The Provider Order Entry system defines a cycle, week, or phase as an episode of treatment. For example, if a therapy calls for monthly administrations over the course of six months, each monthly treatment is considered a cycle. When you write orders for chemotherapy, you must indicate the cycle number for that course of treatment. These cycle numbers allow the system to uniquely identify each month's orders quickly.
If an episode of treatment is defined as a week, Order Entry displays this label rather than cycle. Weeks are numbered just as cycles are.
An additional possibility for adults is a weekly treatment, which is not numbered, but defined solely by its start date. Similarly, pediatric treatments may be broken into phases, also without numbering.
Treatment dates and administration schedules are based on the individual episode rather than the entire multiple-episode course of treatment. You must enter a date to define the start for each episode, either Day 0 or Day1 (depending on the therapy).
When you write the next episode's orders, the start date from the previous episode is displayed. For adult patients, the cycle or week number is incremented by one automatically. Because pediatric treatments often do not follow this one-two-three... sequence (especially numbered weeks), the cycle/week number is blanked for each new set of orders. Pediatric providers should review the treatment plan carefully to determine the patient's current situation.
Some treatments are relatively simple, repeating the same orders during each cycle until the end of treatment. For these treatments, a single group of orders is offered, to be reused for each cycle.
Orders in a regimen or protocol may be optional, or may require tailoring to meet the patient's needs. Such orders include antiemetics, IV for hydration, laboratory tests, non-chemo medications, and general care, among others. The system not only adds these orders to the patient record when you sign them, but also "remembers" the exact setup for the next time you order. When a treatment repeats the same group of orders for each cycle, you have the option to reuse that setup, or return the orders to their original state.
Other therapies are considerably more complex, however. When a therapy requires differing strategies or sets of orders for each cycle, those orders are defined and grouped separately. When a group of orders has been used previously for the selected patient, it is displayed with a red check. When ordering, you must select the appropriate group of orders for the current cycle. This may mean reusing a group, or if the right stage is reached, choosing the next group of orders in the flow. Groups are labeled to guide you to the appropriate choice.