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Topics: Restrictions to Editing Chemo Orders Changing Chemo Orders in an Oncology Protocol Editing Chemo Orders Before Activation Defining Approval and Authorization Approving Chemo 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 |
Approval—Chemotherapy orders that are awaiting approval are inactive. Orders carrying either of these flags cannot be activated until authorized or approved as needed. In addition, the orders cannot be reused in a subsequent treatment. Inactive orders cannot be transcribed, reviewed by a nurse, or transmitted to the pharmacy. The dates for treatment cannot be changed until orders are approved; the orders will expire on the start date of treatment.
Who Can Approve—When their orders require approval, oncology and non-oncology fellows, NPs, and PAs must select a name from the site provider list to assign the attending to approve the orders. Only attending MDs with appropriate authorization can approve chemo orders that are assigned in this way for approval. MDs can approve any orders, not just those assigned to them. If approval is due to a dose change triggered by the weight/height confirmation at activation, either an NP or attending can approve the orders. Approval Notification in Order Entry and the CAS (Clinical Application Suite)—To encourage the prompt approval of chemo orders, the Order Entry system monitors all orders assigned for approval. You will be prompted to approve orders assigned to you every time you log on to Order Entry, switch sites on the UCM, sign orders from the chemo player, or cancel out of the chemo player.
In addition, if you are logged in to the CAS (LMR, Results, etc.), the system checks every five (5) minutes to determine whether there are orders assigned to you for approval. The CAS prompt is a notification only, unlike the Order Entry notice described above. To approve orders, close the notice, click Orders in the CAS, and then open the approval list. The CAS approval notification appears every five minutes until all orders assigned to you are approved.
How Approval is Assigned For Notification—Chemo that does not require approval is defined as "ordered by" the provider who signs; chemo needing approval is "entered by" the provider who signs, and "ordered by" the attending who is assigned to approve. It is the provider that the orders are "ordered by" who is notified that they have chemo to approve. This includes approvals triggered by dose changes at activation. Finding Orders Assigned to You For Approval—Providers who are authorized to approve chemo can access their list of patients with orders assigned to them for approval in three (3) ways:
Orders That Expire Before Approval—Orders that are not approved before the start date of treatment expire. The start date of unapproved orders cannot be changed to prevent expiration. These orders should be discarded; if they are not, they will trigger approval notification for the ordering attending or NP until they are automatically discarded by the system. (See topic list, left, for links to more information on chemo expiration.) Clearing Your List—All of the orders assigned to you must be signed off to clear your list. You have the option to reject chemo orders if needed. Expired orders that were never approved must be discarded to remove them from your list.
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