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Infusion Pharmacy Orders Submitted orders to the pharmacy provide instructions on the type and amount of medication needed to be dispensed for a patient. Completed and submitted orders indicate that a patient has been evaluated and is ready to treat. A quality improvement study shows that submitting completed orders can save up to 10 hours of productivity a week and ensure quicker and safer service to patients.Prior to Submitting an OrderEnsure all criteria are listed in “Text Orders” and that “Prescribing Notes” section has been checked and verified prior to order submission. If there is part of an order that is not needed, make sure to strike a line through it (for example: oral medications).Orders entered by nursing staff must indicate where the verbal order came from. This can be added to the prescribing notes (For example: NS 1000ml over 1hr v.o. Dr. Smith)Please electronically sign all ordersEnsure the following components of an order are complete:Height Required for Cycle 1 Day 1 and documented on a regular basis for the following treatments. Most chemotherapy is administered based on a patient’s height/weight or body surface area. Inaccurate height and weight information leads to inaccurate dosing thereby compromising patient safety.Weight Should be taken at time of infusion. Most chemo is height/weight based or determined by body surface area. Inaccurate height and weight information leads to inaccurate dosing thereby compromising patient safety.Study IDStudy ID is a required verification mechanism and is important when giving blinded medication. Oral MedicationsCertain infusions require pre-medications to suppress nausea, vomiting and other infusion reactions or side effects. Some patients are provided with the option to take oral steroids before they arrive for their Infusion appointment. If patient has already taken oral medications before arriving, it is necessary for the pharmacy to know this information so that they do not dispense a dose of the same medications for the patient.Past Treatment DatesKnowing past treatment dates is a second verification that the patient is treated at the appropriate time in their cycle. Certain cycles require limited treatments while others are administered until the disease regresses, progresses or side effects occur. Administering medication too early or late can be detrimental to the patient. (For example: Certain medications require loading doses, and if too much time has passed between doses an additional loading dose is required.) Labs2445385692975turn page over00turn page overChemotherapy dosage is uniquely adjusted based on a patient’s lab values. Not monitoring labs can result in incorrect doses that can be detrimental to patient safety and efficacy of the drug. (For example: if a drug is to be dosed based on kidney function, it cannot be mixed by pharmacy without recent kidney function lab results.)All labs should be completed within 72hrs (this can vary) of a patient’s appointment. If a lab value is out of range, please indicate if it is ok to proceed with that day’s treatment and who was consulted about the abnormal lab value. If a patient has labs from an outside facility, please turn in a copy of those labs with the order. BP (Blood Pressure)Certain medications can cause hypertension so it is important to monitor a patient’s blood pressure. (For example: If a patient has pre-existing hypertension, they will not be given certain medications.)UrinalysisEnsure that a Urinalysis/UPCR/24hr urine is available. Certain medications can cause kidney damage so it is important to check for protein in a patient’s urine. (High protein levels in urine may indicate a problem.)ECHO/MUGA Used to determine and monitor cardiac function because certain medications cause cardiotoxicity as a side effect. The following medications must have baseline echos and every three months: Trastuzumab Pertuzumab). The following class of medications must have a baseline echo: anthracycline (doxorubicin, doxorubicin liposomal, daunorubicin, idarubicin).Pulmonary ResultsPulmonary toxicity can be caused from medications. It is important to determine baseline pulmonary functions before beginning treatment. Chemo DoseLab parameters or results can require dosage adjustments. It is also important to note whether this adjustment is permanent or temporary. Dose Reductions can be required due to possible toxicities, please note new adjusted dose amount and reason for dose reduction. It is also important to note whether this adjustment is permanent or temporary.Chemo Parameters (less common) please verify maximum dose for specific drugs with limitations on amount given in a patient’s lifetime. Finance Approval Certain medications require prior authorization; financial approval should be documented prior to beginning treatment.Order Cycle ReceivedIf a treatment is withheld or delayed, please indicate whether this is a permanent or temporary delay and what the next scheduled cycle will be so it can be adjusted in TXM. Absence of this information effects continuity of patient care.CADD PumpPharmacy is required to track which patients receive a CADD pump. Please provide the CADD pump when turning in the order.Missing Signatures Policy dictates drugs may not be dispensed without prescribing physicians authorization that it is safe to treat the patient. Certain circumstances also allow for mid-levels or certain pharmacists signatures. ................
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