Overview of Chemo Order Entry

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

Decreasing Doses:

  • For both protocols and regimens, dose decreases are often predefined as modifications for clinical reasons. Dose increases may be predefined in this way also. Dose modifications may include a change to the dose by a defined percentage or to a specific amount, based on a clinical result (e.g. platelets < 50,000)

  • Active chemo orders written from a protocol can be discontinued. See Discontinuing Active Chemo Orders.

  • Discontinue any active medication order when administration must stop. The pharmacy cannot accept doses equal to zero (0). Do not set a dose to zero (0), or decrease a dose by 100%.

Increasing Doses:

  • Dosing for investigational protocols cannot be increased except through pre-defined dose modification.

  • Increases to standard dose amounts when writing or editing chemo orders from a regimen are considered exception orders unless the increase is defined as a dose modification

  • Dosing increases to exception orders are treated as new exception orders

  • Dosing that has been previously decreased can always be restored to the original standard dose

  • For details, see Exception Orders.

Scheduled days:

  • The number of days cannot be more than the standard

  • You cannot decrease the number of days scheduled for an investigational protocol

  • Regimens only—if you decrease the number of days, you must provide a reason when prompted

  • When chemo orders are written and signed, separate sets of sessions are created for every week that chemo is to be given. For orders awaiting activation, as well as active orders, the days you change to must be within the same seven (7) day period as the order session. These periods are defined as days 1 through 7, 8 through 15, and so on, sequentially. For example, you can change the schedule from day 1 to day 3, which are in the same session, but not from day 6 to day 8, which are in different sessions.

All changes:

  • A reason must be entered for any change or D/C orders for chemo drugs (pre-defined dose modifications provide this reason automatically)

  • Changes to active orders written by Fellows are new orders that must be approved by an Attending

  • Changes to authorized exception orders made by NPs or PAs must be approved by an Attending