Standard Operating Procedure for Setting up Chemotherapy Plans and other treatments on ARIA Planner

Transcription

1 Standard Operating Procedure for Setting up Chemotherapy Plans and other treatments on ARIA Planner Objectives and Scope 2 Responsibilities 2 Logging to Planner 3 Plan type, status and classifications 4 Key for Buttons 5 Adding a new regimen 6 Definition 6 Classification 7 Authorised Users 8 Medical Management 8 Phase Setup 9 Plan Details 10 Plan Summary 10 Plan Access 10 Dose/ Range 11 Rounding 12 Dose Banding 12 Infusion Mode 12 Prescription Type 13 Admin Tab 13 Scheduling 14 Changing a selected event 15 Cyclical Changes 15 Approval for Testing 16 Test Patients 17 Second Pharmacist Check List 19 Authorised and Published: Apr 13 Page 1 of 19

2 Objectives and scope How to input the master template(s) of a prescription(s) for standard ACN chemotherapy regimens on ARIA planner. Once the regimen has been added and approved, this will be ready for use on ARIA manager. The purpose of this process is to aid prescribing and avoid errors in dosing, scheduling, administration. Responsibilities Master regimen(s) are to be 1st added by Network Pharmacist. First check should be performed by a second pharmacist who should make any necessary amendments. The regimen should be checked on Planner e.g. to check for dose rounding, banding and scheduling. Second clinician check by the nominated consultants. Third check by a specialist nurse would do the final check for any nursing/ administration related issues. Authorised and Published: Apr 13 Page 2 of 19

3 Logging into Planner You can log into planner by clicking on the Medonc Planner icon. Or if you are already logged into manager by selecting planner from the drop down menu in applications at the top. Open the site with your specific passwords and click on the planner icon. Authorised and Published: Apr 13 Page 3 of 19

4 Plan Types Select regimen from the drop down menu At this screen the Default Plan list is alphabetically for each plan type by plan name (not display name). Plan status This allows viewing any of the plan types by Active versus Inactive Status. Active are the ones that are seen in Manager (as long as the plan is approved for use). Inactive status - the plans are not seen in Manager. This allows plans to be turned off if they are no longer required in Manager. Plan classifications This is defaulted at <ALL>. If you are checking a particular tumour type you can use the disease site tab to filter the list to the tumour type you are checking i.e., breast, brain. Authorised and Published: Apr 13 Page 4 of 19 H:\Cancer Network\Cross Cutting Groups\Chemotherapy & E-Prescribing\E-Prescribing\ARIA User

5 Buttons (right side) Open button Highlight the plan you wish to check and press the open button this opens the plan agenda window and will activate the lower tool bar i.e. colour in the definition, schedule etc tabs. New button This allows you to add regimens to planner. View button This allows viewing an exiting plan. Amend button The Amend button will be disabled if you do not have Access to the plan type or if it still in pending or approved for testing status. (Allows a plan type to be modified once it has been approved for use.) If changes are required for a specific plan, this allows a new version of the plan type to be developed so a new plan does not have to be developed. Copy button This allows adding an new regimen based on an existing regimen after doing the necessary amendments e.g. adding a new regimen for STO3 trial based on ECX regimen. Deactivate button This allows deactivating a regimen so it will not appear on Manager for prescribing. Access button This allows you to give access to specific institutions or remove access for specific users. If there is no institution assigned to a plan in Planner, it will not be available in Manager. Authorised and Published: Apr 13 Page 5 of 19

6 Adding a new regimen Select the correct disease site under plan classification. Then click new. Definition Start by completing the definition section: Plan Name (20 character limit). NOTE Unable to have 2 plans with the same name Example: include an = sign in the name to differentiate a regimen from another plan type. Display Name (80 character limit). - which will show in the regimen list on Planner and Manager. Ensure there is at least one space in the name, so it will be able to wrap appropriately in Manager. Do not use apostrophe ('), quotes (" "), semi-colons (;) or tildes (~) or tabs in the Plan Name or Display Name fields. Avoid using these characters in any fields in Planner. The name should also end with =. Authorised and Published: Apr 13 Page 6 of 19 H:\Cancer Network\Cross Cutting Groups\Chemotherapy & E-Prescribing\E-Prescribing\ARIA User

7 Add a brief description (200 character limit) about the agents used, the doses and the schedule. Click on clinical trial if you are adding a clinical trial. Classification To add a classification: Click add. Select the disease site. Select the site from the value drop down menu. Then it will show under the classification. Authorised and Published: Apr 13 Page 7 of 19

8 Authorised Users This will automatically add the name of the person who created that regimen on Planner Medical Management Then select: The toxicity grading scheme. The formula used for BSA calculation. Authorised and Published: Apr 13 Page 8 of 19 H:\Cancer Network\Cross Cutting Groups\Chemotherapy & E-Prescribing\E-Prescribing\ARIA User

9 Phase set up Phase defaults to phase 1. Phase Name 20 character limit. This can be renamed to match the regimen name, as this is what will appear in the Plan Amendment Summary in the Treatment Tab in Manager. Cycle length and number of cycles will set up the appropriate schedule in the Treatment Tab and in the Schedule Window in Manager as defined in the protocol. Max Drift (days) will highlight the recommended days on either side of the Target Date in the Schedule Window in Manager could be used occasionally in Haematology protocols where the cycle length is variable depending on blood counts but will be default set to 0 days. Service Type, Inpatient, outpatient or inpatient/outpatient to be selected as relevant to the script. Modality, select chemotherapy if straight chemo if chemo-radiation leave the box blank. Schedule Type Cyclical is the one typically used for most chemotherapy. This indicates that treatment will occur repeatedly on a regular schedule. Linear Negative Days is for BMT Regimens ONLY. This allows the regimen to start on a negative day and work up to and past day 0 which is the day the BMT would take place on. (This is strictly for a one cycle event). The Toxicity risk scores for febrile neutropenia and the Hesketh should be completed if the information is available. Toxicity Causes Required is selected when grading a toxicity >= 1 in Manager, the user must enter the Toxicity Cause, prior to approving the toxicity assessment. The Cause Certainty does not have to be completed, but is available if the client chooses to enter it the default setting will be to leave the box blank i.e. toxicity causes optional. The closed to accrual box should not be ticked. The chemo order instruction icon should be a blank note book. Description the drugs in the regimen and how they are given as per ACN policy multiple days should be written as 1,2,3,4 not 1-4 etc. Authorised and Published: Apr 13 Page 9 of 19

10 Plan Details Plan Summary Select Plan Details and Summary from the upper tool bar to open the Plan Summary window. Plan Access This gives access of regimens to specific users and institutions. Select Plan Details and Access from the upper toolbar this default opens the Institutions tab. Institutions tab Access must be granted in Planner prior to the regimen being seen in Manager (Default all regimens that are ACN approved will be seen in all ACN locations.) Users tab Ability to EXCLUDE user access to a Regimen. The Exclude Access checkboxes are not selected as the default. If a checkbox is selected beside a user, the user will not see the Regimen in Manager. (Default all regimens that are trust approved will be seen by all trust users) Authorised and Published: Apr 13 Page 10 of 19

11 Checking adding, removing or amending agents In the lower tool bar click on Agents. Taking you to the agent window. Click New. Add in the first few letters of the agent you want to add Then select the correct agent from the drop down menu Choose the appropriate dose is in the Dose/Range field. The second box is not functional for agents that require dose calculation. Default one number only if the trust protocols state a specific dose rather than a range of doses. If AUC dosing for Carboplatin administration is required for calculating a dose, ensure that AUC is the unit of measure. Correct units form the drop down options Correct route form the drop down options Authorised and Published: Apr 13 Page 11 of 19

12 Select the appropriate rounding from the Rounding Method drop-down list. None You can either leave the field blank or fill in none. The dose would be given at whatever the system calculates it to (using the preset decimal format in Security). -Up if halfway - if a dose is to be rounded to the nearest 10 mg and the dose is calculated in the system to 225 the system would automatically round up to Down if halfway - if a dose is to be rounded to the nearest 10 mg and the dose is calculated in the system to 225 the system would automatically round down to Always up - if a dose is to be rounded to the nearest 10 mg and the dose is calculated in the system to 221 the system would automatically round up to Always down - if a dose is to be rounded to the nearest 10 mg and the dose is calculated in the system to 229 the system would automatically round down to 220. Dose Banding We can specify dose bands as a form of dose rounding. Instead of rounding to a specified number, a user can define a specific dose to be administered for a defined dose range which would be calculated based upon BSA, mg/kg or AUC. If you enter a dose banding table, this will over ride any dose banding set up in security. Ensure the Minimum Dose range is larger than the previous Maximum Dose range. This value needs to be entered to the 4th decimal place (.0001) larger, rather than to the neares1.0. Based upon the number of decimals calculated within the computer there may be a missed dose if there is no decimal place indicated in the dose banding. Infusion mode Displays in Manager as part of the course description. When the route is intravenous, some combination including IV, or injection, the Infusion Mode fields are displayed. You are not required to complete the infusion mode, if the drop-down list does not match what is required by the regimen. The information can be put in the admin notes. If you choose to delete the infusion mode and duration entered select the eraser icon to the right of the duration dropdown list. Check the appropriate Diluent is Select from the Diluent drop-down list with appropriate volume and unit of measure. Diluent ID field- If the same Diluent ID number is entered for another agent, both agents are considered mixed in the same diluent fluid or bag. Indicate appropriate Line # if required (maybe used in heam protocols to specify lines for cyclosporine) If there are multiple infusion lines for treatment, the Line # will indicate a specific agent to be administered through the identified line. Default Leave the Substitutions Allowed default as Yes. (Substitution is usually used for clinical trials if a specific brand is required. If No is selected this does not stop the user in Manager to change it, but it does flag the agent as NO SUBSTITUTIONS ALLOWED on the prescription). Authorised and Published: Apr 13 Page 12 of 19

13 Prescription Type Internal - The agent will be administered within the clinic and dose recordings will be associated with the agent in Manager in the Daily Administration tab in the Drug Administration window. Pickup Internal - The intention is to have the prescription picked up within the clinic or hospital (i.e. TTOs). This could be through either the dispensary or as pre-packs kept on the unit. Pick up external is to only be used for intrathecal drugs. The Admin Tab Is where the admin instructions are entered. The admin instructions will appear in Manager in a notepad icon with the agent. It will be printed on the Rx from Manager if selected to print Admin Instructions. N.B. If you want an agent to be administered BD by the nursing staff (i.e. when set up as internal) often the agent needs to be entered twice and each day entered separately otherwise the administration of each dose cannot be recorded separately. Authorised and Published: Apr 13 Page 13 of 19 H:\Cancer Network\Cross Cutting Groups\Chemotherapy & E-Prescribing\E-Prescribing\ARIA User

14 Scheduling: In the lower tool bar, click on schedule, taking you to the schedule window. You can add a new scheduled event by clicking on the date by the agent you wish to schedule and then click add. You will then be able to complete the information using the drop down boxes. Authorised and Published: Apr 13 Page 14 of 19

15 Changing a scheduled event: To move/alter a scheduled event / drug highlight the scheduled event and click the modify button. To delete an event Click on Delete. Cyclical changes: If you want to add an agent with cyclical changes (e.g. to be added for some cycles and omitted on other cycles), you have to untick cyclical and amend each cycle separately by clicking Add before each cycle. This allows the agent to appear in Manager on the appropriate cycle/day and for the appropriate duration for the regimen. Authorised and Published: Apr 13 Page 15 of 19

16 Approval for testing Before testing the regimen on Test Patient in Manager, the regimen has to be approved. The regimen has to be approved through the Plan Details drop-down list or by using the Approve Check box on the toolbar. Click Analyze. If any messages come up once the analyze button is selected, read and adjust as necessary. Then approve for testing. N.B. If there are any changes made to the regimen while Approved for Testing, you do not have to go back into the Approve for testing window for the changes to take place. The regimen will only be seen in Manager as long as a Test Patient checkbox is selected in the Demographics window. Authorised and Published: Apr 13 Page 16 of 19

17 Test Patients Test patients need to be set up in manager. You then need to enter an appropriate height, weight and diagnosis for the dummy patient. Registering a new test patient Click on the Patient Tab in the open patient window. To register a new patient, click New. Click New and the new patient details window opens to the General tab. Register the new test patient by entering details in the fields shown Test patients should follow the following nomenclature: Surname = zzz1234 trial First name = trial name The minimum data required to continue prescribing using Aria on this page are; Date of Birth: an arbitrary date Sex Error/ Test Patient: Check this box Open the patient IDs tab and fill in the NHS# field with the clinical trial number +/- the clinical trial number field with an arbitrary number. Authorised and Published: Apr 13 Page 17 of 19 H:\Cancer Network\Cross Cutting Groups\Chemotherapy & E-Prescribing\E-Prescribing\ARIA User

18 You can fill in the other fields later as needed. Click OK at bottom right to save the information and return to the open Patient window reopens with the New dummy patient s details highlighted. Open the patient to vital signs. You will need to enter Vital Signs minimum of; Height in cm. Weight in kg and the surface area in m2 will be calculated for you automatically. Enter other details if available. Use various height and weight for different test patients to get different surface areas so as to facilitate system checking. Click Approve under Entered at the bottom bar Authorised and Published: Apr 13 Page 18 of 19

19 Second Pharmacist Check List The second pharmacist should check The paper prescription for the regimen tested on a test patient The regimen set up on ARIA Planner Particulars to be checked: Correct drug(s) selected Correct dosing and units i.e. mg/m2 or mg/kg or AUC based Correct rounding Correct diluents types and volumes Correct duration of administration Correct scheduling Correct number of cycles and cycle length Correct supportive medication (pre-medication and TTOs). Document management Document ratification and history Approved by: Hugo Ford at the NOPG/SACT meeting on 26/02/2013 Date approved: 26 February 2013 Date placed on Apr 2013 electronic library: Review date: One year Authors: Matthew Small Document Owner: Anglia Cancer Network Tel: Version number as approved and published: 1 Unique identifier no.: AngCN-CCG-C44 Authorised and Published: Apr 13 Page 19 of 19