SOP for Screening of Adult Chemotherapy Electronic Prescriptions

Transcription

1 SOP for Screening of Adult Chemotherapy Electronic Prescriptions Contents The following steps should be followed in screening a chemotherapy prescription on ARIA: 1. Patient details 2 2. Patient medical history and drug history 4 3. Patient blood results and vital signs 5 4. Patient medical notes 6 5. Prescription details 7 6. First cycle/ Subsequent cycle checks 9 7. Flow chart Screen for interactions Approve the prescription 13 Authorised and Published: Apr 13 Page 1 of 15

2 1. Patient details: The patient can be found either by entering the hospital number under the patient tab and clicking Search. The patient can also be searched by last name and narrowed down by selecting the relevant provider (consultant). Or by finding the patient s name under the visit tab under the relevant clinic date. Highlight patient name and check the following against the referral form: Patient name. Date of birth. If patient is on a Clinical trial (has a microscope beside date of birth). Authorised and Published: Apr 13 Page 2 of 15

3 Open patient (double click on highlighted name or click on OPEN tab) If further demographic details are required click on view button. Authorised and Published: Apr 13 Page 3 of 15

4 2. Patient medical history and drug history Click on Summary tab. Then check diagnosis check allergies check current medication. Authorised and Published: Apr 13 Page 4 of 15

5 3. Patient blood results and vital signs Click on recent results tab (those tests that are dark blue contain results) or use your local system for checking up-to-date bloods. Check: FBC neutrophils, platelets, haemoglobin. Urea and Electrolytes, EDTA, CrCl. On each subsequent cycle record the patient s latest serum creatinine value in the patient record / profiles and check the serum creatinine level has not deviated from the baseline level by 25% or more. N.B. To add new creatinine reading, click on assessments, then select GFR from the drop down menu, then enter the creatinine new value. Authorised and Published: Apr 13 Page 5 of 15

6 Vital signs check height and weight has been entered recently and approved. Ensure appropriate tests are undertaken for cardiotoxic drugs e.g. 3 monthly ECHO cardiogram / MUGA with trastuzumab. Authorised and Published: Apr 13 Page 6 of 15

7 4. Patient medical notes If further details on previous notes required, click on Notes icon and select the relevant annotation. Check notes for a record of administration problems in previous cycles of treatment, e.g. infusion related reactions or any problems since last cycle that would warrant a dose modification e.g. neutropenia or any other toxicities. Authorised and Published: Apr 13 Page 7 of 15

8 5. Prescription details Click on Rx details tabs You can see the details of the prescription either by opening the small folder next to the selected date. Or by double clicking the date which should expand the details of the prescription to the whole window. By this approach, you can view: The cycle and day numbers. Any dose modifications. Any reason for dose modification by clicking on the dose modification reason note pad. Open the General Orders to see notes made by Dr Rx button opens the Height, weight & SA calculation. You can also view any administration instructions by clicking on the Admin Instruction note pad. Authorised and Published: Apr 13 Page 8 of 15

9 Or you can view the prescription by viewing the treatment tab. Click on Rx on the top bar. Review the treatment cycle prescribed on the Order/Rx tab. Click on Show Summary to see regimen specific information. Select Overview then toggle down to Chemo order instructions. Print if required. Authorised and Published: Apr 13 Page 9 of 15

10 6. First Cycle / Subsequent cycle checks First Cycle Checks Always ensure the prescription is checked against the protocol or clinical trial protocol approved for the indication in your Trust. If not, it must be queried with the prescriber, ensure the Clinician has a valid clinical reason and peer approval, e.g. MDT and local clinical governance, has completed an exceptional use (IFR) or Cancer drug fund (CDF) application form and approval and funding, where appropriate, has been obtained. Record details in the notes. If appropriate check the regimen has NICE approval and meets the criteria. On the first cycle check the regimen is the intended treatment as documented in the referral form. Check the intended start date and exact duration of treatment. Check the administration details are appropriate for the drug, i.e. route and rate of administration and that the drug is compatible with diluent or infusion solutions. Start and stop dates for oral. Supportive meds. For Subsequent cycles Confirm any prescribed change. Check no. of cycles are appropriate for the indication. Check the frequency of administration. Check appropriate support regimens have been prescribed. Check dose modifications are appropriate and reason, and doses are appropriate for counts / clinical chemistry. You can access the prescription order audit report by clicking on the who created, approved and last modified the prescription. to find Authorised and Published: Apr 13 Page 10 of 15

11 7. Flow chart Click on flow sheet icon for previous doses administered. If you are not sure if the agent has been administered or not as has not shown on the flow chart, you can check the drug administration tab. The reason to that might be that the administering nurse has not recorded it on ARIA. In this case the administration has not been recorded but co-signed Authorised and Published: Apr 13 Page 11 of 15

12 You can see data produced in graphs by selecting the data required and click graph icon to show the graph. Select date range. Choose what data you want to see. Select rows to create graph. Authorised and Published: Apr 13 Page 12 of 15

13 8. Screen for interactions Click screen button, then interactions tab to check interactions. Click on Screen. The system will screen all drugs for interactions, contraindications, warnings. It can take a few seconds to do this. Accept or cancel Authorised and Published: Apr 13 Page 13 of 15

14 9. Approve the prescription Before you approve the prescription it has to be approved by the prescriber. So if it is still showing as pending, check with the prescriber and ask them to approve. Once this has been approved by physician and you are happy with the prescription, you can approve (sign for the clinical check). Authorised and Published: Apr 13 Page 14 of 15

15 Click the folder icon if you want to view the prescription details. Tick boxes to select individual prescriptions for approval. And this will show the pharmacy clinical check icon next to the prescription. 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: Tel: Version number as approved and published: 1 Unique identifier no.: AngCN-CCG-C42 Authorised and Published: Apr 13 Page 15 of 15