Unique Plan Description: GYNONC Inpt Carboplatin Desensitization (MH)
Plan Selection Display: GYNONC Inpt Carboplatin Desensitization (MH)
PlanType: Medical                                 
Version: 4          
Begin Effective Date: 2023-12-06 11:48:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-04-18 11:59:00
Available at all facilities: No

GYNONC Inpt Carboplatin Desensitization (MH)
Admit/Discharge/Transfer
	Admit to Observation Status
		T;N
	Discharge Conditional
		Conditions to be met: (if patient ready for discharge following chemotherapy, VS stable)
Activity
	Activity-As Tolerated
		
Diet
	General  Diet
		
IV Solutions
	Sodium Chloride 0.9% IV Flush
		250 mL, IVPB, Q1H, PRN see comment, 25 ml/hr
			Comment: Use as primary/flush with Paclitaxel; To be used for chemo primary line flush bag.  Flush line with 25ml at 200ml/hr after each chemo dose.
Medications
Premeds
	ondansetron
		8 mg, Tablet-Disintegrating, By Mouth, Q8H, PRN nausea and/or vomiting
		8 mg, IV Push, Q8H, PRN nausea and/or vomiting
	LORazepam
		0.5 mg, Tab, By Mouth, Once, for nausea, duration: 1 Dose(s)/Time(s)
			Comment: and/or anxiety
		1 mg, Tab, By Mouth, Once, for nausea, duration: 1 Dose(s)/Time(s)
			Comment: and/or anxiety
	LORazepam Injectable
		0.5 mg, Injection, IV Push, Once, PRN nausea, duration: 1 Dose(s)/Time(s)
			Comment: and/or anxiety
		1 mg, Injection, IV Push, Once, PRN nausea, duration: 1 Dose(s)/Time(s)
			Comment: and/or anxiety
	palonosetron/dexamethasone/NS 50mL
		0.25 mg, IVPB, Once, infuse over 15 min(s), T;N+30
			Comment: Give 30 minutes prior to chemotherapy
		12 mg, EVERY BAG
		50 mL, EVERY BAG
	Zofran/Decadron/NS 50 mL
		16 mg, IVPB, Once, Routine, infuse over 15 min(s), 200 ml/hr, T;N+30
			Comment: 30 min prior to chemotherapy
		20 mg, EVERY BAG
		50 mL, EVERY BAG
	fosaprepitant
		150 mg, INT, IVPB, Once, infuse over 30 min(s), T;N+270
Chemotherapy Agent
	PACLitaxel/NS 500 mL
		175 mg/m2, IVPB, Once, T;N+120, Infuse Over 3 hr
		50 mL, EVERY BAG
		500 mL, EVERY BAG
		Calculate total paraplatin (CARBOplatin) dose prior to medication entry. (AUC = _______  Total dose: _________mg(NOTE)*
		4 AUC CARBOplatin Option:(NOTE)*
	Pepcid
		20 mg, Injection, IV Push, Once, T;N+120
			Comment: Give immediately prior to carboplatin
	Benadryl
		50 mg, Injection, IV Push, Once, T;N+120
			Comment: Give immediately prior to carboplatin
	CARBOplatin/NS 100mL
		10 mL, EVERY BAG
		100 mL, EVERY BAG
		4 AUC(Carboplatin), IVPB, Once, T;N+120, Infuse Over 60 min(s)
			Comment: Bag #1. (0.1% of total dose.) Have emergency meds immediately available to give for anaphylaxis.
		100 mL, EVERY BAG
		10 mL, EVERY BAG
		4 AUC(Carboplatin), IVPB, Once, T;N+180, Infuse Over 60 min(s)
			Comment: Bag #2 (1% of total dose.)
		10 mL, EVERY BAG
		100 mL, EVERY BAG
		4 AUC(Carboplatin), IVPB, Once, T;N+240, Infuse Over 60 min(s)
			Comment: Bag #3 (10% of total dose.)
		100 mL, EVERY BAG
		4 AUC(Carboplatin), IVPB, Once, T;N+300, Infuse Over 60 min(s)
			Comment: Bag #4 (88.9% of total dose) Remainder of Primary Bag to be given over 1 hour.
		5 AUC CARBOplatin Option:(NOTE)*
	Pepcid
		20 mg, Injection, IV Push, Once, T;N+120
			Comment: Give immediately prior to carboplatin
	Benadryl
		50 mg, Injection, IV Push, Once, T;N+120
			Comment: Give immediately prior to carboplatin
	CARBOplatin/NS 100mL
		10 mL, EVERY BAG
		100 mL, EVERY BAG
		5 AUC(Carboplatin), IVPB, Once, T;N+120, Infuse Over 60 min(s)
			Comment: Bag #1. (0.1% of total dose.) Have emergency meds immediately available to give for anaphylaxis.
		10 mL, EVERY BAG
		100 mL, EVERY BAG
		5 AUC(Carboplatin), IVPB, Once, T;N+180, Infuse Over 60 min(s)
			Comment: Bag #2 (1% of total dose.)
		10 mL, EVERY BAG
		100 mL, EVERY BAG
		5 AUC(Carboplatin), IVPB, Once, T;N+240, Infuse Over 60 min(s)
			Comment: Bag #3 (10% of total dose.)
		10 mL, EVERY BAG
		100 mL, EVERY BAG
		5 AUC(Carboplatin), IVPB, Once, T;N+300, Infuse Over 60 min(s)
			Comment: Bag #4 (88.9% of total dose) Remainder of Primary Bag to be given over 1 hour.
		6 AUC CARBOplatin Option:(NOTE)*
	Pepcid
		20 mg, Injection, IV Push, Once, T;N+120
			Comment: Give immediately prior to carboplatin
	Benadryl
		50 mg, Injection, IV Push, Once, T;N+120
			Comment: Give immediately prior to carboplatin
	CARBOplatin/NS 100mL
		10 mL, EVERY BAG
		100 mL, EVERY BAG
		6 AUC(Carboplatin), IVPB, Once, T;N+120, Infuse Over 60 min(s)
			Comment: Bag #1. (0.1% of total dose.) Have emergency meds immediately available to give for anaphylaxis.
		10 mL, EVERY BAG
		100 mL, EVERY BAG
		6 AUC(Carboplatin), IVPB, Once, T;N+180, Infuse Over 60 min(s)
			Comment: Bag #2 (1% of total dose.)
		10 mL, EVERY BAG
		100 mL, EVERY BAG
		6 AUC(Carboplatin), IVPB, Once, T;N+240, Infuse Over 60 min(s)
			Comment: Bag #3 (10% of total dose.)
		10 mL, EVERY BAG
		100 mL, EVERY BAG
		6 AUC(Carboplatin), IVPB, Once, T;N+300, Infuse Over 60 min(s)
			Comment: Bag #4 (88.9% of total dose) Remainder of Primary Bag to be given over 1 hour.
Patient Care

	Resuscitation Status
		T;N, Full Code
		T;N, No Code

Allergy Reaction Protocol
Activity
	Position Patient
		T;N
			Comment: If hypotensive, keep patient supine with legs elevated or bed in trendelenberg
IV Solutions
	Sodium Chloride 0.9%
		500 mL, IV, Routine, Bolus
		1,000 mL, IV, Routine, 30 ml/hr
Medications
	Benadryl
		50 mg, Injection, IV Push, Once, PRN, allergic reaction, NOW
		25 mg, Injection, IV Push, Once, PRN, allergic reaction, NOW
	Decadron (MH/WH)
		20 mg, Injection, IV PUSH, Once, PRN, allergic reaction
	SOLU-Medrol
		125 mg, Injection, IV Push, Once
	EPINEPHrine
		0.5 mg, Injection, SUBCUTANEOUS, Once
		0.5 mg, Injection, IM-Intramuscular, Once
		0.5 mg, Injection, SUBCUTANEOUS, Q10MIN, PRN, anaphylaxis, 3 Dose(s)/Time(s)
		0.5 mg, Injection, IM-Intramuscular, Q10MIN, PRN, anaphylaxis, 3 Dose(s)/Time(s)
		For infants and children up to age 12 < 30kg(NOTE)*
		0.01 mg/kg, Injection, SUBCUTANEOUS, Q5MIN, PRN, anaphylaxis, 3 Dose(s)/Time(s)
		0.01 mg/kg, Injection, IM-Intramuscular, Q5MIN, PRN, anaphylaxis, 3 Dose(s)/Time(s)
		For infants and children up to age 12 > or equal to 30kg(NOTE)*
		0.3 mg, Injection, SUBCUTANEOUS, Q5MIN, PRN, anaphylaxis, 3 Dose(s)/Time(s)
		0.3 mg, Injection, IM-Intramuscular, Q5MIN, PRN, anaphylaxis, 3 Dose(s)/Time(s)
Patient Care
	Pharmacy Consult
		T;N, Allergy Reaction Protocol was entered on this patient, please verify allergy, and add allergen to patient allergies in medical record
	Discontinue Medication
		T;N, Discontinue IV medication or infusion and remove tubing
	Notify MD
		T;N, Contact PCP for additional orders

CHEMO Reaction Protocol
Vital Signs
	Vital Signs
		Assess vital signs every 2 to 5 minutes until the patient is stable. Place patient into a recumbent position with elevation of the lower extremities if hypotensive
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		Reassess vital signs every 15 minutes x 2, then q30min x 2, or more frequently as needed, I&O, etc until stable
Activity
	Position Patient
		T;N
			Comment: If hypotensive, keep patient supine with legs elevated or bed in Trendelenburg.
IV Solutions
	Sodium Chloride 0.9% IVPB
		500 mL, Solution-Injection, IVPB, DAILY, PRN see comment, 999 ml/hr
			Comment: for reaction to chemotherapy
		1,000 mL, Solution-Injection, IVPB, DAILY, PRN see comment, 999 ml/hr
			Comment: for reaction to chemotherapy
Medications
	Benadryl
		50 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: for moderate to severe reaction to chemotherapy
		25 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: for moderate to severe reaction to chemotherapy
	Decadron (MH/WH)
		20 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: for moderate to severe reaction to chemotherapy, 1st choice steroid
	SOLU-Medrol
		125 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: for moderate to severe reaction to chemotherapy, 2nd choice steroid
	Solu-CORTEF
		100 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: for moderate to severe reaction to chemotherapy, 3rd choice steroid
	EPINEPHrine
		0.5 mg, Injection, SUBCUTANEOUS, DAILY, PRN see comment
			Comment: for hypersensitivity reaction not resolved by diphenhydramine and/or anaphylactic				reactions to chemotherapy, may repeat every 10 minutes for up to 3 doses
		0.5 mg, Injection, IM-Intramuscular, DAILY, PRN see comment
			Comment: for hypersensitivity reaction not resolved by diphenhydramine and/or anaphylactic				reactions to chemotherapy, may repeat every 10 minutes for up to 3 doses
Patient Care
	Notify MD
		T;N, Contact the oncologist if any of the reaction protocol medications are administered to the patient.

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase