Unique Plan Description: ONC R-ICE
Plan Selection Display: ONC R-ICE
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2025-01-16 14:48:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-03-10 12:55:38
Available at all facilities: Yes

ONC R-ICE
Vital Signs
	Vital Signs
		T;N
			Comment: Prior to beginning rituximab-abbs infusion, then with each rate change and PRN
Laboratory
	CBC with Diff
		T;N, Stat, spec type = Blood
		T+1;0400, Routine, Q24H, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Stat, spec type = Blood
		T+1;0400, Routine, Q24H, spec type = Blood
	Uric Acid
		T+1;0400, Routine, Q24H
	Urinalysis
		T;N, Stat, Stat, spec type = Urine
	Pregnancy Test Urine
		T;N, Stat, Stat, spec type = Urine
IV Solutions
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><HEAD><META content="text/html; charset=windows-1252" http-equiv=Content-Type><STYLE> BODY margin:0; P margin:0 </STYLE><META name=GENERATOR content="MSHTML 11.00.10570.1001(NOTE)*
	Sodium Chloride 0.9%
		250 mL, IV, T;N+30, 4 Day(s), 25 ml/hr
			Comment: use as primary/flush with rituximab-abbs, and etoposide/Ifosfamide/Carboplatin
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		1,000 mL, IV, T+1;1200
			Comment: Start 2 hours pre Ifosfamide and continue 2 hours post Ifosfamide
	mesna/NS 500 mL
		5,000 mg/m2, IVPB, Once, T+1;1400, Infuse Over 24 hr
		50 mL, EVERY BAG
		500 mL, EVERY BAG
		120 mg/m2, IVPB, Once, Infuse Over 10 min(s)
		10 mL, EVERY BAG
		100 mL, EVERY BAG
Medications
	filgrastim
		5 mcg/kg, SUBCUTANEOUS, DAILY, T+5;1200
			Comment: start on day 6; round to 300 mcg or 480 mcg vial
	ondansetron
		8 mg, Tablet-Disintegrating, By Mouth, Q8H, PRN nausea and/or vomiting
			Comment: Use if not relieved by prochlorperazine (if ordered)
		8 mg, Injection, IV Push, Q8H, PRN nausea and/or vomiting
			Comment: Use if not relieved by prochlorperazine (if ordered)
	prochlorperazine
		10 mg, Tab, By Mouth, Q8H, PRN nausea and/or vomiting
		10 mg, Injection, IV Push, Q8H, PRN nausea and/or vomiting
Premeds
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	acetaminophen
		1,000 mg, Tab, By Mouth, Once, T;N+30
			Comment: give 30 minutes prior to rituximab-abbs
		650 mg, Tab, By Mouth, Once, T;N+30
			Comment: give 30 minutes prior to rituximab-abbs
	diphenhydrAMINE
		50 mg, Injection, IV Push, Once, T;N+30,
		25 mg, Injection, IV Push, Once, T;N+30,
	ondansetron
		8 mg, Injection, IV Push, Once, T;N+240
			Comment: Day 1 ,30 minutes prior to chemotherapy
	dexAMETHasone
		8 mg, Injection, IV Push, Once, T;N +240
			Comment: Day 1 ,30 minutes prior to chemotherapy
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	dexamethasone Injectable
		12 mg, Injection, IV Push, Once, T+1;1200
			Comment: Day 2 30 min prior to chemotherapy
	palonosetron
		0.25 mg, Injection, IVPB, Once, T+1;1200
			Comment: give on day 2, 30 minutes prior to chemotherapy
	fosaprepitant
		150 mg, INT, IVPB, Once, T+1;1200
			Comment: Day 2, infuse over 30 min(s), give on day 2, 30 minutes prior to chemotherapy
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	dexamethasone Injectable
		8 mg, Injection, IV Push, Once, T+2;1400
			Comment: Day 3, 30 min prior to Etoposide
Chemotherapy Agent
	riTUXimab-abbs/NS 500mL
		500 mL, IV, T;N+60, 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
	CARBOplatin/NS 250 mL
		5 AUC(Carboplatin), IVPB, Once, T+1;1330, Infuse Over 30 min(s)
			Comment: Day 2
		25 mL, EVERY BAG
		250 mL, EVERY BAG
	etoposide/NS 500 mL
		100 mg/m2, IVPB, Q24H, T;N+270, 3 Dose(s)/Time(s), Infuse Over 60 min(s)
			Comment: Days 1-3
		50 mL, EVERY BAG
		500 mL, EVERY BAG
	ifosfamide/NS 1000mL
		5,000 mg/m2, IVPB, Once, T+1;1400, Infuse Over 24 hr
			Comment: Day 2
		40 mL, EVERY BAG
		1,000 mL, EVERY BAG
Patient Care

	Obtain Consent/Permit for:
		T;N, or verify Consent for Chemotherapy
	Hazardous Drug Precautions
		T;N
	IV-Maintain
		T;N
			Comment: insure 2 means of vascular access
	Oral Care
		BID
			Comment: Strict oral care
	Notify MD
		T;N, Any abnormal baseline vital signs or Symptoms of moderate to severe reaction or severe hypersensitivity.
		T;N, Contact Provider for further orders if allergic reaction protocol initiated.
	Initiate MD Plan for:
		T;N, Chemo Reaction protocol if patient experiences reaction to treatment

*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