Overview of Chemo Order Entry

Topics:

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

Worksheet—The desensitization worksheet is approved for calculating stepwise concentrations, administration rates, and duration of chemotherapy medications, for adult patients only. It is standardized by Dana Farber Partners Cancer Care (DFPCC) for use in both inpatient and outpatient treatment in DFCI and MGH infusion units.

Oncologist responsibilities:

Ordering the chemotherapy medication to be desensitized (see Ordering Desensitization)

Discarding or discontinuing the chemotherapy medication in COE as needed
Reordering of the chemotherapy order if allergist needs the desensitization spreadsheet to be rewritten

Allergist responsibilities:

Adding/editing/deleting the desensitization worksheet for the approved chemotherapy medications once the medication has been written by the oncologist
Updating the allergy record to include the medication if needed (see Recording Allergies, Restrictions, and Adverse Reactions)
If the patient has an order for any medication that was just added to the allergy record, you will be prompted to provide a reason for overriding the intervention (see Responding to Drug Allergy Interventions)
Ordering, discarding or discontinuing the consequent orders associated with the desensitization worksheet

Allergists do not have access to writing or editing chemotherapy medication orders. Allergy fellows can calculate and submit the desensitization worksheet; approval by an allergy attending is not required.

Desensitization associated orders—Oncology hypersensitivity orders are already established for each regimen and protocol that contains a set of medications that support desensitization. These medications ordered by the oncologist for treating hypersensitivity are not the same as the medication orders associated with desensitization. See Selecting Associated Orders for Desensitization.

Ordering—Desensitization can only be ordered for approved medications after consulting with an allergist. The desensitization process is not available for Exception orders or orders in Exception regimens.

An allergist, determining that a chemotherapy medication should not be desensitized, will contact the oncologist to discontinue the medication or edit the order to omit the desensitization request.

Current verbal communication between the oncologist, allergist, pharmacy, and nursing regarding the administration standards for desensitization are not replaced by the system processing of the order.

The patient's order status is flagged DESENZ when there are chemo orders awaiting submission of a desensitization worksheet. When the worksheet is submitted, the DESENZ flag is cleared.

Any chemotherapy medication order written by an oncologist for desensitization requires an allergy desensitized worksheet. When chemotherapy is given over a more than seven days, a worksheet must be submitted for each week that an order is scheduled. For example, a chemo med scheduled for days 1 and 8 requires a desensitization worksheet for both days 1 and 8. See Calculating, Editing, and Submitting a Desensitization Worksheet.

Expiration—Current chemotherapy expiration rules apply to chemotherapy medications that require desensitization. The desensitization worksheet and consequent orders will expire if the chemotherapy medication expires. If the worksheet is not submitted before the medication expires, the order is no longer available for desensitization calculation.

Activation—Chemotherapy order sessions including desensitization orders must be activated, like any other chemotherapy orders. Chemo sessions containing orders that still await submission of the desensitization worksheet are flagged Pending Desens. See Activating Chemo Orders.

Once any desensitization pending flags are cleared, the session status progresses to Pending (activation). The orders then follow standard chemotherapy activation rules. See Overview of Activating Chemo Orders.

Subsequent treatment cycles—Desensitization is carried forward for subsequent chemotherapy orders when ordering from a previous setup. The desensitization worksheet must be calculated anew and submitted for the subsequent chemo orders. Previously activated worksheets and consequent orders can be copied and modified as needed for the subsequent treatment. See Submitting a Desensitization Worksheet (step 3) and Copying Previous Associated Orders for Desensitization.

Editing the worksheet—Allergists can make changes to the desensitization worksheet while the order is awaiting activation. Edits are carried though for subsequent treatment cycles when reusing previous orders. See Editing the Desensitization Worksheet Before Chemo Activation.

Changes after activation—Once the chemo orders are activated, the desensitization worksheet cannot be edited. If changes are needed, the chemo orders must be discontinued and rewritten by the oncology provider. The allergist must then create a desensitization worksheet for the new orders.