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Topics: Restrictions to Editing Chemo Orders Changing Chemo Orders in an Oncology Protocol Editing Chemo Orders Before Activation Reusing Previous 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 |
Changes to Treatments: "Previous" is an automatic process that stores any changes you make to the treatments in a protocol or regimen—dosing, instructions, exceptions, and so on—when you sign. If you edit orders while they are awaiting activation or after they are active, the changes are also saved for future use for that patient. When ordering subsequent treatments after the first has been written, you are offered the option to reuse the previous orders, or set the regimen to the standard treatment default orders and selections. Ordering from Previous: The prompt to reuse previously signed chemotherapy order settings displays detailed information about both the standard orders, and the orders as previously signed. Key Features:
If you reuse the previous settings, all selections, order edits, additional non-chemo orders, and exception orders are included. At DFCI, this includes prescriptions for oral investigational medications. Pediatric Orders: Some issues regarding conditional dosing for pediatric treatments are currently awaiting resolution. Check orders carefully if you reuse previous setting when writing from pediatric treatments. Orders Previously Omitted By the Ordering Provider: Chemotherapy medications that are required by the treatment are pre-selected in the initial orders. The ordering provider can deselect the medication, but must provide a reason for doing so. This omission and the reason for it are carried forward automatically when ordering from previous. The order can be reselected as needed. Orders Previously Omitted By Dosing Rules: The dosing calculation used for some chemo medications is determined by conditions defined by the regimen or protocol. Conditions can be based on the patient's age, weight, BSA (body surface area), or the raw or corrected GFR (glomerular filtration rate). A selected or preselected medication can be omitted automatically by the dosing rules. When ordering from previous where the rules set determined that a preselected medication should be omitted, the ordering provider is prompted to review the need for that chemo medication. The order can be reselected for recalculation, and ordered or omitted automatically as the dosing rules indicate; alternately, the ordering provider can manually omit the order. If the order is recalculated and omitted, the prompt to re-evaluate will occur for subsequent order sessions. If the order is manually omitted, it remains so for subsequent sessions. Reusing Single Use Treatments: You will be prompted to select a treatment if the previous orders have been defined as "single use." This is a double check to ensure that you do want to order a single-use treatment more than once. Changes to the Chemo Agents in the Standard Treatment: The use of the previous setup may be prevented if the chemotherapy medications in the standard regimen have been changed significantly since you wrote the previous orders. In this case, a message about the edit will be presented when you write new orders. You will not be able to reuse your previous settings. A general care order is added to the set to inform nursing and pharmacy that previous settings did not automatically carry over, and that all dosing should be checked. Changes to the Non-Chemo Medication Orders in the Standard Treatment—If non-chemo medication orders have been changed significantly since the last time you wrote orders from the regimen or protocol, but the chemo agents have not been edited, you have the option to order the treatment setup as previous, except for those non-chemo medication orders. Read the description of previous orders when the option is offered. Non-chemo orders revert to the standard setup when you order from previous in this case. Orders Discontinued After The Session Was Signed: The affect of discontinuing a chemo order that has been signed—whether it has been activated or not—is to delete the scheduled days, not to omit or uncheck it on the order set. You must enter the days to administer that drug if you want to include it in the orders. Previous orders were discarded: If the previous set of chemo orders was discarded rather than activated, you cannot reuse the parameters from the discarded orders. Discarded orders cannot be retrieved; the orders must be written from the standard treatment. Previous Orders Awaiting Approval or Authorization: If the previous set of orders is still awaiting approval or authorization, you will not be able to reuse your previous settings. Previously Approved Exceptions, MDs: When a chemo attending or fellow reuses authorized or approved exception orders without changes, no further authorization is needed. All fellows orders must be approved. Previously Approved Exceptions, NPs: NPs can reuse previously authorized or approved exception orders. At MGH, if no changes are made when writing the new orders, no MD approval is required. All reused exception orders at DFPCC, and those that have been edited by the NP at MGH, require Attending approval. If an NP does not choose to reuse previous orders the contain authorized or approved exceptions, the new orders must be approved by an MD. |