Unique Plan Description: ONC VIP
Plan Selection Display: ONC VIP
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2022-09-13 08:38:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-04-18 12:21:44
Available at all facilities: Yes

ONC VIP
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, spec type = Urine
	Urinalysis
		T+1;0400, Routine, Routine, spec type = Urine
IV Solutions
	Sodium Chloride 0.9%
		1,000 mL, IV, T;N+120, 1 Dose(s)/Time(s)
			Comment: Give 500mL over 30 minutes pre-cisplatin and post-cisplatin.  Use as primary flush with cisplatin.
		1,000 mL, IV, T+1;N, 1 Dose(s)/Time(s)
			Comment: Give 500mL over 30 minutes pre-cisplatin and post-cisplatin.  Use as primary flush with cisplatin.
		1,000 mL, IV, T+2;N, 1 Dose(s)/Time(s)
			Comment: Give 500mL over 30 minutes pre-cisplatin and post-cisplatin.  Use as primary flush with cisplatin.
		1,000 mL, IV, T+3;N, 1 Dose(s)/Time(s)
			Comment: Give 500mL over 30 minutes pre-cisplatin and post-cisplatin.  Use as primary flush with cisplatin.
		1,000 mL, IV, T+4;N, 1 Dose(s)/Time(s)
			Comment: Give 500mL over 30 minutes pre-cisplatin and post-cisplatin.  Use as primary flush with cisplatin.
		250 mL, IV, T;N+120, 25 ml/hr
			Comment: Use as primary/flush with etoposide, and ifosfamide.
Premeds
	dexamethasone IVPB
		12 mg, INT, IVPB, Once, T;N+120, duration: 1 Dose(s)/Time(s)
			Comment: Give 30 minutes prior to chemotherapy.
	dexAMETHasone
		12 mg, Tab, By Mouth, Once, T;N+120, duration: 1 Dose(s)/Time(s)
			Comment: Give 30 minutes prior to chemotherapy, May change to IV if patient unable to tolerate PO.
		8 mg, By Mouth, Q24H, T+1;N+120, duration: 6 Dose(s)/Time(s)
			Comment: Give on days 2 through 7, may change to IV if patient unable to tolerate PO.
		8 mg, Injection, IV Push, Q24H, T+1;N+120, duration: 6 Dose(s)/Time(s)
			Comment: Give on days 2 through 7.
	Emend for Injection
		150 mg, INT, IVPB, Once, T;N+120
			Comment: Give on day 1, 30 minutes prior to chemotherapy
	palonosetron
		0.25 mg, Injection, IV Push, Once, T;N+120
			Comment: Give 30 minutes prior to chemotherapy on Day 1.
		0.25 mg, Injection, IV Push, Once, T+3;N+120
			Comment: Give 30 minutes prior to chemotherapy on Day 4.
	furosemide
		20 mg, Injection, IV Push, Q24H, T;N+120, duration: 5 Dose(s)/Time(s)
			Comment: Give 30 minutes prior to cisplatin on days 1 through 5.
	OLANZapine
		5 mg, By Mouth, QHS, duration: 5 Dose(s)/Time(s)
			Comment: Give on days 1 through 5.
		10 mg, By Mouth, QHS, duration: 5 Dose(s)/Time(s)
			Comment: Give on days 1 through 5.
Chemotherapy Agent
		Day 1(NOTE)*
	mesna/NS 100 mL
		120 mg/m2, IVPB, Once, T;N+270, Infuse Over 10 min(s)
			Comment: Give prior to first bag of ifosfamide on day 1.Begin with first dose of ifosfamide and continue for 24 hours post chemotherapy.
		10 mL, EVERY BAG
		100 mL, EVERY BAG
		Days 1-5(NOTE)*
	CISplatin/NS 1000mL
		20 mg/m2, IVPB, Q24H, T;N+150, 5 Dose(s)/Time(s), Infuse Over 1 hr
			Comment: Insure hydration is given before and after.  Daily on days 1 through 5.
		40 mL, EVERY BAG
		1,000 mL, EVERY BAG
	etoposide/NS 500 mL
		75 mg/m2, IVPB, Q24H, T;N+210, 5 Dose(s)/Time(s), Infuse Over 1 hr
			Comment: Infuse over 1 hour daily on days 1 through 5.
		50 mL, EVERY BAG
		500 mL, EVERY BAG
	ifosfamide/NS 1000mL
		1,200 mg/m2, IVPB, Q24H, T;N+280, 5 Dose(s)/Time(s), Infuse Over 3 hr
			Comment: Daily on days 1 through 5.
		40 mL, EVERY BAG
		1,000 mL, EVERY BAG
	mesna/NS 100 mL
		1,200 mg/m2, IV, DAILY, T;N+280, 5 Dose(s)/Time(s), 43.3 ml/hr
			Comment: Continuous infusion days 1 through 5.
		40 mL, EVERY BAG
		1,000 mL, EVERY BAG
Medications

	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.
	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.
	filgrastim
		5 mcg/kg, Injection, SUBCUTANEOUS, Q24H, T+6;1200, duration: 10 Dose(s)/Time(s)
			Comment: Round 300mcg or 480mcg vial. Give daily on days 7 through 16.
Patient Care
	Obtain Consent/Permit for:
		T;N, Chemotherapy
	Hazardous Drug Precautions
		T;N
	IV-Maintain
		T;N
			Comment: Ensure 2 vascular access devices
	Neuro Checks
		T;N, Q4H-Sch
	Notify MD
		Any abnormal baseline vial signor symptoms of moderate to severe reaction or severe hypersensitivity.
		For additional orders if patient experiences reaction to treatment.
	Initiate MD Plan for:
		T;N, Allergy Reaction protocol if patient experiences reaction to treatment.

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