Topics:

Writing Chemo Orders

Chemo Treatment Plans

Restrictions to Editing Chemo Orders

Changing Chemo Orders in an Oncology Protocol

Editing Chemo Orders Before Activation

Editing Active Chemo Orders

Exception Orders

Reusing Previous Orders

Defining Approval and Authorization

Approving Chemo

Desensitization

Activating Chemo Orders

Activation Dates and Expiration of Inpatient Chemo Orders

Ordering, Activation, and Expiration of Chemo Pre-Admission Orders

Activation Dates and Expiration of Ambulatory Chemo Orders

Expiration of Active Chemo Orders

Handling Orders Across Treatment Locations

Sending Chemo Sessions Between MGH Inpatient & Ambulatory

Standing Orders for Ambulatory Chemo

Pharmacy Activation—At DFCI only, pharmacists can activate orders for chemotherapy. However, pharmacy cannot activate via the Edit/View Inactive function on the UCM (patient list); pharmacists must access the orders via the Activate button. This prevents the possibility of activating the orders twice (once by pharmacy, and again by the administering RN).

Expiration Rules for Ambulatory Sessions Awaiting Activation—At midnight on the date of expected treatment start for the week, the session status is set to Expired. For two (2) additional days, the treatment date can be changed to reset the status to awaiting activation. Sessions that are expired for more than three (3) days cannot be updated, and must be discarded before orders for more recent treatment dates can be activated. At midnight seven (7) days after the expected treatment date, the expired sessions are purged from the patient record automatically.

Postpone Day1/ Day 0 or Start of Week Visit Date, Orders Awaiting Activation—If the patient will not receive treatment as scheduled, you can reset the visit date to prevent the orders that are awaiting activation from expiring. See Changing the Treatment Date.

When the treatment date for any chemo order session except the first session is changed before activation, the treatment date of the chemo orders is linked to the activation date and time of the session, to ensure proper expiration of the orders.

The option  to change the date of Day 1 or Day 0 is only  available if the sessions containing Day 1 or Day 0 orders have not been activated, or if the session is the first set in the order set  for a mid treatment set of orders.

Postpone Treatment Date, Orders Active—If you activate orders and the treatment must be delayed, you can reset the treatment date of any day in the session to prevent the orders from expiring. For example, you can move the date of day 9 forward one or more days; the following days in the treatment will also move forward. See Changing the Treatment Day. A new order is created for each chemo medication that is affected by a change of treatment date. The change date orders must be activated as with any new chemo order.