link for steps, 
for
additional detailsClick
link for steps, for
additional details
For inpatient and ambulatory orders, click Write (ALT+W).
For pre-admission orders, click Special Orders (ALT+O), then Pre-Admit (ALT+I), then New (ALT+N).
Enter the expected date of the visit.
Typing—use mm/dd/yy format, or T = today logic, with T+1 = tomorrow, T+30 = thirty days from today, for example.
Calendar—Click the icon to the right of the date field to open the calendar. Click 34 to change the month displayed. Click a date to select it. Click OK if needed.
Click OK (ALT+O).
For ambulatory orders, click the select the visit location.
Click OK (ALT+O).
Click Chemo (ALT+H)
Click Add (ALT+A)
Click to select a treatment.
Click OK (ALT+ O ).
This prompt occurs only if a treatment plan in the LMR is finalized, and only when writing the initial set of chemo orders. The diagnosis and regimen can be changed as needed when writing chemo orders.
Click Yes (ALT+Y) to automatically select the diagnosis and regimen shown.
Click No (ALT+N) to continue without pre-selecting the diagnosis an regimen.
A message displays if the patient has chemo orders awaiting activation.
Click OK (ALT+O) to acknowledge.
Click Cancel (ALT+C) unless you are writing orders for another treatment, or unless you are editing active orders.
See also:
To add orders to the current treatment, or to write orders for a new cycle, week, phase, or weekly treatment, click Continue (ALT+ O ).
To automatically discontinue the existing orders and write new orders, click D/C Existing (ALT+ D ).
This option is not available for BWH Ambulatory Infusion units.
The discontinued orders are listed as part of the session when you finish ordering.
To return to the session scratch pad, click Cancel (ALT+ C ) or Edit (ALT+E).
See also: Editing Active Chemo Orders
Protocols are not offered if the patient is not enrolled with Quality Assurance Clinical Trials (QACT) or the MGH Pediatric Protocol registration . See Overview of Chemo Order Entry .
For the initial treatment, select a diagnosis.
If the option is available, select from the Indications drop-down list.
Indication is required if present.
The information must be updated when ordering subsequent treatments after 60 days.
Type the identifying number in the Cycle /Week field, if empty. Press TAB or click the next field to continue.
Phase (pediatric) and Weekly (adult) treatments are not numbered—no entry is needed.
For adult patients on cycle-defined treatments, the cycle number increments automatically for subsequent cycles after the first is written.
For pediatric treatments defined by week or cycle, you must enter the number every time. The numbers need not be sequential.ࠀ
Type the date of Day 1 or Day 0 of the treatment. Press TAB or click the next field to continue.
If you are writing the orders after the patient has started treatment, enter the past date that the treatment started. You will be prompted to confirm that Day 1/ Day0 is in the past.
The relation of the current date to the initial date of treatment is displayed to the right of the Day 1/ Day 0 field. "Today is day..." will be a negative number if the start of treatment is set for the future; and positive if the treatment starts today or has already started.
For the initial treatment, select a diagnosis.
If you plan to add exception orders, or order from a regimen for an alternate diagnosis, click to check Exception Orders (ALT+E) .
Only MDs can write exception orders. See Overview of Exception orders for more information.
See also: Writing Exception Orders for Chemotherapy Medications.
To order from a regimen for an alternate diagnosis:
If you haven't already, click to check Exception Orders (ALT+E) .
Click Alternate Diagnosis (ALT+T) .
Select an alternate diagnosis.
Select a treatment from the Regimen drop-down list.
If you select the Exception regimen, you must write every order from scratch. The custom regimen will be saved for the patient.
The options available are based on the primary diagnosis, or the alternate diagnosis if that option is selected.
Pediatric regimens are offered only to clinicians with pediatrics authorization.
If the option is available, select from the Indications drop-down list.
Indication is required if present.
The information must be updated when ordering subsequent treatments after 60 days.
Type the identifying number in the Cycle /Week field, if empty. Press TAB or click the next field to continue.
Phase (pediatric) and Weekly (adult) treatments are not numbered—no entry is needed.
For adult patients on cycle-defined treatments, the cycle number increments automatically for subsequent cycles after the first is written.
For pediatric treatments defined by week or cycle, you must enter the number every time. The numbers need not be sequential.
Type the date of Day 1 or Day 0 of the treatment. Press TAB or click the next field to continue.
If you are writing the orders after the patient has started treatment, enter the past date that the treatment started. You will be prompted to confirm that Day 1/ Day0 is in the past.
The relation of the current date to the initial date of treatment is displayed to the right of the Day 1/ Day 0 field. "Today is day..." will be a negative number if the start of treatment is set for the future; and positive if the treatment starts today or has already started.
If no data is available from the LMR, type the patient’s height and weight, using customary US or metric units. At the request of the Chemotherapy Safety Committee, only one type of unit is allowed, dependent on the care setting. The alternative units and BSA are calculated automatically. Press TAB or click the next field to continue.
If there is data available from the patient’s ambulatory Longitudinal Medical Record (LMR), the difference between the LMR weight and the most recent Chemo Order Entry (COE) weight is displayed. For comparison and calculation, as with manual entry described above, the care setting determines which unit—US customary or metric—is used. If there is no previous COE weight (including the case that the last COE weight is expired), the difference is 100%.
To display the LMR data, click View LMR Weight & Height. The values, entry date, and percent difference are displayed. As with manual entry described above, the care setting determines which unit—US customary or metric—is used. Click Update COE with LMR Information (ALT+U) to use this data for ordering chemo; click Cancel (ALT+C) to close the display without using the LMR weight. The alternative units and BSA are calculated automatically.
Weight and height for chemo calculations is stored separately from any other order entry values—for example, the values used for weight-based dosing of medications ordered outside of a regimen or protocol. Weight must be re-entered every 30 days for oncology patients, every 90 days for patients receiving chemotherapy for other conditions.
Validate the weight (triggered alert as outlier for age group)
Weight entered is outside of the expected range for a patient in this age group.
Check the data entered.
To change the height, weight, or both, click Incorrect (ALT+I) and type correct values, then click OK (ALT+ O ).
To continue, click Correct (ALT+ O ).
Validate the height (triggered alert as outlier for age group)
Height entered is outside of the expected range for a patient in this age group.
Check the data entered.
To change the height, weight, or both, click Incorrect (ALT+I) and type correct values, then click OK (ALT+ O ).
To continue, click Correct (ALT+ O ).
Click OK (ALT+ O ).
If you choose not to use the LMR weight (see Setting Up Treatment—Enter Weight) when there is greater than 5% difference between the LMR and previous COE weight, you must provide a reason for doing so.
Type your reason.
Click OK (ALT+O).
Check the data entered.
To change the height, weight, or both, click Incorrect (ALT+I) and type correct values, then click OK (ALT+ O ).
To continue, click Correct (ALT+ O ).
If adding to an existing cycle or week (orders are active or awaiting activation), click Correct (ALT+ O ).
To return to the setup form, click Incorrect (ALT+I) and type correct number, then click OK (ALT+ O ).
If adding orders to an treatment that has already started, or ordering in mid-treatment, click Correct (ALT+O) .
To return to the setup form, click Incorrect (ALT+I) . Change the date, then click OK (ALT+ O ).
The end of treatment date is calculated by adding the defined length of the existing treatment to its day 1/day 0 date.
Type the reason.
Click OK (ALT+ O ).
See Chemo Overview: Reusing Exception Orders for information on the requirements for reusing previous orders.
Read the description of previous orders when the option is offered. Ordering from previous may be limited to chemotherapy agents when significant changes have been made to the standard non-chemo medication orders. Non-chemo orders revert to the standard setup when you order from previous in this case.
To use the standard regimen, click No (ALT+N).
To start with what was ordered on the previous treatment, click Yes (ALT+Y).
If prompted that the standard treatment has been modified since the last time it was ordered for the selected patient and the changes require that you start from the new standard setup:
To access the LMR Oncology Infusion Flowsheet, click Infusion Flowsheet (ALT+F).
To continue writing orders for adult patients, providers who have access to the webLMR must review previously administered chemotherapy by clicking Infusion Flowsheet.
Click OK (ALT+O) to acknowledge the message.
If prompted that orders were discontinued after the session was signed, click OK (ALT+O) to acknowledge the message.
The effect of discontinuing a chemo order that has been signed—whether it has been activated or not—is to delete the scheduled days, not to omit or uncheck it on the order set. You must enter the days to administer that drug if you want to include it in the orders.
Click OK (ALT+O) to acknowledge the message.
If you want to use the same settings as the orders awaiting approval/authorization, ask the provider who is assigned to sign off.
Click OK (ALT+O) to acknowledge the message.
The chemotherapy medications in the standard regimen have been changed significantly since the previous orders were written. You will not be able to reuse your previous settings. A general care order is added to the set to inform nursing and pharmacy that previous settings did not automatically carry over, and that all dosing should be checked.
Click OK (ALT+O) to acknowledge the message.
The previous set of chemo orders was discarded rather than activated. You cannot reuse the parameters from the discarded orders. Discarded orders cannot be retrieved; the orders must be written from the standard treatment.
Click OK (ALT+ O ).
Physician instructions are defined as needed for the selected regimen or protocol. To review, click the regimen (red) or protocol (purple) folder. Click the Physician Instructions tab if needed.
If the selected treatment is set up with one or more mutually exclusive sets of orders, you are prompted to select one. The player will display the first set of orders in the selected folder.
Click to select an item on the drop-down list.
Click OK (ALT+ O ).
To widen the folder display when the label is long, click Expand (ALT+X). Click Contract (ALT+ N ) to reverse.
Click the yellow folder 
you
need if it isn't open 
.
Click Select (ALT+S).
Confirming previous: If opting to reuse previous orders that have been defined as "single use," you must select a yellow folder. The previous setup will be provided if you select the same folder that was used to write the previous orders.
Check information on the actual treatment administered previously—access the LMR Oncology Infusion Flowsheet
Click Infusion Flowsheet (ALT+F).
Click Orders in the CAS to return to the chemo player, and LMR to toggle back to the Infusion flowsheet.
The first set of
orders is displayed in the orders list. Items that
are checked 
are added to the order for the patient.
To check or uncheck an item, click the corresponding checkbox.
If you uncheck an order that is defined as required by the treatment, type a reason for omitting the order, then click OK (ALT+ O ).
To view order details, select a line from the list and click Zoom (ALT+Z). Click Close (ALT+C) to return to the list.
If all of the orders in a set don't fit into the display, click More (ALT+M) to view the rest. You must view all orders to continue.
Click Next (ALT+N) to view another order set.
Select orders and edit as needed.
Repeat this process for all order sets in the current folder.
The final set includes chemotherapy agents and related medications. See Chemo orders—select and edit below for more information.
To complete the orders, having reached the final order set folder, click OK (ALT+O).
If you haven't already, click Next (ALT+N) or Previous (ALT+P) to open the folder with the order to edit, then click the line for an order to select it.
The order's parameters are displayed in the tab sections at the bottom. Click a tab to view its contents.
The summary cannot be changed. If available, type instructions as needed.
Press TAB to update the order display in the list.
If you haven't already, click Next (ALT+N) or Previous (ALT+P) to open the folder with the order to edit, then click the line for an order to select it.
The order's parameters are displayed in the tab sections at the bottom. Click a tab to view its contents.
Select options and type instructions as needed.
Med tab dose—Click to select a dose from the drop-down list. For Other, when prompted, type the amount, then select the units, or click Other Unit and type a description.
Med tab frequency—Click to select a frequency from the drop-down list. For Other, when prompted, type a description.
Med tab as needed administration—Click to check PRN,
or to change existing reason(s),
click 
.
When prompted, check one or more reasons. For reasons needing additional
parameters, indicated by (__), click the Less than or Greater than
checkbox, then type the threshold number and units. Click OK
(ALT+O) to close the reasons list.
Start/duration tab Start time—Click to select an option. For Other, see Defining non-standard start times.
Start/duration tab duration—Type the total number of doses, days, or hours to give the medication.
Start/duration tab duration unit—Click to select doses, days, or hours.
Instructions tab—Type as needed.
Press TAB to update the order display in the list.
If you haven't already, click Next (ALT+N) or Previous (ALT+P) to open the folder with the order to edit, then click the line for an order to select it.
The order's parameters are displayed in the tab sections at the bottom. Click a tab to view its contents.
Select options and type instructions as needed.
IV1 tab Amount or Alt (alternate amount) —Type the rate. For Alt Amount, click to select cc/m2/hr for the weight/BSA-based rate.
IV1 tab Start—Click to select an option. For Other, see Defining Non-Standard Start Times.
Scheduled days can be changed by clicking Other, then clicking the By Day option in the Start day section. When prompted, type the day number(s) as described, then click OK (ALT+ O ).
IV1 tab Site—Click to select from the drop-down list.
IV1 tab Heplock When—Type a description of the condition(s) to meet for adding a saline lock to the IV.
IV Fluids with the saline lock option selected automatically generate two (2) consequent medication orders on completion. See Overview of Consequent Orders .
Instructions tab—Type as needed.
Press TAB to update the order display in the list.
If you haven't already, click Next (ALT+N) or Previous (ALT+P) to open the folder to add the order to.
Click Edit (ALT+E). The Orders For This Session scratch pad opens.
Click a button in the session scratch pad to select an order type.
Click Add (ALT+A) or the appropriate order button in the Add New Order section to open the related order form.
Complete the order form and click OK (ALT+O).
Repeat the process for additional orders in that category, then click Close (ALT+C). The new orders are listed in the Orders For This Session scratch pad.
Click Sign (ALT+S).
Type your signing key when prompted, then click OK (ALT+O).
The new orders are checked automatically in the orders list. The next time you or any other authorized clinician writes chemo for this patient, these orders will be available if you opt to reuse the previous orders rather than revert to the standard regimen.
Click Next (ALT+N) to open the Chemotherapy folder and display the orders in the grid to the right.
Type the patient's serum creatinine concentration, then press TAB. The creatinine clearance result is calculated automatically based on the CrCl equation required by the treatment.
For exception orders, type the target AUC. To modify a target AUC preset by the regimen or protocol:
Click AUC Modifications (ALT+ M ).
Click to select a modification option.
Click OK (ALT+ O ).
The AUC Dose is calculated automatically when you move to the next entry.
If allowed by the treatment, click one of the two recalculation options.
Recalculated dosing is based on the creatinine value entered when these orders are activated. If the resulting dose differs by more than five percent (5%) from the original the orders must be approved by an attending oncologist or pediatric oncology NP or PA . Dosing changes triggered by NP/PA activation must be approved by an attending.
If you choose not to allow recalculation, type a reason for doing so.
Click OK (ALT+ O ). The calculated Total Dose is entered automatically.
Type a weight for calculations using customary US or metric units. The alternative units and BSA are calculated automatically.
Click OK (ALT+ O ).
If any of the orders is PO, a message reminding you to use dose options appears. Click OK (ALT+O).
Missing scheduled days: If an order for chemo was discontinued, a message displays that an order does not have scheduled days. Click OK (ALT+O). You must restore the scheduled days to include the order in this session. See Editing scheduled days.
Results for laboratory tests that have been defined as relevant for the chemo medications in this session are displayed in a grid above the order list.
Items that are checked are added to the order for
the patient. To check an item, click the corresponding checkbox.
To view order details, select a line from the list and click Zoom (ALT+Z). Click Close (ALT+C) to return to the list.
If all of the orders in a set don't fit into the display, click More (ALT+M) to view the rest. You must view all orders to continue.
Click Previous (ALT+P) to view another order set.
Click OK (ALT+ O ) to complete the orders.
Click to remove the check.
If you uncheck an order that is defined as required by the treatment, type a reason for omitting the order, then click OK (ALT+ O ).
Click the line for an order to highlight it and display its parameters in the section beneath the order list.
Click either Dose field as appropriate to the dosing you want to change.
If defined for the selected medication, dose changes and reasons are presented in a list box. Click a line in the Choose Dose Modification list to select it.
Dose modifications defined as percentages or changes by a specified amount are calculated automatically. The modification description includes what dose the calculation is based on—either the amount of the original standard dose for the regimen or protocol, or the previous dose order.
For a protocol order, if Dose Modifications are not defined, changes to the dosing are not allowed.
If dose modifications for a regimen are not presented, type the amount for the dose you want. The new dose cannot be greater than the standard.
The pharmacy does not accept zero (0) doses. If you enter 0 or choose a modification that results in a zero dose, click OK (ALT+ O ) to acknowledge the message. Choose a different dose, or omit the order entirely.
If a reason for the dose modification is not defined, type your reason when prompted.
Click OK (ALT+ O ).
Click the standard dose field.
If correction is needed, type the patient's serum creatinine concentration, then press TAB. The creatinine clearance result is calculated automatically based on the CrCl equation required by the treatment.
For exception orders, type the target AUC. To modify a target AUC preset by the regimen or protocol:
Click AUC Modifications (ALT+ M ).
Click to select a modification option.
If dose modifications are not presented, type the target AUC for the dose you want.
If a reason for the dose modification is not defined, type your reason when prompted.
Click OK (ALT+ O ).
The AUC Dose is calculated automatically when you move to the next entry.
If allowed by the treatment, click one of the two recalculation options.
Recalculated dosing is based on the creatinine value entered when these orders are activated. If the resulting dose differs by more than five percent (5%) from the original the orders must be approved by an attending oncologist or pediatric oncology NP or PA . Dosing changes triggered by NP/PA activation must be approved by an attending.
If you choose not to allow recalculation, type a reason for doing so.
Click OK (ALT+ O ). The recalculated Total Dose is entered automatically.
Click the standard dose field.
Type the weight to be used in calculating dosing in either pounds (lbs) or kilograms (kg). Alternate units and the BSA are calculated automatically.
Click OK (ALT+ O ). The recalculated Total Dose is entered automatically.
Reasons and orders for dosing options
If you haven't already:
From the chemo folder in the chemo player, click to select the order, then click Dosing Options on the Chemo Med tab.
For exception orders, click Dosing Options on the Chemo Medication order form.
For each dose (up to 6), type an amount. Units are displayed to the left of the field.
For each dose (up to 6), click to select an option from the frequency drop-down list. For Other, type a description when prompted, then click OK (ALT+O).
For each dose (up to 6), type to indicate which day(s) to schedule the dose. Number days before day 1/day 0 as negative (for example, -3); define a range of consecutive days with the first and last day inclusive, and a colon between (for example, starting on day 1, administering each day through 6, is 1:6).
Type instructions as needed.
Click OK (ALT+O).
If the total amount of the dose or doses you ordered does not add up to equal exactly the total dose calculated for the order, you are required to provide a reason. Check that your order is correct.
If the reason for the difference is that the available strength of the medication doesn't exactly match the calculated dose, or if you rounded the amount, just click OK. "To accommodate dose rounding/tablet size" is the reason entered by default.
If you need to add to or change the reason provided, type and/or delete text, then click OK.
This entry becomes part of the order.
Orders written for ambulatory care do not transfer to inpatient records, and vice versa. When entering orders for your patient to continue with treatment mid cycle, be aware that the correct day 1 date should be entered upon ordering. This will ensure that the treatment which the patient has received at another facility will not be duplicated upon administration. For example: Your patient began treatment on 1/1/10 and received days 1 and 2 as an outpatient. Your patient is now being admitted to inpatient on day 3 (1/3/10). When writing the inpatient orders, be sure to enter the day 1 date as 1/1/10. If the day 1 date is entered as today, you will need to delete days 1 and 2 from the scheduled days for all applicable orders.
Chemo meds must have scheduled days to be included in the order session. A chemo med with no numbers after "Day(s)" in the description is not part of the orders even if it is checked off.
If an active chemo order from a previous treatment was discontinued, the scheduled days for the order were deleted automatically. You must restore the scheduled days to include the order in the current session.
Click the Schedule tab, then click Sched days/doses.
Click the Days (ALT+Y) option.
In the Days field, type numbers separated by commas (,) to designate days of the treatment. There are limits to the changes allowed. 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 (:).
If you decrease the number of scheduled days, type the reason when prompted.
Click OK (ALT+ O ).
Click to select an agent from the list.
Click the Do Not Recalculate tab.
Type a reason for preventing recalculation of dosing in the field provided.
Repeat for each chemo medication ordered, as needed.
To queue the order for the allergist team to calculate concentrations, infusion rates, and durations when the patient needs to be desensitized:
Click to select an order from the list.
Click the Desensitize tab.
Click the Desensitize checkbox.
Click the checkbox to affirm that you have discussed the case for desensitization with an allergist.
Only continuous infusion medications that are approved for desensitization can be requested. Consult the allergist team before ordering desensitization. Orders for desensitization are flagged <DESEN>, and the patient Order Status includes the <DESENZ> flag. See Overview of Desensitization Orders .
Click to select an agent from the list.
Click the Instructions tab.
Type in the field provided to add, edit, or remove text.
Repeat for each chemo medication ordered, as needed.
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 .
Click Add Chemo (ALT+A).
Type all or part of the name of the medication in the Med name field, then press TAB.
Select an administration method from the Route list to narrow the list of results. Combo or multiple routes are not allowed.
Click Search (ALT+ S ). Results that match your criteria are listed.
If available, to restart the search based on a different age-based population, click the option at the bottom of the results window.
Press the down arrow key or click a line to select from the displayed list.
Click OK (ALT+ O ) or press ENTER .
If applicable, the IV Type window opens. Click to select an option, then click OK (ALT+ O ).
Wait a moment for the system to pull up dosing information on the med you selected. Select the method for dosing (dosed by).
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.
One-time (X1) medications cannot have scheduled days.
Click Scheduled days/doses (ALT+ H ).
Click Days (ALT+Y).
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 (:).
Click OK (ALT+ O ) to return to the medications form.
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.)
Select an option from the Fluid drop-down list as the primary diluent. For Other, type a description when prompted, then click OK.
Type the amount of fluid needed.
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.)
For each one needed, select from an Additive drop-down list.
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.
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.
Click OK (ALT+ O ). The order is added to the open Chemo folder.
If you haven't already, after you have opened the Chemo folder (last in the group), having selected and adjusted all orders as needed, click OK (ALT+ O) .
Type a reason for adding exception orders to the regimen. The reason should include details sufficient for the reviewing oncologist to sign off on the exception.
Click OK (ALT+ O ).
Chemo High Dose—This warning is triggered when the patient's order or orders for a given medication exceed the recommended maximum dose for either the day or the week. If both the daily and the weekly maximum are exceeded, a warning is presented for each. The calculation for total dose includes only those orders entered into the Order Entry system.
To lower the dose:
Click No, Change Dose (ALT+N) . The player opens to the Chemo folder.
Click the line for the indicated order, then decrease the dose. See Editing chemo orders in the player.
To accept the dose as written:
Click Yes, Continue Order (ALT+Y) .
Type a reason for the high dose in the field provided.
Click Close (ALT+C) .
Each order selected is checked to determine if it exceeds the maximum dosing recommendations (see chemo high dose warning, above), if it is listed in the patient's allergy record, and/or if it is likely to interact with any of the patient's current active medication orders or with any of the other orders selected in the regimen/protocol. A separate alert is presented for every order as it is reviewed, for each intervention—drug-drug interactions, allergies, and high dose. In each case, you have the option to remove the order that triggered the alert. You can opt to keep an order that triggers an alert (except for level 1 drug-drug interactions); you must indicate your reasons and course of action for doing so. See also:
Responding to DDI level 1 alerts (caused by an exception order)
Click Memo (ALT+M).
Type to add, edit, or delete the note.
Click OK (ALT+O).
To view order details, select a line from the list and click Zoom (ALT+Z). Click Close (ALT+C) to return to the list.
To view or print a list of chemo and medication orders only, click View Chemo (ALT+V).
To print a list of these orders, click Print All (ALT+A).
To print a single order, click to select it on the list, then click Print Order (ALT+P).
To view order details, select a line from the list and click Zoom (ALT+Z).
Click Close (ALT+C) to return to the review and sign list.
To make changes before signing, click Return to Player (ALT+R). Select, deselect, and edit orders as needed, then click OK (ALT+O).
Click Sign (ALT+S).
Select an option and complete as appropriate to indicate whether treatment should be administered based on one or more of the patient's lab results:
The option not to administer treatment under described conditions is selected by default. To indicate what test results or other parameters should be considered before starting administration, click the associated checkbox. You must check and complete at least one parameter for this option. For ANC and Platelet Count, type the test result minimum; for Bilirubin and Creatinine, type a maximum (the greater and less than signs are already there). For SGOT/SGPT (AST/ALT), include the test name and a less than maximum or greater than minimum description. For other, type a description.
To indicate that the patient can be treated without considering lab results, click the option to administer regardless of laboratory values.
Click OK (ALT+O).
Type your signing key.
Assign provider for orders requiring either approval or authorization . To look up a provider:
Type at least three letters of the last name, followed by a comma (,), and one or more letters from the first name (no spaces).
Press ENTER. The Providers list opens, displaying any names that matched your input.
Click to select a name, or press ENTER to take as typed.
Life-Sustaining Treatment—All inpatients must have orders. If the patient needs and doesn't have active orders for Life-Sustaining Treatment, the three options—Full, Limited, or Unknown—are active beneath the key field. To change from the default of Unknown, click another option.
Click OK (ALT+O).
Allergies—If there is no allergy information on the patient, the Allergies tab pops to the front.
To open the Allergies order form and record known allergies, click Enter Allergies (ALT+E).
If the patient has no known allergies, click NKA (ALT+K).
If you have no information on drug allergies for this patient, click Allergies Unknown (ALT+K).
Click OK (ALT+O).
If the orders were written using the Special Orders > Pre-Admit function, the orders awaiting activation are displayed in the Pre-Admit/NICO session list. See Viewing Pre-Admission/NICO orders .
Inpatient orders written via the Write function are new inpatient chemo orders (NICO) awaiting activation. To access these orders, see Viewing Pre-Admission/NICO Orders .
Ambulatory orders written via the Write function are pending activation. To access these orders, see Viewing Ambulatory Chemo Orders .
See also Overview of Chemo Order Entry .