To track and improve the effectiveness of administration of epoetin and darbepoetin in treating chemotherapy-induced anemia, or for other chemotherapy-related reasons, Order Entry provides guidelines during the ordering process. These guidelines are based on the reason for treatment, the patient's hemoglobin (HGB), and the treatment stage.
Reason for Treatment: Clinicians writing an order for epoetin or darbepoetin SC with adult dosing are prompted to indicate a reason for administration. If the reason is chemotherapy-induced anemia or chemo-related, the order must follow defined clinical guidelines.
Last known hemoglobin (HGB): If the patient does not have a HGB result less than seven (7) days old in the Partners Clinical Data Repository (CDR), the ordering clinician must enter a result. The most recent HGB result on record triggers one of the following responses:
Over 12.1 mg/dl—treatment with epoetin or darbepoetin is not warranted, and the order is canceled.
Between 10 mg/dl and 12.1 mg/dl—provide symptoms and a diagnosis.
9.9 mg/dl or less—provide a diagnosis.
At MGH, if the HGB is entered manually, a laboratory order for HGB is included automatically as a consequence of this order. Likewise, for patients who have no Ferritin result less than three (3) months old, the lab order is written automatically. The labs, like the med order, must be signed to become an active part of the patient's orders.
Treatment Stage: Having provided indications for treatment, the ordering clinician must then select the treatment stage: initiation, second cycle, or maintenance. Guidelines appropriate to the stage of treatment for dosing and frequency of administration are displayed, but not entered into the medication order form.