sign to save your work.