Orders for chemotherapy are split into non-chemo session #1, chemotherapy session #2, and chemotherapy session #3 as needed. Sets of sessions are further split into weeks by scheduled day. There are restrictions on who can activate certain types of orders. See Overview of Chemo Activation for details.
Open the orders session list:
Click Activate (ALT+A).
Open the orders list:
Select the session for the orders you want to activate..
Click Activate (ALT+A).
In MGH ambulatory units, you are notified if the patient isn't registered for the visit on arrival. Click OK (ALT+O).
The sessions for an unregistered patient are preceded by an asterisk (*). At present, this message is the only result. A new pharmacy ordering system is under construction, which requires that a patient be registered to accept an order. When the new system is implemented, you will not be able to activate the orders until the patient is registered for the visit.
Confirm the patient's height and weight record:
For sessions containing orders based on the chemotherapy weight (any pediatric sessions, and the chemotherapy session #2 for adults), the patient's height, weight, and calculated BSA, as recorded when the orders were written, is displayed.
Check the entries and update the weight or height if needed. The BSA is recalculated automatically.
Click OK (ALT+O).
If the dosing (based on either the weight or the BSA) for one or more of the chemo orders changes by more than five percent (5%), the orders must be approved. An NP or MD can approve the change when an RN did the activation; an oncology attending must approve NP activation-based dose changes.
Confirm the patient's serum creatinine:For sessions containing orders with AUC dosing, the patient's serum creatinine is displayed as recorded when the orders were written, along with the calculated creatinine clearance and AUC.
Check the serum creatinine and update if needed. The creatinine clearance and AUC are recalculated automatically.
Click OK (ALT+O).
If the dosing for chemo medications is based on the patient's weight, BSA, or creatinine clearance (AUC dosing), doses may be recalculated. The ordering clinician does have the option to prevent dose recalculation. However, if a new dose is calculated, and the change is more than 5%, the orders will need to be approved by a chemo attending or nurse practitioner.
Review the entries for the patient's GFR (glomerular filtration rate):
This prompt appears for sessions containing chemo orders with dosing calculations that are determined by conditional rules, which are based on the patient's GFR, BSA, weight, age, or a combination of any of these.
Click OK (ALT+O) after reviewing the information.
If you changed the weight or creatinine (see above), the dosing rules may trigger a change in the calculation used to determine the dose. If this happens, the message appears stating that the pediatric AUC rule used to calculate the original dose has changed. Click OK (ALT+O) to acknowledge the message.
To display cumulative dose information, click Cumulative Dose (ALT+U). This is not available for NSMC inpatient. See Evaluating Cumulative Dose Information.
To display chemo orders from all sites that have been activated in the past 6 months, click Chemo View (Historical). See Viewing Historical Chemo Information.
To view details of an order:
Select its line and click Zoom (ALT+Z).
Click Close (ALT+C) to return to the Order Summary.
To open KnowledgeLink
Click 
.
Click Exit (ALT+E) to close KnowledgeLink.
Click Pop Out (ALT+P) to open KnowledgeLink in a separate window from the CAS.
Toggle between Order Entry and KnowledgeLink by clicking the icons in the taskbar.
Click 
to close the KnowledgeLink window.
To access the LMR Oncology Infusion Flowsheet:
Click Infusion Flowsheet (ALT+F).
Toggle between Order Entry and the LMR by clicking the buttons on the left in the CAS.
Laboratory results are displayed beneath the orders list. These are results that have been reported in the previous 21 days, which are defined as relevant to the chemo medications for the current regiment or protocol. Today’s results are bold and underlined. Results outside of the reporting lab's reference range are flagged in red followed by H (high) or L (low). If no results are displayed, check the Results viewer by clicking Results in the CAS toolbar on the left. (See Checking Last Known Values for Lab Results.)
To activate orders:
Click Yes (ALT+Y) when you have reviewed all of the listed orders appropriately.
Click OK (ALT+O) to activate the orders in the session.
For ambulatory chemotherapy orders, when prompted, click to select the treatment location, then click OK (ALT+O).
When prompted, type your clinical key and click OK (ALT+O).
A weight or creatinine change entered at activation may cause a significant (more than 5%) change in the calculated dose, or a change of the formula used to calculate the dose. In both cases, the orders must be approved. Click OK (ALT+O) to acknowledge the message. The ordering provider is notified of the approval requirement. See Overview of Chemotherapy Approval Notification.
For ambulatory chemotherapy orders, click Yes (ALT+Y) when prompted to print, or No (ALT+N) if paper copies of the orders are not needed.
On returning to the special order sessions list, click Close (ALT+C).
See also: Overview of Chemo Activation