Unique Plan Description: GYNONC Inpt Paclitaxel Desensitization (MH)
Plan Selection Display: GYNONC Inpt Paclitaxel Desensitization (MH)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2026-07-06 12:32:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2026-07-06 12:32:37
Available at all facilities: No

GYNONC Inpt Paclitaxel 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)
Vital Signs
	Vital Signs
		T;N
Activity
	Activity-As Tolerated
		T;N
Diet
	General  Diet
		T;N
IV Solutions
	Sodium chloride 0.9% Chemo Flush
		25 mL, IVPB, Q1H, PRN IV line flush, 200 ml/hr
			Comment: To be used for chemo primary line flush bag. Use with paclitaxel and carboplatin. Flush line with 25mL at 200mL/hr after each chemo dose.
Medications
	ondansetron
		8 mg, Tablet-Disintegrating, By Mouth, Q8H, PRN nausea and/or vomiting
		8 mg, IV Push, Q8H, PRN nausea and/or vomiting
	Pepcid
		20 mg, Injection, IV Push, Once, T;N+90
			Comment: 30 minutes prior to chemotherapy
	Benadryl
		50 mg, Injection, IV Push, Once, T;N+90
			Comment: 30 minutes prior to chemotherapy
	Zofran/Decadron/NS 50 mL
		16 mg, IVPB, Once, Routine, infuse over 15 min(s), 200 ml/hr, T;N+90
			Comment: Give 30 minutes prior to chemotherapy
		12 mg, EVERY BAG
		50 mL, EVERY BAG
	LORazepam
		0.5 mg, Tab, By Mouth, Once, PRN nausea, duration: 1 Dose(s)/Time(s)
			Comment: and/or anxiety
		1 mg, Tab, By Mouth, Once, PRN 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+90
			Comment: Give 30 minutes prior to chemotherapy
		12 mg, EVERY BAG
		50 mL, EVERY BAG
	fosaprepitant
		150 mg, INT, IVPB, Once, infuse over 30 min(s), T;N+90
			Comment: 30 minutes prior to chemotherapy
Chemotherapy Agent
	PACLitaxel/NS 100 mL
		0.175 mg/m2, 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.Extremely Hazardous Drug / Antineoplastic / Chemotherapy Gown, Double Gloves, Face Mask, Eye Protection / Use a 0.2 micron filter.
		10 mL, EVERY BAG
		100 mL, EVERY BAG
		1.75 mg/m2, IVPB, Once, T;N+180, Infuse Over 60 min(s)
			Comment: Bag #2 (1% of total dose.) Extremely Hazardous Drug / Antineoplastic / Chemotherapy Gown, Double Gloves, Face Mask, Eye Protection / Use a 0.2 micron filter
		50 mL, EVERY BAG
		100 mL, EVERY BAG
		17.5 mg/m2, IVPB, Once, T;N+240, Infuse Over 60 min(s)
			Comment: Bag #3 (10% of total dose.) Extremely Hazardous Drug / Antineoplastic / Chemotherapy Gown, Double Gloves, Face Mask, Eye Protection / Use a 0.2 micron filter
		50 mL, EVERY BAG
		100 mL, EVERY BAG
	PACLitaxel/NS 500 mL
		155.575 mg/m2, IVPB, Once, T;N+300, Infuse Over 180 min(s)
			Comment: Bag #4 (88.9% of total dose) Remainder of Primary Bag to be given over 3 hours. Extremely Hazardous Drug / Antineoplastic / Chemotherapy Gown, Double Gloves, Face Mask, Eye Protection / Use a 0.2 micron filter
		50 mL, EVERY BAG
		500 mL, EVERY BAG
	CARBOplatin/NS 250 mL
		250 mL, EVERY BAG
		4 AUC(Carboplatin), IVPB, Once, T;N+480, Infuse Over 30 min(s)
			Comment: Extremely Hazardous Drug / Antineoplastic / PPE Requirements: Chemotherapy gown, double gloves, face mask, eye protection
		25 mL, EVERY BAG
		5 AUC(Carboplatin), IVPB, Once, T;N+480, Infuse Over 30 min(s)
			Comment: Extremely Hazardous Drug / Antineoplastic / PPE Requirements: Chemotherapy gown, double gloves, face mask, eye protection
		25 mL, EVERY BAG
		250 mL, EVERY BAG
		6 AUC(Carboplatin), IVPB, Once, T;N+480, Infuse Over 30 min(s)
			Comment: Extremely Hazardous Drug / Antineoplastic / PPE Requirements: Chemotherapy gown, double gloves, face mask, eye protection
		25 mL, EVERY BAG
		250 mL, EVERY BAG
Patient Care

	Resuscitation Status
		T;N, Full Code
		T;N, No Code
	Communication to HOSPITAL RN
		Use lab results from the past 24 hours for chemotherapy administration
Consults/Follow-up
	Pharmacy Consult
		Pharmacist allowed to round doses to nearest measurable volume (0.1 mL) and/or vial size if dose change is not greater than 5% of original calculated dose.
Non Categorized

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, IV Large Volume, IVPB, DAILY, PRN for see comment, 999 ml/hr
			Comment: for reaction to chemotherapy
		1,000 mL, IV Large Volume, IVPB, DAILY, PRN for see comment, 999 ml/hr
			Comment: for reaction to chemotherapy
Medications
	Benadryl
		50 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: Give at first sign of hypersensitivity reaction; symptoms may include: hives, rash, itching, and/or facial flushing.
		25 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: Give at first sign of hypersensitivity reaction; symptoms may include: hives, rash, itching, and/or facial flushing.
	Decadron (MH/WH)
		20 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: Give 1-2 minutes after diphenhydramine if no improvement or if symptoms worsen to include: hypotension, shortness of breath, facial/lip/tongue swelling, and/or any other signs /symptoms of a severe allergic reaction.
	SOLU-Medrol
		125 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: Give if dexamethasone unavailable or ineffective and additional steroids are needed, per provider.
	EPINEPHrine
		0.5 mg, Injection, IM-Intramuscular, DAILY, PRN for see comment
			Comment: Give immediately for airway obstruction/anaphylaxis reaction. Or give for hypersensitivity reaction not resolved by diphenhydramine and steroids. May repeat every 10 minutes for up to 3 doses.
		0.5 mg, Injection, SUBCUTANEOUS, DAILY, PRN for see comment
			Comment: Give immediately for airway obstruction/anaphylaxis reaction. Or give for hypersensitivity reaction not resolved by diphenhydramine and steroids. May repeat every 10 minutes for up to 3 doses.
	meperidine
		25 mg, Syringe, IV Push, Once, PRN for see comment
			Comment: For chills and rigors
	morphine  IV
		2 mg, Syringe, IV PUSH, Once, PRN for see comment
			Comment: For chills and rigors
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