Unique Plan Description: ONC immune Effector Cell CRS Management
Plan Selection Display: ONC immune Effector Cell CRS Management
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2024-03-18 15:46:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-07-16 12:31:38
Available at all facilities: No

ONC immune Effector Cell CRS Management
Admit/Discharge/Transfer
	Admit to Critical Care Inpatient Status (MH)
		T;N, Anticipated LOS 2 midnight or more, Consult Intensivist: Pulmonary Medicine Specialist
			Comment: If hypotension persists after IVF, tocilizumab, and dexamethasone
Activity
	Up with Assistance
		
Laboratory
	UA (Culture if Positive)
		T;N, Stat, Stat, spec type = Urine
Diagnostic Tests
	Chest 1 View
		Routine, Fever
	Echo
		Stat
			Comment: If hypotension persists after IV fluids, tocilizumab, and dexamethasone
	EKG (ECG)
		T;N, Routine
IV Solutions
Grade 1
	Sodium Chloride 0.9%
		1,000 mL, IV, 1 Dose(s)/Time(s), 100 ml/hr
			Comment: Grade 1:
		1,000 mL, IV, T;N+600, 125 ml/hr
			Comment: Grade 1:
Grade 2
	Sodium Chloride 0.9%
		1,000 mL, IV, 1 Dose(s)/Time(s), 999 ml/hr
			Comment: Grade 2:
		1,000 mL, IV, T;N+600, 125 ml/hr
			Comment: Grade 2:
	vasopressin 10units/NS 50mL
		50 mL, IV, STAT, Duration: 4 hr, Increment Increase: 0.01 unit/min, Increment Decrease: 0.01 unit/min, Increment Freq: 30 min(s), Max Dose: 0.1 unit/min
			Comment: Grade 2:If the dose has been titrated twice within the specified timeframe and goal parameter is not achieved, the titration dose can be doubled until the ordered parameter is achieved or maximum dose is reached.  IV may be re-initiated after weaning within 12hours, re-initiate at the last dosing rate that maintained Goal parameter. Discontinue order after 12hr if patient does not require IV re-initiation.
		10 units, EVERY BAG, 0.01 unit/min
Medications
Grade 1
	acetaminophen
		1,000 mg, Tab, By Mouth, Q6H, PRN for fever
			Comment: Grade 1: as needed for fever; do not exceed 4000mg/24hr
	ibuprofen
		800 mg, Tab, By Mouth, Q8H, PRN for fever
			Comment: Grade 1: as needed for fever.  Use as second line after Acetaminophen.  Avoid if thrombocytopenia or renal dysfunction
	vancomycin - Pharmacy to Dose
		Pharmacy to Dose, IVPB, PHARMACY TO DETERMINE
			Comment: Grade 1:
	cefepime
		2,000 mg, Injection-Premix, IVPB, Q8H
			Comment: Grade 1:
	filgrastim
		10 mcg/kg, Solution, SUBCUTANEOUS, Q24H
			Comment: Grade 1: Dose is rounded to the nearest vial size
	tocilizumab
		8 mg/kg, INT, IVPB, Once
			Comment: Grade 1: Dose to not exceed 800mg.  For persistent fever lasting greater than 3 days
	levETIRAcetam
		500 mg, Tab, By Mouth, BID
			Comment: Grade 1: If not already on seizure prophylaxis
Grade 2
	dexamethasone IVPB
		12 mg, INT, IVPB, Once, T;N, duration: 1 Dose(s)/Time(s)
			Comment: Grade 2:
	dexAMETHasone
		4 mg, Tab, By Mouth, Once
			Comment: Grade 2:
Patient Care

	Cooling Blanket
		T;N, fever
	Cardiac Telemetry Monitoring
		Telemetry Indications: Other
Therapies
	Consult Speech Language (MH), Evaluate and Treat
		T;N
			Comment: Immune Effector Cell Therapy patient Evaluate within 24 hrs, MBS if appropriate. Order diet as recommends Methodist Speech Therapy; call 402-354-4461 and leave message for consult.

Oxygen Protocol
Respiratory Therapy
	Oxygen Therapy
		T;N
	Pulse Oximetry Spot Check RT
		T;N, BID
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID

Blood Culture Set
Laboratory

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	.Blood Culture.
		T;N, Stat, spec type = Blood
		T;N, Routine, spec type = Blood
		Timed, spec type = Blood
		T+1;0400, Routine, spec type = Blood
	.Blood Culture
		T;N, Stat, spec type = Blood
		T;N, Routine, spec type = Blood
		Timed, spec type = Blood
		T+1;0400, Routine, spec type = Blood

*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