Medical Staff Users: Cytotoxic Orders

Introduction

This is referring to work performed in the main by Radiology/Oncology services for protocol driven chemotherapy, which has then to be aseptically prepared in Pharmacy. Whilst not all of it is protocol driven you would expect that the core of the work would be governed by a protocol of one form or another.

This is a specialist area with many requirements for data collection for national databases to individual patient profiles. How then do we manage to perform this using essentially the same interface as that for in-patient prescriptions. The answer lies in the protocol, in that by the time you come to prescribe all the work has been done,to a greater extent in drawing up the protocol. Another factor here is that the majority of prescribing will be done by senior medical staff as opposed to the in-patient situation where it is mainly the junior staff that would enter the prescription data.

The follwing outlines the core elements in protocol construction. The additional system requirements will detail the schematic further. Outline of Protocol entry.

System Requirements -protocols

  1. The system must cope with both adult & paediatric oncology
  2. The system must have protocol entry facilities
  3. Protocols will be accessible by named field
  4. Access to write options must be password controlled (e.g. Consultant level or Pharmacist -Oncology services)
  5. Access to read options must be password controlled
  6. Access to print options must be password controlled
  7. The system must have the facility to copy protocol for amendment/creation of new ones
  8. There must be a field whereby 'Clinical Trial' can be entered if required.
  9. When selecting drugs there must be a facility to display a pick lists if drugs likely to be user defined by headers (e.g. cytotoxic & immunosuppressant drugs section 8 of BNF or anti-emetics or IV fluids e.t.c.)
  10. For drugs which are reconstituted diluents must be linked to the drug
  11. Drug doses will be entered in the format: 
    		 Day X  	 Drug a  x mg/kg
            			 Drug b  x mg/m2 

		 Day Y
    and so on until protocol complete
  12. The system will calculate doses based on the dose suffix (I.e. either by Wt, IBW or BSA)
  13. There must be a facility to state maximum dose allowed per treatment/cycle/cumulative
  14. There must be a comment section to include biochemical test reminders warnings contact numbers e.t.c.
  15. Hard copies must be available
  16. Protocols must be authorised by a consultant and a pharmacist.
  17. There should be a valid from & valid to.. Field, that defines a protocol in use period.
  18. The system must allow entry of a diagnosis (or facility to download from PMI/EPR)
  19. This must be a searchable field
  20. The system must allow entry of a treatment indication for a given protocol.
  21. There must be the facility to enter a user defined list (ADJUVANT, RADICAL, PALLIATIVE) of indications available.
  22. The indication field must be searchable.
  23. The system must allow entry of a treatment usage for a given protocol.
  24. There must be the facility to enter a user defined list (first line, second line or third line) of usage available.
  25. The usage field must be searchable
  26. There must be a field indicating whether the treatment is confirmed or not

Additional system requirements -prescribing

  1. The prescribing interface must be the same as for inpatients, outpatients' e.t.c.
  2. The prescriber must be able to state the location at which treatment is to be administered (E.g. Out-patients, day hospital on the ward or combination)
  3. There must be a facility to amend this treatment location field as the patient moves through the system
  4. Access to prescribe chemotherapy must be restricted to those clinicians authorised to prescribe such medicines.
  5. Upon selection of a protocol the system will display a list of protocols
  6. Items on this list will be browsable
  7. On selection of a protocol and the start date the doses and dosing schedule will be calculated and displayed for review.
  8. There must be a facility to prescribe the number of cycles to be administered
  9. The system must build a treatment schedule to include proposed no. of cycles.
  10. A scheduler must take account of bank holidays leap years e.t.c. in allotting treatment days
  11. The scheduler must inform the prescriber when bank holidays interven in a therapy schedule
  12. The system will allow treatment to be scheduled for bank holidays
  13. A harsd copy of the schedule will be available grouped for example by patient, protocol, prescriber, indication, ward
  14. The system must allow modification (password controlled) of doses by either direct entry or percentage increments
  15. The system must allow entry of whether a treatment regimen is confirmed or not, this may be ammended upto the time of processing by the Pharmacy
  16. The system should allow tracking of doses being prepared in Pharmacy so as they can be informed when prepared doses are ready
  17. The schedule will flag confirmed and non-confirmed treatment schedules
  18. The Pharmacy must have access to the scheduler as appropriate
  19. There must be a facility to transmit a confirmed order action to Pharmacy
  20. The system must interface with the proposed Pharmacy computer system so that an order can be prepared once confirmation is given
  21. A chemotherapy medication history must be available from the system
  22. The system must be able to cost individual treatments using data from the core Pharmacy system.
  23. The system must have the facility to display schedule of chemotherapy, by patient, prescribing Dr, team.
  24. This schedule should include user defined biochemical parameters to be monitored/entered
  25. The system should have a facility to record 'performance status' as part of the prescription (number from 0 (unwell) to 4 (normal life))
  26. Performance status should be included in the patient medication history.
  27. There should be a facility whereby a consultant can visit a patient in another unit or at home and prescribe at the 'bedside' then upload the data to the live system on return to the unit or via NHSnet.

Please feel free to E-mail me any comments/contributions or questions

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Copyright - Will Willson 1999
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