Unique Plan Description: ONC GemOX + Rituximab
Plan Selection Display: ONC GemOX + Rituximab
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2026-01-12 15:01:09
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2026-01-12 15:01:09
Available at all facilities: Yes

ONC GemOX + Rituximab
Laboratory
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	CBC with Diff
		T;N, Stat, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Stat, spec type = Blood
	Uric Acid
		T;N, Stat, spec type = Blood
	Pregnancy Test Urine
		T;N, Stat, Stat, spec type = Urine
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	CBC with Diff
		T+1;N, Routine, Q24H, spec type = Blood
	Comprehensive Metabolic Panel
		T+1;N, Routine, Q24H, spec type = Blood
	Uric Acid
		T+1;N, Routine, spec type = Blood
IV Solutions
	Sodium chloride 0.9% Chemo Flush
		25 mL, IVPB, Q1H, PRN IV line flush, 200 ml/hr
			Comment: To be used for chemo primary line flush bag.  Use with gemcitabine and rituximab. Flush line with 25mL at 200mL/hr after each chemo dose.
	Dextrose 5% in water Chemo flush
		25 mL, IVPB, Q1H, PRN IV line flush, 200 ml/hr
			Comment: To be used for chemo primary line flush bag.  Use with oxaliplatin. Flush line with 25mL at 200mL/hr after each chemo dose.
Medications
Premeds
	acetaminophen
		1,000 mg, Tab, By Mouth, Once, T;N+60
			Comment: give 30 minutes prior to rituximab-abbs
		650 mg, Tab, By Mouth, Once, T;N+60
			Comment: give 30 minutes prior to rituximab-abbs
	diphenhydrAMINE
		50 mg, Injection, IV Push, Once, T;N+60
			Comment: give 30 minutes prior to rituximab-abbs
		25 mg, Injection, IV Push, Once, T;N+60
			Comment: give 30 minutes prior to rituximab-abbs
	fosaprepitant
		150 mg, INT, IVPB, Once, infuse over 30 min(s), T;N+450
			Comment: infuse over 30 min(s), give on day 1, 30 minutes prior to chemotherapy
	Aloxi/Decadron/NS 50mL
		0.25 mg, IVPB, Once, Routine, infuse over 15 min(s), 200 ml/hr, T;N+450
			Comment: give on day 1, 30 minutes prior to chemotherapy
		12 mg, EVERY BAG
		50 mL, EVERY BAG
Chemotherapy Agent
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	riTUXimab-abbs/NS 500mL
		500 mL, IV, Routine, T;N+90, 1 Dose(s)/Time(s)
			Comment: Initial infusion: Start an infusion rate of 50 mg/hour; if there is no infusion-related reaction, increase the rate by 50 mg/hour increments every 30 minutes, to a maximum rate of 400 mg/hour.
		375 mg/m2, EVERY BAG, 50 mg/hr
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		500 mL, IV, Routine, T;N+90, 1 Dose(s)/Time(s)
			Comment: Standard infusion rate: If patient tolerated initial infusion, start at 100 mg/hour; if there is no infusion-related reaction, increase the rate by 100 mg/hour increments every 30 minutes, to a maximum rate of 400 mg/hour.
		375 mg/m2, EVERY BAG, 100 mg/hr
	gemcitabine/NS 250 mL
		1,000 mg/m2, IVPB, Once, T;N+480, Infuse Over 30 min(s)
			Comment: give on Days 1. Extremely Hazardous Drug / Antineoplastic / PPE Requirements: Chemotherapy gown, double gloves, face mask, eye protection.
		25 mL, EVERY BAG
		250 mL, EVERY BAG
	oxaliplatin/D5W 500mL
		100 mg/m2, IVPB, Once, T;N+510, Infuse Over 120 min(s)
			Comment: give on Days 1. Extremely Hazardous Drug / Antineoplastic / PPE Requirements: Chemotherapy gown, double gloves, face mask, eye protection.
		50 mL, EVERY BAG
		500 mL, EVERY BAG
Nausea Vomiting
	ondansetron
		8 mg, Tablet-Disintegrating, By Mouth, Q8H, PRN nausea and/or vomiting
			Comment: nausea or vomiting not relieved by prochlorperazine (if ordered)
		8 mg, Injection, IV Push, Q8H, PRN nausea
			Comment: nausea or vomiting not relieved by prochlorperazine (if ordered) (give oral first if able)
	prochlorperazine
		10 mg, Tab, By Mouth, Q8H, PRN nausea and/or vomiting
		10 mg, Injection, IV Push, Q8H, PRN nausea and/or vomiting
			Comment: give oral first if able
Patient Care

	Obtain Consent/Permit for:
		T;N, or verify Consent for Chemotherapy
	Hazardous Drug Precautions
		T;N
	IV-Maintain
		T;N
			Comment: ensure 2 means of vascular access
	Notify MD
		Any abnormal baseline vital signs or symptoms of moderate to severe reaction or severe hypersensitivity.
	Initiate MD Plan for:
		T;N, CHEMO Allergy Reaction protocol if patient experiences reaction to treatment.
	Notify MD
		T;N, For additional orders if patient experiences reaction to treatment.
Consults/Follow-up
	Pharmacy Consult
		Pharmacist allowed to round doses to nearest measurable volume (0.1 mL) and/or vial size if dose change is not greater than 5% of original calculated dose.

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, IV Large Volume, IVPB, DAILY, PRN for see comment, 999 ml/hr
			Comment: for reaction to chemotherapy
		1,000 mL, IV Large Volume, IVPB, DAILY, PRN for see comment, 999 ml/hr
			Comment: for reaction to chemotherapy
Medications
	Benadryl
		50 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: Give at first sign of hypersensitivity reaction; symptoms may include: hives, rash, itching, and/or facial flushing.
		25 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: Give at first sign of hypersensitivity reaction; symptoms may include: hives, rash, itching, and/or facial flushing.
	Decadron (MH/WH)
		20 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: Give 1-2 minutes after diphenhydramine if no improvement or if symptoms worsen to include: hypotension, shortness of breath, facial/lip/tongue swelling, and/or any other signs /symptoms of a severe allergic reaction.
	SOLU-Medrol
		125 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: Give if dexamethasone unavailable or ineffective and additional steroids are needed, per provider.
	EPINEPHrine
		0.5 mg, Injection, IM-Intramuscular, DAILY, PRN for see comment
			Comment: Give immediately for airway obstruction/anaphylaxis reaction. Or give for hypersensitivity reaction not resolved by diphenhydramine and steroids. May repeat every 10 minutes for up to 3 doses.
		0.5 mg, Injection, SUBCUTANEOUS, DAILY, PRN for see comment
			Comment: Give immediately for airway obstruction/anaphylaxis reaction. Or give for hypersensitivity reaction not resolved by diphenhydramine and steroids. May repeat every 10 minutes for up to 3 doses.
	meperidine
		25 mg, Syringe, IV Push, Once, PRN for see comment
			Comment: For chills and rigors
	morphine  IV
		2 mg, Syringe, IV PUSH, Once, PRN for see comment
			Comment: For chills and rigors
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