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

Standing orders for ambulatory chemotherapy—As of July 11, 2012, chemo providers are prompted to select a pre-defined set of orders for intravenous access and line maintenance on completing the first orders an adult patient at an ambulatory MGH or DFCI location. These access and flush orders, which are part of the nursing standing orders, are required for regulatory compliance, product bar coding, and electronic documentation of the chemo administration.

  • Orders in the set include IV fluids, infusion instructions, flush solutions, and related medications; each site has a different set

  • All orders in the set a pre-selected; providers have the option to deselect as appropriate

  • Providers cannot add orders to the set

  • Orders from the set are flagged "AF" (access and flush) in the summary and detailed views

  • AF orders must be activated the same as other chemotherapy-related orders

  • AF orders are listed  for activation as an Access and Flush session, separate from other chemo sessions (chemo-related session #1, chemotherapy session #2, and provider-activated chemotherapy session #3)

  • AF orders can be edited before or after activation, but edited orders are no longer part of the AF set

  • AF orders are not included in the "previous" chemo functionality (see Reusing Previous Orders)

  • The prompt to order occurs if the patient does not already have orders from the AF set, either active or pending activation

  • Clicking No when prompted to order access and flush defers the decision for a week; the prompt is triggered again when any provider writes ambulatory orders after seven (7) days

  • AF orders expire 365 days after activation, persisting through one (1) year of chemotherapy

  • Standing orders are not defined for inpatient or for pediatric patients

  • The Access and Flush order set is accessible outside of the chemotherapy order session, but in that  case, orders from the set are not handled as chemo-related AF orders (see Sets and Templates > Ordering from a set (ambulatory chemotherapy units only)

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