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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 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 |
Patient records across sites—Order Entry is used to write orders for chemotherapy given at MGH inpatient and ambulatory infusion units, as well as Dana Farber ambulatory units at DFCI and Faulkner Hospital. 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. MGH and DFCI as institutions do include any of the ambulatory locations offered when choosing a visit location. For example, orders written at an ambulatory infusion unit at DFCI can't be transferred to an inpatient unit at BWH; orders for an MGH inpatient cannot be sent to DFCI. When orders are needed at a different institution, you must write new orders from the new location, then discard or discontinue the original orders. Chemotherapy View of Historic Orders: Providers can now display a list of previously activated orders for the selected patient when writing, reviewing, approving, and activating orders for chemotherapy. The list includes chemo order sessions from all sites that were activated in the last 6 months, and includes chemotherapy and chemo-related (chemo sessions #1 and #3) orders as well as non-chemo (session #2) orders. The orders are sorted by activation date, most recent to oldest. The list can be limited to orders from selected sites, as well as a defined time frame. The list can be filtered to show only chemotherapy and chemo-related (chemo sessions #1 and #3) orders or only non-chemo (session #2) orders. The sessions can be sorted by regimen or protocol. See Viewing Historical Chemo Information. Sending chemo sessions between MGH inpatient and ambulatory—As of December 13, 2011, providers at all MGH locations can send chemo sessions that are still awaiting activation from the inpatient order entry to ambulatory order entry, and vice versa. The requirements described below do not apply in this case. Note that the send feature is not available for orders that have already been activated. See Overview of Sending Chemo Orders Across Sites. Day 1/Day 0 in the past—When entering the date for the initial day of treatment (day1/day 0) when you write new orders, enter the same date you did for the original orders. (This is, of course, the day that treatment initialized.) You will be prompted to confirm that day 1/day 0 is in the past. The form will then display what day of treatment today is—for example, if you enter the date of two weeks ago as day 1, it will display "Today is day 14." Any orders with scheduled days before day 14 will automatically expire as you sign, because their administration dates are in the past. Automatic expiration of order sessions—Orders for chemotherapy, once authorized or approved as needed, split into sets of two sessions each. Each set covers seven days of treatment, split into non-chemo and chemotherapy orders. These sets are activated for use on the first day of the seven, allowing the chemo nurse to verify the patient's weight (and height) for dose calculations. If all of the orders in a session are expired, the session itself is expired. This causes problems for two reasons—restrictions on activating orders, and the midnight purge of expired orders. Activating orders when there are expired sessions—Orders for chemotherapy must be activated in chronological order. The orders for week two cannot be activated if there are orders for week one still on the list, even if the sessions for week one are expired. While nurses can discard expired sessions of non-chemo orders, sessions that include chemotherapy must be discarded by an MD, NP, or PA. Automatic purge of sessions—When a set of chemo orders has expired all of the remaining inactive orders for the treatment, expired or otherwise, are purged from the patient record automatically at midnight of the third day after a treatment was scheduled to start. Unless you are ordering inside of that three-day window, your orders will be purged at midnight if you do not take care of the orders scheduled in the past. Deleting scheduled days that have passed (regimens only)—For chemotherapy ordered from regimens, you can prevent the creation of expired sessions by deleting scheduled days that have already passed. If the patient changes sites in mid-week of treatment, write orders at the new site, using the same day 1/day 0 date, then remove the scheduled days that have passed for every order that has scheduled days. For example, if your patient is being admitted on day ten (10), having received treatment as an outpatient for week one and the on the first two (2) days of week two, delete days one through nine (1-9) from the scheduled days for all applicable orders. When you do this, the set of non-chemo/chemo orders for week one will not be created at all, and the first set of orders for treatment will start with the current date as day 10. Discarding expired sessions—You cannot delete scheduled days for investigational protocols. Sets of non-chemo/chemo orders for weeks that have passed will appear in the patient's list of orders awaiting activation, but the order sessions in those sets will be expired. For MGH inpatients, you must immediately discard the expired sessions to prevent all of the orders—expired or otherwise—from being discarded automatically at midnight.
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