Unique Plan Description: ONC mFOLFOX6
Plan Selection Display: ONC mFOLFOX6
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2024-06-17 08:57:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-06-17 08:57:00
Available at all facilities: Yes

ONC mFOLFOX6
Laboratory
	CBC with Diff
		T;N, Stat, spec type = Blood
		T;N, Routine, Q24H, spec type = Blood
	Comprehensive Metabolic Panel
		T+1;0400, Routine, Q24H, spec type = Blood
		T;N, Stat, spec type = Blood
	Pregnancy Test Urine
		T;N, Routine, Routine, Urine Random, spec type = Urine
IV Solutions
	Dextrose 5% in Water
		250 mL, IV, Routine, T;N, 1 Dose(s)/Time(s), 25 ml/hr
			Comment: Use as primary flush with oxaliplatin and fluorouracil
Premeds
	ondansetron/dexamethasone/NS 50mL
		16 mg, IVPB, Once, Routine, infuse over 15 min(s), 200 ml/hr, T;N+120
			Comment: 30 min prior to chemotherapy
		20 mg, EVERY BAG
		50 mL, EVERY BAG
	fosaprepitant
		150 mg, INT, IVPB, Once, infuse over 30 min(s), T;N+60
			Comment: Infuse over 30 min(s), give on day 1, 30 minutes prior to chemotherapy
Chemotherapy Agent
	oxaliplatin/D5W 500mL
		85 mg/m2, IVPB, Once, T;N+120, Infuse Over 2 hr
			Comment: Give on day 1, run concurrently with leucovorin
		50 mL, EVERY BAG
		500 mL, EVERY BAG
	leucovorin
		400 mg/m2, INT, IVPB, Once, infuse over 2 hr, T;N+120
			Comment: Give on day 1 with oxaliplatin
	fluorouracil
		400 mg/m2, Injection, IV Push, Once, T;N+240
			Comment: Day 1 after Leucovorin is complete. Do not give with Leucovorin.
	Fluorouracil/D5W 1000 mL
		1,000 mL, T;N+240, 2 Dose(s)/Time(s), 23 hr
			Comment: Days 1 and 2, start after Fluorouracil IV push is completed. Total dose is 2400 mg/m2 infused over 46 hours
		40 mL, EVERY BAG
		1,200 mg/m2, EVERY BAG
Medications

	dexAMETHasone
		8 mg, Tab, By Mouth, DAILY, T;N+1, duration: 2 Dose(s)/Time(s)
			Comment: Give on days 2 and 3
	ondansetron
		8 mg, Tablet-Disintegrating, By Mouth, Q8H, PRN nausea and/or vomiting
			Comment: For nausea/vomiting not relieved by prochlorperazine
		8 mg, Injection, IV Push, Q8H, PRN nausea and/or vomiting
			Comment: For nausea/vomiting not relieved by prochlorperazine and patient unable to tolerate oral
	prochlorperazine
		10 mg, Tab, By Mouth, Q6H, PRN nausea and/or vomiting
		10 mg, Injection, IV Push, Q6H, PRN nausea and/or vomiting
			Comment: If patient unable to take PO
Patient Care
	Neurological Assessment-Focused
		Q4H-Sch
			Comment: Baseline and through day 5
	Notify MD
		Any abnormal baseline vital signs or Symptoms of moderate to severe reaction or severe hypersensitivity.
	Obtain Consent/Permit for:
		T;N, Chemotherapy
	Hazardous Drug Precautions
		T;N
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 .
	Consult Care Management
		Education
			Comment: Please arrange for neulasta administration at discharge if discharging after chemotherapy infusions are completed.

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, Solution-Injection, IVPB, DAILY, PRN see comment, 999 ml/hr
			Comment: for reaction to chemotherapy
		1,000 mL, Solution-Injection, IVPB, DAILY, PRN see comment, 999 ml/hr
			Comment: for reaction to chemotherapy
Medications
	Benadryl
		50 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: for moderate to severe reaction to chemotherapy
		25 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: for moderate to severe reaction to chemotherapy
	Decadron (MH/WH)
		20 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: for moderate to severe reaction to chemotherapy, 1st choice steroid
	SOLU-Medrol
		125 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: for moderate to severe reaction to chemotherapy, 2nd choice steroid
	Solu-CORTEF
		100 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: for moderate to severe reaction to chemotherapy, 3rd choice steroid
	EPINEPHrine
		0.5 mg, Injection, SUBCUTANEOUS, DAILY, PRN see comment
			Comment: for hypersensitivity reaction not resolved by diphenhydramine and/or anaphylactic				reactions to chemotherapy, may repeat every 10 minutes for up to 3 doses
		0.5 mg, Injection, IM-Intramuscular, DAILY, PRN see comment
			Comment: for hypersensitivity reaction not resolved by diphenhydramine and/or anaphylactic				reactions to chemotherapy, 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
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