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Topics: Restrictions to Editing Chemo Orders Changing Chemo Orders in an Oncology Protocol Editing Chemo Orders Before Activation Exception Orders Defining Approval and Authorization 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 |
Defining Exceptions: Exception orders are defined in Provider Order Entry as orders for chemotherapy medications outside of those included in a standard regimen. Exceptions are allowed only with regimens; it is not possible to add an exception order to an investigational protocol. Exception orders and edits to non-chemo orders in a regimen are specific to the selected patient. This includes orders in the Exception Order regimen, which must be rewritten for each individual patient. Changes to exception orders are considered exceptions, with the same authorization or approval requirements as any new exception. MGH Exceptions: At MGH, all new exception orders must be written by an MD and authorized by an attending with specialized regimen authorization. Orders awaiting authorization of exceptions cannot be edited. DFCI Exceptions: At present, not all of the standard regimens in use at Dana Farber Partners Cancer Care are available via Order Entry. Until this is done, exception orders and exception regimens can be written by MDs without secondary authorization. Exceptions By Fellows: All orders written by Fellows must be approved by an Attending Oncologist, in addition to authorization of exceptions if needed. NP Writing Orders: An NP can reuse previous orders containing exceptions. See Reusing Previous Orders. Options for exceptions: You can write exception orders as part of a standard regimen, build a custom regimen, or select orders from an alternate regimen, one not usually associated with the patient's selected diagnosis. See the Options for Exception Orders for more information. Email Notification: At DFCI, MGH Inpatient and Ambulatory, and North Shore Medical Cancer Center, the pharmacy receives automatic notification via email when the chemo exception orders are signed. This email allows the pharmacy time to review the orders for clinical necessity, and to ensure that the patient’s insurance carrier will cover the cost of the medications before they are administered.
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