Unique Plan Description: ONC TIP
Plan Selection Display: ONC TIP
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2026-04-02 10:52:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2026-04-02 10:52:00
Available at all facilities: Yes

ONC TIP
Laboratory
STAT Lab
	CBC with Diff
		T;N, Stat, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Stat, spec type = Blood
DAILY Lab
	CBC with Diff
		T+1;N, Routine, Q24H, spec type = Blood
	Comprehensive Metabolic Panel
		T+1;N, Routine, Q24H, spec type = Blood
Tomorrow's Lab
	Uric Acid
		T+1;N, Routine, spec type = Blood
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 cisplatin, PACLitaxel, and ifosfamide. Flush line with 25mL at 200mL/hr after each chemo dose.
	Sodium Chloride 0.9%/KCl/Magnesium Sulfate
		0.5 gm, IV, Q24H, infuse over 120 min(s), T;N+180, duration: 3 Dose(s)/Time(s)
			Comment: Prehydration prior to ifosfamide on Days 1 through 3
		10 mEq, EVERY BAG
		1,000 mL, EVERY BAG
		0.5 gm, IV, Q24H, T;N+540, 3 Dose(s)/Time(s), Infuse Over 120 min(s)
			Comment: Posthydration after cisplatin on Days 1 through 3.
		10 mEq, EVERY BAG
		1,000 mL, EVERY BAG
Medications
Premeds
	fosaprepitant
		150 mg, INT, IVPB, Once, infuse over 30 min(s), T;N+90
			Comment: Give on Day 1, 30 minutes prior to chemotherapy.
	palonosetron/dexamethasone/NS 50mL
		0.25 mg, IVPB, Once, Routine, infuse over 15 min(s), 200 ml/hr, T;N+90
			Comment: Give on Day 1, 30 minutes prior to chemotherapy.
		12 mg, EVERY BAG
		50 mL, EVERY BAG
	dexamethasone Injectable
		8 mg, Injection, IV Push, Q24H, T+1;N+270, duration: 2 Dose(s)/Time(s)
			Comment: Give on Days 2 and 3, 30 minutes prior to chemotherapy.
	diphenhydrAMINE
		25 mg, Injection, IV Push, Once, T;N+90
			Comment: Give on Day 1, 30 minutes prior to chemotherapy.
	famotidine
		20 mg, Injection, IV Push, Once, T;N+90
			Comment: Give on Day 1, 30 minutes prior to chemotherapy.
	furosemide
		20 mg, Injection, IV Push, Q24H, T;N+405, duration: 3 Dose(s)/Time(s)
			Comment: Give 15 minutes prior to cisplatin on Days 1 through 3.
	prochlorperazine
		10 mg, Injection, IV Push, Once, T+1;N+270
			Comment: Give on Day 2, 30 minutes prior to chemotherapy.
	palonosetron
		0.25 mg, Injection, IV Push, Once, T+2;N+270
			Comment: Give on Day 3, 30 minutes prior to chemotherapy.
Chemotherapy Agent
	PACLitaxel/NS 500 mL
		175 mg/m2, IVPB, Once, T;N+120, Infuse Over 180 min(s)
			Comment: Give on Day 1. Extremely Hazardous Drug / Antineoplastic / PPE Requirements: Chemotherapy gown, double gloves, face mask, eye protection.
		50 mL, EVERY BAG
		500 mL, EVERY BAG
	ifosfamide/NS 500mL
		1,200 mg/m2, IVPB, Q24H, T;N+300, 3 Dose(s)/Time(s), Infuse Over 120 min(s)
			Comment: Give on Days 1 through 3. Prehydration required. Extremely Hazardous Drug / Antineoplastic / PPE Requirements: Chemotherapy gown, double gloves, face mask, eye protection.
		50 mL, EVERY BAG
		500 mL, EVERY BAG
	CISplatin/NS 500mL
		25 mg/m2, IVPB, Q24H, T;N+420, 3 Dose(s)/Time(s), Infuse Over 120 min(s)
			Comment: Give on Days 1 through 3. Posthydration required. Extremely Hazardous Drug / Antineoplastic / PPE Requirements: Chemotherapy gown, double gloves, face mask, eye protection.
		50 mL, EVERY BAG
		500 mL, EVERY BAG
Scheduled Medications
	mesna/NS 100 mL
		240 mg/m2, IVPB, Q24H, T;N+285, 3 Dose(s)/Time(s), Infuse Over 15 min(s)
			Comment: Give 15 minutes prior to each ifosfamide dose. Give on Days 1 through 3.
		10 mL, EVERY BAG
		100 mL, EVERY BAG
		240 mg/m2, IVPB, Q24H, T;N+540, 3 Dose(s)/Time(s), Infuse Over 15 min(s)
			Comment: Give 4 hours from the start of each ifosfamide dose. Give on Days 1 through 3.
		10 mL, EVERY BAG
		100 mL, EVERY BAG
		240 mg/m2, IVPB, Q24H, T;N+780, 3 Dose(s)/Time(s), Infuse Over 15 min(s)
			Comment: Give 8 hours from the start of each ifosfamide dose. Give on Days 1 through 3.
		10 mL, EVERY BAG
		50 mL, EVERY BAG
	dexAMETHasone
		8 mg, Tab, By Mouth, DAILY, T+3;N, duration: 3 Dose(s)/Time(s)
			Comment: Give on Days 4 through 6
	OLANZapine
		5 mg, Tab, By Mouth, QHS, T+2;N, duration: 4 Dose(s)/Time(s)
			Comment: Give nightly on Days 3 through 6
	prochlorperazine
		10 mg, Tab, By Mouth, Q6H, PRN nausea and/or vomiting
		10 mg, Injection, IV Push, Q6H, PRN nausea and/or vomiting
			Comment: Give oral first if able
	ondansetron
		8 mg, Tab, By Mouth, Q8H, PRN nausea and/or vomiting
			Comment: If prochlorperazine ineffective.
		8 mg, Injection, IV Push, Q8H, PRN nausea and/or vomiting
			Comment: If prochlorperazine ineffective (give oral first if able)
	LORazepam
		0.5 mg, Tab, By Mouth, Q6H, PRN nausea and/or vomiting
			Comment: For anticipatory nausea/vomiting, or if prochlorperazine and ondansetron ineffective.
		0.5 mg, Injection, IV Push, Q6H, PRN nausea and/or vomiting
			Comment: For anticipatory nausea/vomiting, or if prochlorperazine and ondansetron ineffective (give oral first if able).
Other
Patient Care

	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.

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