Transcript Development of Chemotherapy Order Templates in CPRS

DEVELOPMENT AND IMPLEMENTATION OF CHEMOTHERAPY ORDER
TEMPLATES IN CPRS
Ed Pelikan R.Ph. and Kimberly Bell PharmD.
Background
Development of Standard Order Sets
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 premedications
•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
Excel Calculation Worksheet
Chemotherapy calculator
automatically populates
fields with chemotherapy
doses
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
Spread sheet that feeds data into calculation
worksheet
•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
1. Diagnosis,
cycle number
and dates are
entered
Height, weight
and lab data
automatically
pulled from chart
Initial Evaluation of Process
Hold
Parameters
Pre-medications
Chemotherapy
calculator opens
excel worksheet that
calculates chemo
doses and is
populated in the
order field below
•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