Order Chemo Meds—Exception Orders

• Show all steps

• Show all details

Click link for steps, for additional details

• Select the patient

• Start the chemo order session

• Set up the treatment—Regimen/protocol, diagnosis, numbering, day 1/day 0, patient height and weight

• Confirm treatment setup

• Reusing previous order parameters

• Open the chemo player

• Check information on the actual treatment administered previously —access the LMR Oncology Infusion Flowsheet

• Non-chemo orders—select, edit, add

• Chemo orders—select

• Edit chemo orders

• Add a chemo exception order (MD only)

Only chemotherapeutic or chemo-related medications can 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 above, Add Orders to a Non-Chemo Set .

1. Click Add Chemo (ALT+A).

2. Look up the medication

   1. Type all or part of the name of the medication in the Med name field, then press TAB.

   2. Select an administration method from the Route list to narrow the list of results. Combo or multiple routes are not allowed.

   3. Click Search (ALT+ S ). Results that match your criteria are listed.

3. Select from the search results

   1. If available, to restart the search based on a different age-based population, click the option at the bottom of the results window.

   2. Press the down arrow key or click a line to select from the displayed list.

   3. Click OK (ALT+ O ) or press ENTER .

   4. If applicable, the IV Type window opens. Click to select an option, then click OK (ALT+ O ).

4. Define the dosing and other information

   1. Wait a moment for the system to pull up dosing information on the med you selected. Select the method for dosing (dosed by). Only those units of measure that have a high dose limit will be available for ordering.

   2. Click the Standard Dose field to set the values for calculating the total dose.

   • For other dosing (non-AUC), type the amount of the standard dose based on the units you selected. The Total Dose is calculated automatically and displayed when you move to the next entry.

   • For AUC dosing, click to select either the Cockroft-Gault or Jelliffe formula. Type the patient's most current serum creatinine, then press TAB. The Creatinine Clearance is calculated automatically, based on the formula you chose. Type a Target AUC, then press TAB to calculate the AUC Dose. By default, the order is set to recalculate based on the creatinine level entered by the nurse when the order is activated. If you don't want this, click the Do Not Recalculate option, then type a reason in the field beneath. Click OK (ALT+O O ). The calculated Total Dose is displayed on the form.

5. Set the schedule

   One-time (X1) medications cannot have scheduled days.

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

   2. Click Days (ALT+Y).

   3. Type numbers separated by commas (,) to designate days of the treatment. 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 (:).

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

6. For pediatrics only, as needed define fluids and additives for IV drugs

   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).

7. If the order needs to be activated by a chemo attending, fellow, NP, or PA, click to check This chemotherapy medication will be administered by the Provider.

8. For a PO med and an adult patient, to allow the modifications to the administration (to accommodate available tablet strength, or to allow splitting the administration) , click to check Adult PO dose options.

9. Click OK (ALT+ O ). The order is added to the open Chemo folder.

• Complete the session

• Add a memo as needed (which is saved as a General Care order)

• As needed, view order details, view or print a list of chemo and medication orders only, or make changes before signing.

• Sign the session

• Check the orders awaiting activation

• See also Overview of Chemo Order Entry .