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Click 
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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).
Ambulatory or pre-admission: Enter the expected visit date
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).
Ambulatory only: Select the visit location
For ambulatory orders, click the select the visit location.
Click OK (ALT+ O).
Click Chemo (ALT+H)
Click Add (ALT+A)
If the patient is registered to more than one protocol
Click to select a treatment.
Click OK (ALT+O).
If the patient has a finalized treatment plan in the LMR
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.
If the patient has chemotherapy orders awaiting activation
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:
If the patient has active chemo orders
To add orders to the current treatment, or to write orders for a new cycle, week, phase, or weekly treatment, click Continue (ALT+T).
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
Review historic chemo orders from all sites
Set up the treatment—Regimen/protocol, diagnosis, numbering, day 1/day 0, patient height and weight
Select the treatment— protocol
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.
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.
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.
Data checking for the patient's weight and height in the LMR is available only at MGH and DFCI ambulatory sites.
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.
Click OK (ALT+ O).
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).
LMR Users using COE weight with greater than 5% difference from LMR weight
If you choose not to use the LMR weight (see above, Set up the 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).
Confirm or change treatment number
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).
Confirm or change if day 1 or day 0 is in the past
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).
Indicate reasons if writing orders that start before the end of the current treatment
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).
Reusing previous order parameters
See Chemo Overview: Reusing Exception Orders for information on the requirements for reusing previous orders.
This patient has previously signed chemo orders. The orders as defined by the standard regimen or protocol are displayed by default. Up to three (3) previous order sessions from the last six (6) months are displayed on the tabs beneath. Each previous tab is labeled with the date the orders were signed.
Hold the mouse pointer over a dated tab to display the name of the regimen or protocol.
Click a dated tab to display the orders in that previous session.
Orders from a previous session that differ from the standard for the regimen or protocol are highlighted with bold text.
On the initial implementation of this enhancement, only the standard regimen or protocol and the last signed previous session is available. Additional sessions will be included as they are signed.
Acknowledge treatment-specific physician instructions
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.
Select one (for mutually exclusive treatments)
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).
Select folder (treatment as needed)
To widen the folder display when the label is long, click Expand (ALT+X). Click Contract (ALT+ N T ) 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.
Non-chemo orders—select, edit, add
Select orders from a non-chemo set
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) scroll down the list 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.
Evaluate Cumulative Dose Information
Click Next (ALT+N) to open the Chemotherapy folder and display the orders in the grid to the right.
Results for relevant laboratory tests are displayed in a grid above the order list. If no result is displayed, check the Results viewer by clicking Results in the CAS toolbar on the left—see Checking Last Known Values for Lab Results
The patient's serum creatinine is displayed if available. 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
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.
Set up pediatric AUC rule-driven dosing if prompted
Click to select the method for determining the GFR:
Calculate GFR using available laboratory results for creatinine concentration in plasma and a timed, measured volume urine collection
GFR from another source, reported as creatinine clearance
Type the results:
For Calculate GFR: Type results for the patient's urine creatinine in mg/ml, the total volume of the urine collection in ml, plasma creatinine in mg/dl, and the number of hours the urine was collected. Press TAB to move through the fields quickly. The calculations for the raw GFR and GFR corrected for BSA are performed as you type, and displayed automatically.
For GFR from another source:
Type the result for the creatinine clearance.
Click the option to indicate the formula used, raw or corrected for BSA.
Type the source of the creatinine clearance result, foe example CDR (clinical data repository).
Review the results, then click OK (ALT+O).
Set up weight for dosing if prompted
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 a chemo order scheduled days, below.
Additives: When chemotherapy agents are ordered as infusions mixed with additional IV fluids, the dose of any additives is calculated automatically. The total dose for the electrolyte displays in the summary and detail (zoom) views, the chemo medication Additives tab, and on the paper printout.
Select orders from the chemo set
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.
Omit order selections in the chemo set
Click to remove the check.
If you uncheck an order that is defined as required by the treatment, when prompted, 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 (see above, Chemo orders—select, Omit order selections).
If a reason for the dose modification is not defined, type your reason when prompted.
Click OK (ALT+O).
Click the standard dose field.
Modification of Pedi AUC dosing is not allowed.
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 you need a target AUC that isn’t listed as a modification option, it must be reviewed and authorized. You must omit the original chemo medication from the orders, and write the order with the dosing you need as an exception.
See also:
Omitting Chemo Meds: Ordering Chemotherapy > Chemo Orders—Select > Omit order selections in the chemo set
Writing Chemo Exception Orders: Ordering Chemotherapy > Add a chemo exception order (MD only)
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.
If required by the regimen or protocol, the Frame Size options are active. Click to select one to indicate the patient's relative body frame size.
Click OK (ALT+ O). The recalculated Total Dose is entered automatically.
Adjust dosing of oral medications
Reasons and orders for dosing options
Dosing options are provided for several reasons:
The available strength does not match up exactly with a calculated dose
You want to give doses in more than one administration, in equal or varying amounts
Dosing options are required, not optional. The setting is defined as part of the regimen or protocol for selected adult chemo meds. All pediatric PO chemo meds require dosing options.
Each completed line will create a separate order for administration. The original order is unchecked. To change the dosing options, click to select the original order, and repeat the process.
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.
If needed, make limited changes to the scheduled day(s)
If a patient needs to be treated at a location other than the institution (MGH, DFCI, or BWH) where the original orders were written, those orders cannot be transferred to the records at the new unit. (Note: As of December 13, 2011, providers at all MGH locations can send chemo sessions that are still awaiting activation from inpatient order entry to ambulatory order entry, and vice versa.) When entering new orders for your patient to continue with treatment in 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 and received days 1 and 2 as an outpatient. Your patient is now being admitted to inpatient on day 3 (1/3). When writing the inpatient orders, be sure to enter the day 1 date as 1/1. 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. See Overview of Handling Chemo Across Treatment Locations.
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.
For some protocols, scheduled days cannot be changed. If allowed, the Scheduled Days button is active.
Click the Schedule tab, then click Sched days/doses.
For protocols, click OK (ALT+O) to acknowledge that you have read the instructions regarding required permission from the Sponsor, Principal Investigator, and IRB to change days of treatment.
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 change dose calculation tab.
Click to check or uncheck the checkbox.
If preventing recalculation of dosing, type a reason in the field provided.
Repeat for each chemo medication ordered, as needed.
Checking the checkbox and entering a reason prevents automatic recalculation of weight-based dosing when the nurse updates the patient's chemo weight at activation.
This option is selected automatically when there is a weight available from the LMR that is 5% greater or less than the chemo weight you entered when selecting this regimen or protocol, and you chose NOT to update the chemo weight with the weight from the LMR. Your reason for declining the update is stored as the reason to prevent recalculation of the weight-based dosing upon activation.
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.
When prompted, lookup the name of the allergist with whom you discussed the desensitization orders:
Type at least the first three (3) letters of the allergist’s last name.
Click Search.
Click to select the name from the search results.
Click OK (ENTER).
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.
Update administration instructions
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.
Write or Edit a prescription for an oral investigational chemo med
Open the medication prescription form:
To write a new medication prescription, click line for the chemo med needing a prescription, then click Add Prescription.
To view or edit an existing medication prescription, click line for the prescription ("Take Home Prescription"), then click View/Edit Prescription.
If you want to manually enter patient directions, click to check As Directed Prescription (Enter Directions Below). The text for the Sig line will read "See Directions", rather than being constructed automatically from the dose, form, frequency, and duration.
Select a Strength from the drop-down list. If Other, type a description, then click OK (ALT+O).
If you have not checked As Directed Prescription, select the appropriate Dose, Form, and Frequency.
If needed, type the number of days for the administration duration—for ___ day(s).
Type a Dispense amount, then select the appropriate form. Day(s) and Month(s) supply are at the end of the list.
Type the number of Refills allowed, if any.
If needed, type a description in the Directions field.
The scheduled days are automatically added to the directions.
Directions are required if you checked As Directed Prescription, which automatically defines the Sig as "See Directions".
If you did not check As Directed Prescription, directions should not conflict with the Sig that is automatically constructed from the dose, form, frequency, and duration.
Directions print on the prescription.
To avoid medication prescription errors:
Include a brief notation of purpose (e.g., "for cough"), unless inappropriate.
Do not use vague instructions such as "Take as directed" as the sole direction for use.
Avoid use of abbreviations and Latin directions for use.
No Substitutions is selected by default. Click to uncheck if appropriate.
Click Sign/Print.
When prompted:
Type your clinical signing key.
Click to select printing options. You can opt to print to the pharmacy or to the local printer, or to both, or not to print at all.
Click OK.
You can write more than one prescription for the same chemo medication order. Medication prescriptions are not replicated when chemo order sessions split for activation by week. See Overview of Chemo Activation.
The medication prescription is active immediately on signing the chemo order session, or if needed, after the session is authorized or approved.
If you opt to print, nothing will print until the chemo orders are signed, and authorized or approved if needed. See Overview of Chemotherapy Approval or Authorization.
You can print or reprint the medication prescription from the active orders list to the local printer—see Printing Active Orders: Prescription for Oral Investigational Chemo Medication.
Once active, the medication prescription cannot be edited.
Presentation—Writing Prescriptions for Chemo
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.
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.
Select from the search results
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).
Define the dosing and other information
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). 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.
For pediatrics only, as needed define fluids and additives for IV drugs
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) .
When prompted as applicable, provide the reason for writing exception orders
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).
Respond to the Chemo High Dose Warnings
Chemo High Dose—This warning is triggered when the patient's order or orders for a given medication exceed the recommended maximum dose for the day, the week, and/or the patient's lifetime. A warning is presented for each (daily, weekly, lifetime) as applicable. 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)
Add a memo as needed (which is saved as a General Care 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).
Define parameters for treatment when prompted.
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:
Results for relevant laboratory tests are displayed to the right. 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
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).
Check the orders awaiting activation
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 .