Unique Plan Description: NCS ONC Research Phase 1
Plan Selection Display: NCS ONC Research Phase 1
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2026-03-04 13:41:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2026-03-04 13:41:00
Available at all facilities: Yes

NCS ONC Research Phase 1
Admit/Discharge/Transfer
	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
	Admit to Observation Status
		T;N
Vital Signs
	Vital Signs
		Q4H-Sch
			Comment: Strict - whether sleeping or not
	Weight
		DAILY
Activity
	Activity-Up as Tolerated
		T;N
Diet
	Regular Diet
		T;N
Laboratory
	NCS Research Kit Draw
		T;N, Stat, spec type = Blood
			Comment: Lab draw for NCS research protocol sendout kit.  See RN for Kit.
	CBC with Diff
		T;N, Routine, spec type = Blood
		T+1;0400, Routine, Q24H, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Routine, spec type = Blood
		T+1;0400, Routine, Q24H, spec type = Blood
	Magnesium Level
		T;N, Routine, spec type = Blood
		T+1;0400, Routine, spec type = Blood
	Phosphorus
		T;N, Routine, spec type = Blood
		T+1;0400, Routine, Q24H, spec type = Blood
	LDH
		T;N, Routine, spec type = Blood
	Uric Acid
		T;N, Routine, spec type = Blood
	Protein Electrophoresis Serum with Immunofixation
		
	Bence Jones Urine (Immunofixation).
		
	Hepatitis B Core Antibody IgM (Acute)
		T;N, Stat, spec type = Blood
	Hepatitis C Virus (HCV) Antibody with Rflx to PCR Confirmation
		T;N, Routine, spec type = Blood
	COVID-19 (2019 Novel Coronavirus) by PCR
		T;N, Stat, spec type = Nasopharyngeal Swab
	PT - MH/WH/JE
		T;N, Stat, spec type = Blood
	INR - MH/WH/JE
		T+1;0400, Routine, Q24H, spec type = Blood
	Pregnancy Test Urine
		T;N, Routine, Routine, Urine Random, spec type = Urine
	Ferritin Level Oncology
		T;N, Routine, spec type = Blood
	C Reactive Protein High Sensitivity
		T;N, Routine, spec type = Blood
	Lactate
		T;N, Routine, spec type = Blood
	LDH
		T;N, Routine, spec type = Blood
IV Solutions
	Sodium chloride 0.9% Chemo Flush
		250 mL, IV, Once, 25 ml/hr, T;N+30
			Comment: Use as primary/flush
	Dextrose 5% in water Chemo flush
		250 mL, IVPB, Once, 25 ml/hr
			Comment: Use as primary/flush
Medications
	elranatamab-bcmm
		12 mg, Solution, SUBCUTANEOUS, Once
			Comment: Each injection may be up to 2 mL in volumeInjection site maximum of 4 unique sites distributed across the 2 lower and the 2 upper abdominal quadrants (up to 1 injection location per quadrant). Administer the required number of injections in the following order: 1. Lower left quadrant; 2. Lower right quadrant 3. Upper left quadrant 4. Upper right quadrant Injections to the abdomen are preferred. If subcutaneous injections in the abdominal location are not possible, injections can be administered in a distributed manner in the thighs. If subcutaneous injections in the upper extremities (eg, deltoid, upper and lower arm) are not permitted and more than 1 study intervention is administered SC, the 2 treatments should not be administered in the same quadrant whenever possible so that it will be easier to distinguish which drug caused any injection site reactions that may occur. Document the participant's injection site(s) and mark the injection sites on the participant's abdomen
Premeds
	diphenhydrAMINE
		25 mg, Injection, IV Push, Once
			Comment: Premedicate 1 hours prior to each dose
	acetaminophen
		650 mg, Tab, By Mouth, Once
			Comment: Premedicate 1 hours prior to each dose
	dexAMETHasone
		20 mg, Tab, By Mouth, Once
			Comment: Premedicate 1 hours prior to each dose
Patient Care

	Obtain Consent/Permit for:
		T;N, NCS Research Phase 1
	Resuscitation Status
		Full Code
		No Code
	VTE Advisor
		T;N, Medical
	Weight
		T+1;0400, DAILY
	Intake and Output
		T;N, Q6H-Sch
			Comment: Notify oncologist if urine output <300mL/8H
	Incentive Spirometer
		T;N, Q2H-Sch
	Order Lab
		Blood Culture Set,  UA (culture if pos) and Chest 1  View if temp >/= 100.4 for greater than 1 hour or a single temperature of >/= 101.4 and notify attending hematologist/oncologis
	IV-Maintain
		
	Order/Transfuse Blood Product
		T;N, Packed cells, 1 unit
			Comment: For hgb <7grams/dL.  Use irradiated and leukocyte reduced products. Enter order for: acetaminophen 650mg PO once prior to transfusion.
		T;N, Platelet, 1 unit
			Comment: For platelet count < or = 10,000. Use irradiated & leukocyte reduced product. Enter order for: acetaminophen 650mg PO once prior to transfusion
	Complete ICE Assessment Tool
		To be completed at shift change. And PRN with RN change and/or mental status change., Q12H-Start of Shift
	Complete CRS Grading
		T;N
			Comment: 9am and 9pm. And PRN with mental status change
	Neurological Assessment-Focused
		T;N, Q4H-Sch, see comment
			Comment: With mental status change
	Notify MD
		T;N, if HR <60 or >120, SBP <90 or >180, DBP >100, SPO2 <90%, Temp >38 degree C
		If patient is positive for ICANs/CRS
	Cardiac Telemetry Monitoring
		Telemetry Indications: Other
	Notify MD
		Contact Provider for further orders if allergic reaction protocol initiated
Therapies
	Pulse Oximetry Spot Check RT
		T;N, BID
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID

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.

Tocilizumab-BAVI (Tofidence)
Medications
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	tocilizumab-bavi
		400 mg, INT, IVPB, Once, infuse over 1 hr, T;N
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		600 mg, INT, IVPB, Once, infuse over 1 hr, T;N
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		800 mg, INT, IVPB, Once, infuse over 1 hr, T;N
	Pharmacy Consult
		Pharmacist to confirm 2 doses of tocilizumab available per requirements
			Comment: Pharmacy to document estimated dose.  Pharmacist to confirm 2 doses of tocilizumab available per requirements
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	tocilizumab-bavi
		8 mg/kg, INT, IVPB, Once, infuse over 1 hr, T;N
			Comment: CRS: 1st dose out of max 3 doses in 24 hours, max single dose 800 mg
		8 mg/kg, INT, IVPB, Once, PRN see comment, infuse over 1 hr, T;N+480
			Comment: REQUEST IF NEEDED: PRN CRS 2nd dose if symptoms not resolved.  Max 3 doses in 24 hours, max single dose 800 mg
	dexamethasone IVPB
		10 mg, INT, IVPB, Once, PRN see comment, T;N+480, duration: 1 Dose(s)/Time(s)
			Comment: REQUEST IF NEEDED: If a second dose of tocilizumab is given, it is necessary to give dexamethasone with 2nd dose of tocilizumab
	tocilizumab-bavi
		8 mg/kg, INT, IVPB, Once, PRN see comment, infuse over 1 hr, T;N+960
			Comment: REQUEST IF NEEDED: PRN CRS 3rd dose if symptoms not resolved.  Max 3 doses in 24 hours, max single dose 800 mg

*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