Unique Plan Description: ONC mFOLFIRINOX
Plan Selection Display: ONC mFOLFIRINOX
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2026-02-19 10:49:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2026-02-19 10:49:00
Available at all facilities: Yes

ONC mFOLFIRINOX
Laboratory
	CBC with Diff
		T;N, Stat, spec type = Blood
		T;N, Routine, Q24H, spec type = Blood
	Comprehensive Metabolic Panel
		T+1;0400, Routine, Q24H, spec type = Blood
		T;N, Stat, spec type = Blood
	Pregnancy Test Urine
		T;N, Routine, Routine, Urine Random, spec type = Urine
IV Solutions
	Dextrose 5% in water 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 oxaliplatin, irinotecan, and fluorouracil. Flush line with 25mL at 200mL/hr after each chemo dose.
Premeds
	Aloxi/Decadron/NS 50mL
		0.25 mg, IVPB, Once, Routine, infuse over 15 min(s), 200 ml/hr, T;N+90
		12 mg, EVERY BAG
		50 mL, EVERY BAG
	fosaprepitant
		150 mg, INT, IVPB, Once, infuse over 30 min(s), T;N+90
			Comment: Infuse over 30 min(s), give on day 1, 30 minutes prior to chemotherapy
	atropine
		0.2 mg, Injection, IV Push, Once, T;N+240
			Comment: Give prior to irinotecan
Chemotherapy Agent
	oxaliplatin/D5W 500mL
		85 mg/m2, IVPB, Once, T;N+120, Infuse Over 2 hr
			Comment: Give on day 1, run concurrently with leucovorin. Patient should avoid exposure to cold temperatures (iced drinks and environment). Extremely Hazardous Drug / Antineoplastic / PPE Requirements: Chemotherapy Gown, Double Gloves, Face Mask, Eye Protection
		50 mL, EVERY BAG
		500 mL, EVERY BAG
	leucovorin
		400 mg/m2, INT, IVPB, Once, infuse over 2 hr, T;N+120
			Comment: Give on day 1 with oxaliplatin
	irinotecan/D5W 500mL
		150 mg/m2, IVPB, Once, T;N+240, Infuse Over 90 min(s)
			Comment: Give on Day 1. This agent is an irritant. Extremely Hazardous Drug / Antineoplastic / PPE Requirements: Chemotherapy Gown, Double Gloves, Face Mask, Eye Protection
		50 mL, EVERY BAG
		500 mL, EVERY BAG
	Fluorouracil/D5W 1000 mL
		1,000 mL, IVPB, T;N+330, 2 Dose(s)/Time(s), 23 hr
			Comment: Give on Days 1 and 2. Total dose is 2400 mg/m2 infused over 46 hours. Extremely Hazardous Drug / Antineoplastic / PPE Requirements: Chemotherapy Gown, Double Gloves, Face Mask, Eye Protection
		1,200 mg/m2, EVERY BAG
		40 mL, EVERY BAG
Medications

	dexAMETHasone
		8 mg, Tab, By Mouth, DAILY, T;N+1, duration: 2 Dose(s)/Time(s)
			Comment: Give on days 2 and 3
	ondansetron
		8 mg, Tablet-Disintegrating, By Mouth, Q8H, PRN nausea and/or vomiting
			Comment: For nausea/vomiting not relieved by prochlorperazine
		8 mg, Injection, IV Push, Q8H, PRN nausea and/or vomiting
			Comment: For nausea/vomiting not relieved by prochlorperazine and patient unable to tolerate oral
	prochlorperazine
		10 mg, Tab, By Mouth, Q6H, PRN nausea and/or vomiting
		10 mg, Injection, IV Push, Q6H, PRN nausea and/or vomiting
			Comment: If patient unable to take PO
Patient Care
	Neurological Assessment-Focused
		Q4H-Sch
			Comment: Baseline and through day 5
	Obtain Consent/Permit for:
		T;N, or verify Consent for Chemotherapy
	Hazardous Drug Precautions
		T;N
	IV-Maintain
		T;N
			Comment: ensure 2 means of vascular access
	Notify MD
		Any abnormal baseline vital signs or symptoms of moderate to severe reaction or severe hypersensitivity.
	Initiate MD Plan for:
		T;N, CHEMO Allergy Reaction protocol if patient experiences reaction to treatment.
	Notify MD
		T;N, For additional orders if patient experiences reaction to treatment.
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.
	Consult Care Management
		Education
			Comment: Please arrange for neulasta administration at discharge if discharging after chemotherapy infusions are completed.

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