Unique Plan Description: ONC Rituximab-abbs
Plan Selection Display: ONC Rituximab-abbs
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2021-11-01 09:48:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-04-18 12:20:47
Available at all facilities: Yes

ONC Rituximab-abbs
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;N, Routine, spec type = Blood
	Basic Metabolic Panel
		T+1;0400, Routine, Q24H, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Stat, spec type = Blood
	Hepatitis B Surface Antigen
		T;N, Stat, spec type = Blood
	Pregnancy Test Urine
		T;N, Stat, Stat, spec type = Urine
IV Solutions
Chemotherapy Agent
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	riTUXimab-abbs/NS 500mL
		500 mL, IV, Routine, 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, 50 mg/hr
	Sodium Chloride 0.9%
		1,000 mL, IV, Routine, T;N+30, 1 Dose(s)/Time(s), 20 ml/hr
			Comment: Use as flush or carrier fluid for rituximab
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	riTUXimab-abbs/NS 500mL
		500 mL, IV, Routine, T;N+60, 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, 50 mg/hr
	Sodium Chloride 0.9%
		1,000 mL, IV, Routine, T;N+30, 1 Dose(s)/Time(s), 20 ml/hr
			Comment: Use as flush or carrier fluid for rituximab
Medications

Premeds
	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
			Comment: give 30 minutes prior to rituximab-abbs
	diphenhydrAMINE
		50 mg, Injection, IV Push, Once, T;N+30
			Comment: give 30 minutes prior to rituximab-abbs
		25 mg, Injection, IV Push, Once, T;N+30
			Comment: give 30 minutes prior to rituximab-abbs
Patient Care

	Obtain Consent/Permit for:
		T;N, Obtain or verify consent for chemotherapy
	IV-Maintain
		T;N
			Comment: insure 2 vascular access devices
	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, Allergy Reaction protocol if patient experiences reaction to treatment.

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