Chemo: Any time a clinician writes orders for chemotherapy, he or she must enter or confirm the patient's weight (and height). These values are used to calculate the patient's BSA (body surface area), as well as any weight-based dosing of chemotherapeutic agents.
Weight and height for chemo calculations is stored separate from any other order entry values—for example, the values used for weight-based dosing of medications ordered outside of a regimen or protocol. Weight must be re-entered every 30 days for oncology patients, every 90 days for patients getting chemotherapy for other treatments.
For adults (patients over 19 years old), this is the only weight data collected. Only chemo drugs use weight-based dosing for these patients.
For patients defined as pediatric (less than 19 years old), any weight-based orders included in a chemo order session are calculated using this chemo weight. These include chemotherapeutics, non- chemo medications, IV fluids, and blood products. These orders can be added to the chemo order session when the session is first written, or when editing a chemo session before it is activated.
For NICO (New Inpatient Chemo Orders), pre-admission, and ambulatory orders, the nurse must confirm the chemo weight when activating. Because the chemo weight can be used for orders other than chemo agents for pediatric patients, this weight must be confirmed for all orders when the patient is under 19 years old.
Non-chemo: For patients under 19 years old at MGH only (both inpatient and ambulatory), orders for medications, IV fluids, and blood products may be written as weight-based. If these orders are not included in a chemotherapy set, the non-chemo weight on file is used for calculations. Any clinician writing new orders is prompted to enter or update this weight if there is none on file for the current admission, or if the current weight entry is over 7 days old. This weight can also be updated manually as needed.