DEVELOPMENT AND IMPLEMENTATION OF CHEMOTHERAPY ORDER TEMPLATES IN CPRS

1. DEVELOPMENT AND IMPLEMENTATION OF CHEMOTHERAPY ORDER TEMPLATES IN CPRS Ed Pelikan R.Ph. and Kimberly Bell PharmD. • Background • Overview of Current Process • Template within CPRS guides physicians through the order process • All orders are free-texted into the order set- no pre-printed orders • Physician individually enters each medication and dose in the regimen and all pre-medications • Text order is created in CPRS which pharmacy uses to enter infusion orders and nurses use for verification when administering chemotherapy • Limitations to Current Process • All orders are free-text which increase the potential for errors • No standardization of regimens or ancillary medications • Time consuming for physicians to enter orders • Cumulative doses not easily tracked in system • No electronic order check of calculations • Goals of Template Development • Increased efficiency and accuracy of order entry by physicians • Standardization of regimens and all ancillary medications • Increased safety with electronic order checks • Standardization and increased efficiency of order entry by pharmacy to include standard solutions and infusion times • Development of Standard Order Sets • Informatics and Pharmacy worked to design a standard order template that could be used for various regimens to include hold parameters, pre-medications, chemotherapy medications, and any ancillary medications required for the regimen. Recent height and weight and lab data for physician reference is pulled into the order. The order template was reviewed by oncologists and oncology nurses for input. • A dose calculator was built that would calculate the BSA, using the Mostellar formula, and doses of all medications in a given regimen. The dose calculator allows for physician adjustment of doses and justification for adjustment. A carboplatin dose calculator was also built which will use the Cockcroft-Gault creatinine clearance calculation and will cap all doses at a creatinine clearance of 125ml/min • All programming for these order sets was done using a combination of visual basic code and excel spreadsheet formulas • All info for each regimen was compiled by the oncology pharmacist and reviewed by an oncologist prior to being built into the CPRS template. • Regimens were built individually by informatics using the info provided. • All regimens were first placed into a “test mode” so that all info and calculations can be verified. Once verified they are moved into the regular order set. • All physicians, pharmacists, and nurses were trained on the order entry process Sample Order CPRS Order Set Chemotherapy calculator automatically populates fields with chemotherapy doses 1. Diagnosis, cycle number and dates are entered Excel Calculation Worksheet Physician can free text a dose change and document a reason for dose adjustment which will print in the orders. Dose adjustment drop down menu automatically calculates % dose reduction Height, weight and lab data automatically pulled from chart • Initial Evaluation of Process • Physicians happy with the ease of order entry and decreased time required to write orders • Increased accuracy and efficiency of pharmacy order entry • Additional education needed to familiarize nurses with process • Future Directions • Templates will continue to be built for all commonly used regimens • Addition of links to articles for reference of each regimen • Training for all Fellows in clinic on the use of templates • Training for rest of pharmacy staff on orders Hold Parameters Pre-medications Spread sheet that feeds data into calculation worksheet Chemotherapy calculator opens excel worksheet that calculates chemo doses and is populated in the order field below