/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/beacon-protocols/,/clinical/cckm-tools/content/beacon-protocols/hem---myeloma/,

/clinical/cckm-tools/content/beacon-protocols/hem---myeloma/name-96921-en.cckm

201710282

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Beacon Protocols,Hem - Myeloma

CSC HEM Bendamustine(28D:1,4) Bortezomib(28D:1,4,8,11) Dexamethasone(28D:1,4,8,11) VER 10-9-17 (HL 5600)

CSC HEM Bendamustine(28D:1,4) Bortezomib(28D:1,4,8,11) Dexamethasone(28D:1,4,8,11) VER 10-9-17 (HL 5600) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Hem - Myeloma


CSC HEM BENDAMUSTINE (28D:1,4)/BORTEZOMIB(28D:1,4,8,11)/DEXAMETHASONE(28D:1,4,8,11) VER: 10-09-
17 –  Properties
Pre-Cycle –  10/2/2017 through 10/8/2017 (7 days), Planned
Day 1, Pre-Cycle –  Planned for 10/2/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
Consent
Verify Consent
Verify informed consent has been obtained.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S Approximate, Expires: S+397, Routine
GLUCOSE
Expected: S Approximate, Expires: S+397, Routine
BUN
Expected: S Approximate, Expires: S+397, Routine
CREATININE
Expected: S Approximate, Expires: S+397, Routine
CALCIUM
Expected: S Approximate, Expires: S+397, Routine
BILIRUBIN, TOTAL
Expected: S Approximate, Expires: S+397, Routine
AST/SGOT
Expected: S Approximate, Expires: S+397, Routine
ALT/SGPT
Expected: S Approximate, Expires: S+397, Routine
ALKALINE PHOSPHATASE
Expected: S Approximate, Expires: S+397, Routine
Take Home Medications
ondansetron (ZOFRAN) 8 MG tab
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 1 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

Take 1 tab by mouth every 8 hours as needed for nausea/vomiting., 8 mg, Disp-30 tab, R-5, EVERY 8 HOURS PRN
starting S, Local Printer
acyclovir (ZOVIRAX) 400 MG tab
Take 1 tab by mouth 2 times daily. Take continuously., 400 mg, Disp-60 tab, R-11, 2 X DAILY starting S, Local Printer
sulfamethoxazole-trimethoprim (BACTRIM DS) 800-160 MG per tab
Take 1 tablet by mouth twice daily on Saturday and Sunday., Disp-16 tab, R-5, starting S
famotidine (PEPCID) 20 MG tab
Take 1 tab by mouth 2 times daily., 20 mg, Disp-60 tab, R-5, 2 X DAILY starting S, Local Printer
Take Home Medications (delete all that do not apply)
TBO-filgrastim (GRANIX) 300 MCG/0.5ML soln prefilled syringe
Inject 300 mcg under skin one time daily in evening. Begin Day ***. Continue until ANC is greater than *** after
nadir., 300 mcg, Disp-10 Syringe, R-0, 1 X DAILY (PM) starting S, Local Printer
RPh may substitute filgrastim at an equivalent dose and qty based on insurance coverage.
TBO-filgrastim (GRANIX) 480 MCG/0.8ML soln prefilled syringe
Inject 480 mcg under skin one time daily in evening. Begin Day ***. Continue until ANC is greater than *** after
nadir., 480 mcg, Disp-10 Syringe, R-0, 1 X DAILY (PM) starting S, Local Printer
RPh may substitute filgrastim at an equivalent dose and qty based on insurance coverage.
Cycle 1 –  10/9/2017 through 11/5/2017 (28 days), Planned
Day 1, Cycle 1 –  Planned for 10/9/2017
Treatment Plan Information
Reference Information (1)
MULTIPLE MYELOMA: Ludwig H, et al. Blood 2014;123(7):985-91.
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC, Creatinine, AST, ALT and Total Bilirubin.
This medication will not be e-prescribed. If patient is present, script will go to printer. Otherwise,
script will go to nursing or tech pool.   Invalid items: Pharmacy   Details...
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 2 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or
equal to 50K/µL or Creatinine Clearance less than or equal to 40 mL/min or AST greater than 2.5 X ULN
or ALT greater than 2.5 X ULN or Total Bilirubin greater than 1.5 X ULN.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to bendamustine can occur.  For first and second dose, patient should be treated in a location
to optimize emergency care. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
Should be administered IV push over at least 2 minutes.
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bendamustine (BENDEKA) 70 mg/m2 in sodium chloride 0.9 % 50 mL bag
70 mg/m2, Intravenous, ONCE, 1 dose Starting when released
Administer over 10 minutes. Hypersensitivity reaction to bendamustine can occur. For first and second dose, patient
should be treated in a location to optimize emergency care. See emergency medications.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 3 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
DAY 4 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: bortezomib and bendamustine for 60 minutes.
DAY 8 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: bortezomib for 30 minutes.
DAY 11 FOLLOW-UP
LABS: CBC, ANC (DIFF if to be done locally); CHEMOTHERAPY ROOM APPOINTMENT: bortezomib for 30 minutes.
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if to be done locally),
Electrolytes, Glucose, Calcium, BUN, Creatinine, Total Bilirubin, AST, ALT and Alkaline Phosphatase; CHEMOTHERAPY
ROOM APPOINTMENT: bendamustine and bortezomib for 60 minutes.
Day 4, Cycle 1 –  Planned for 10/12/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to bendamustine can occur.  For first and second dose, patient should be treated in a location
to optimize emergency care. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 4 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
Should be administered IV push over at least 2 minutes.
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bendamustine (BENDEKA) 70 mg/m2 in sodium chloride 0.9 % 50 mL bag
70 mg/m2, Intravenous, ONCE, 1 dose Starting when released
Administer over 10 minutes. Hypersensitivity reaction to bendamustine can occur. For first and second dose, patient
should be treated in a location to optimize emergency care. See emergency medications.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 8, Cycle 1 –  Planned for 10/16/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 5 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

Nursing Procedure, Assessment and Monitoring
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 11, Cycle 1 –  Planned for 10/19/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S+3 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+3 Approximate, Expires: S+365, Routine
Nursing Procedure, Assessment and Monitoring
Flush Venous Access Device per Guidelines
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 6 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 2 –  11/6/2017 through 12/3/2017 (28 days), Planned
Day 1, Cycle 2 –  Planned for 11/6/2017
Treatment Plan Information
Reference Information (1)
MULTIPLE MYELOMA: Ludwig H, et al. Blood 2014;123(7):985-91.
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S+18 Approximate, Expires: S+365, Routine
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 7 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

ABSOLUTE NEUTROPHIL COUNT
Expected: S+18 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+18 Approximate, Expires: S+397, Routine
GLUCOSE
Expected: S+18 Approximate, Expires: S+397, Routine
BUN
Expected: S+18 Approximate, Expires: S+397, Routine
CREATININE
Expected: S+18 Approximate, Expires: S+397, Routine
CALCIUM
Expected: S+18 Approximate, Expires: S+397, Routine
BILIRUBIN, TOTAL
Expected: S+18 Approximate, Expires: S+397, Routine
AST/SGOT
Expected: S+18 Approximate, Expires: S+397, Routine
ALT/SGPT
Expected: S+18 Approximate, Expires: S+397, Routine
ALKALINE PHOSPHATASE
Expected: S+18 Approximate, Expires: S+397, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC, Creatinine, AST, ALT and Total Bilirubin.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 50K/µL
or Creatinine Clearance less than or equal to 40 mL/min or AST greater than 2.5 X ULN or ALT greater than 2.5 X ULN or
Total Bilirubin greater than 1.5 X ULN.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to bendamustine can occur.  For first and second dose, patient should be treated in a location
to optimize emergency care. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 8 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
Should be administered IV push over at least 2 minutes.
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bendamustine (BENDEKA) 70 mg/m2 in sodium chloride 0.9 % 50 mL bag
70 mg/m2, Intravenous, ONCE, 1 dose Starting when released
Administer over 10 minutes. Hypersensitivity reaction to bendamustine can occur. For first and second dose, patient
should be treated in a location to optimize emergency care. See emergency medications.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
DAY 4 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: bortezomib and bendamustine for 60 minutes.
DAY 8 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: bortezomib for 30 minutes.
DAY 11 FOLLOW-UP
LABS: CBC, ANC (DIFF if to be done locally); CHEMOTHERAPY ROOM APPOINTMENT: bortezomib for 30 minutes.
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if to be done locally),
Electrolytes, Glucose, Calcium, BUN, Creatinine, Total Bilirubin, AST, ALT and Alkaline Phosphatase; CHEMOTHERAPY
ROOM APPOINTMENT: bendamustine and bortezomib for 60 minutes.
Day 4, Cycle 2 –  Planned for 11/9/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 9 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to bendamustine can occur.  For first and second dose, patient should be treated in a location
to optimize emergency care. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
Should be administered IV push over at least 2 minutes.
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 10 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bendamustine (BENDEKA) 70 mg/m2 in sodium chloride 0.9 % 50 mL bag
70 mg/m2, Intravenous, ONCE, 1 dose Starting when released
Administer over 10 minutes. Hypersensitivity reaction to bendamustine can occur. For first and second dose, patient
should be treated in a location to optimize emergency care. See emergency medications.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 8, Cycle 2 –  Planned for 11/13/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 11 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 11, Cycle 2 –  Planned for 11/16/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S+3 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+3 Approximate, Expires: S+365, Routine
Nursing Procedure, Assessment and Monitoring
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 12 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

Cycle 3 –  12/4/2017 through 12/31/2017 (28 days), Planned
Day 1, Cycle 3 –  Planned for 12/4/2017
Treatment Plan Information
Reference Information (1)
MULTIPLE MYELOMA: Ludwig H, et al. Blood 2014;123(7):985-91.
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S+18 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+18 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+18 Approximate, Expires: S+397, Routine
GLUCOSE
Expected: S+18 Approximate, Expires: S+397, Routine
BUN
Expected: S+18 Approximate, Expires: S+397, Routine
CREATININE
Expected: S+18 Approximate, Expires: S+397, Routine
CALCIUM
Expected: S+18 Approximate, Expires: S+397, Routine
BILIRUBIN, TOTAL
Expected: S+18 Approximate, Expires: S+397, Routine
AST/SGOT
Expected: S+18 Approximate, Expires: S+397, Routine
ALT/SGPT
Expected: S+18 Approximate, Expires: S+397, Routine
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 13 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

ALKALINE PHOSPHATASE
Expected: S+18 Approximate, Expires: S+397, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC, Creatinine, AST, ALT and Total Bilirubin.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 50K/µL
or Creatinine Clearance less than or equal to 40 mL/min or AST greater than 2.5 X ULN or ALT greater than 2.5 X ULN or
Total Bilirubin greater than 1.5 X ULN.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to bendamustine can occur.  For first and second dose, patient should be treated in a location
to optimize emergency care. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
Should be administered IV push over at least 2 minutes.
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 14 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bendamustine (BENDEKA) 70 mg/m2 in sodium chloride 0.9 % 50 mL bag
70 mg/m2, Intravenous, ONCE, 1 dose Starting when released
Administer over 10 minutes. Hypersensitivity reaction to bendamustine can occur. For first and second dose, patient
should be treated in a location to optimize emergency care. See emergency medications.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
DAY 4 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: bortezomib and bendamustine for 60 minutes.
DAY 8 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: bortezomib for 30 minutes.
DAY 11 FOLLOW-UP
LABS: CBC, ANC (DIFF if to be done locally); CHEMOTHERAPY ROOM APPOINTMENT: bortezomib for 30 minutes.
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if to be done locally),
Electrolytes, Glucose, Calcium, BUN, Creatinine, Total Bilirubin, AST, ALT and Alkaline Phosphatase; CHEMOTHERAPY
ROOM APPOINTMENT: bendamustine and bortezomib for 60 minutes.
Day 4, Cycle 3 –  Planned for 12/7/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to bendamustine can occur.  For first and second dose, patient should be treated in a location
to optimize emergency care. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 15 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
Should be administered IV push over at least 2 minutes.
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bendamustine (BENDEKA) 70 mg/m2 in sodium chloride 0.9 % 50 mL bag
70 mg/m2, Intravenous, ONCE, 1 dose Starting when released
Administer over 10 minutes. Hypersensitivity reaction to bendamustine can occur. For first and second dose, patient
should be treated in a location to optimize emergency care. See emergency medications.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 8, Cycle 3 –  Planned for 12/11/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 16 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 11, Cycle 3 –  Planned for 12/14/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S+3 Approximate, Expires: S+365, Routine
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 17 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

ABSOLUTE NEUTROPHIL COUNT
Expected: S+3 Approximate, Expires: S+365, Routine
Nursing Procedure, Assessment and Monitoring
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 4 –  1/1/2018 through 1/28/2018 (28 days), Planned
Day 1, Cycle 4 –  Planned for 1/1/2018
Treatment Plan Information
Reference Information (1)
MULTIPLE MYELOMA: Ludwig H, et al. Blood 2014;123(7):985-91.
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 18 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S+18 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+18 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+18 Approximate, Expires: S+397, Routine
GLUCOSE
Expected: S+18 Approximate, Expires: S+397, Routine
BUN
Expected: S+18 Approximate, Expires: S+397, Routine
CREATININE
Expected: S+18 Approximate, Expires: S+397, Routine
CALCIUM
Expected: S+18 Approximate, Expires: S+397, Routine
BILIRUBIN, TOTAL
Expected: S+18 Approximate, Expires: S+397, Routine
AST/SGOT
Expected: S+18 Approximate, Expires: S+397, Routine
ALT/SGPT
Expected: S+18 Approximate, Expires: S+397, Routine
ALKALINE PHOSPHATASE
Expected: S+18 Approximate, Expires: S+397, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC, Creatinine, AST, ALT and Total Bilirubin.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 50K/µL
or Creatinine Clearance less than or equal to 40 mL/min or AST greater than 2.5 X ULN or ALT greater than 2.5 X ULN or
Total Bilirubin greater than 1.5 X ULN.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to bendamustine can occur.  For first and second dose, patient should be treated in a location
to optimize emergency care. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 19 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
Should be administered IV push over at least 2 minutes.
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bendamustine (BENDEKA) 70 mg/m2 in sodium chloride 0.9 % 50 mL bag
70 mg/m2, Intravenous, ONCE, 1 dose Starting when released
Administer over 10 minutes. Hypersensitivity reaction to bendamustine can occur. For first and second dose, patient
should be treated in a location to optimize emergency care. See emergency medications.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
DAY 4 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: bortezomib and bendamustine for 60 minutes.
DAY 8 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: bortezomib for 30 minutes.
DAY 11 FOLLOW-UP
LABS: CBC, ANC (DIFF if to be done locally); CHEMOTHERAPY ROOM APPOINTMENT: bortezomib for 30 minutes.
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if to be done locally),
Electrolytes, Glucose, Calcium, BUN, Creatinine, Total Bilirubin, AST, ALT and Alkaline Phosphatase; CHEMOTHERAPY
ROOM APPOINTMENT: bendamustine and bortezomib for 60 minutes.
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 20 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

Day 4, Cycle 4 –  Planned for 1/4/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to bendamustine can occur.  For first and second dose, patient should be treated in a location
to optimize emergency care. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 21 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
Should be administered IV push over at least 2 minutes.
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bendamustine (BENDEKA) 70 mg/m2 in sodium chloride 0.9 % 50 mL bag
70 mg/m2, Intravenous, ONCE, 1 dose Starting when released
Administer over 10 minutes. Hypersensitivity reaction to bendamustine can occur. For first and second dose, patient
should be treated in a location to optimize emergency care. See emergency medications.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 8, Cycle 4 –  Planned for 1/8/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 22 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 11, Cycle 4 –  Planned for 1/11/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S+3 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+3 Approximate, Expires: S+365, Routine
Nursing Procedure, Assessment and Monitoring
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 23 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 5 –  1/29/2018 through 2/25/2018 (28 days), Planned
Day 1, Cycle 5 –  Planned for 1/29/2018
Treatment Plan Information
Reference Information (1)
MULTIPLE MYELOMA: Ludwig H, et al. Blood 2014;123(7):985-91.
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S+18 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+18 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+18 Approximate, Expires: S+397, Routine
GLUCOSE
Expected: S+18 Approximate, Expires: S+397, Routine
BUN
Expected: S+18 Approximate, Expires: S+397, Routine
CREATININE
Expected: S+18 Approximate, Expires: S+397, Routine
CALCIUM
Expected: S+18 Approximate, Expires: S+397, Routine
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 24 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

BILIRUBIN, TOTAL
Expected: S+18 Approximate, Expires: S+397, Routine
AST/SGOT
Expected: S+18 Approximate, Expires: S+397, Routine
ALT/SGPT
Expected: S+18 Approximate, Expires: S+397, Routine
ALKALINE PHOSPHATASE
Expected: S+18 Approximate, Expires: S+397, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC, Creatinine, AST, ALT and Total Bilirubin.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 50K/µL
or Creatinine Clearance less than or equal to 40 mL/min or AST greater than 2.5 X ULN or ALT greater than 2.5 X ULN or
Total Bilirubin greater than 1.5 X ULN.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to bendamustine can occur.  For first and second dose, patient should be treated in a location
to optimize emergency care. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 25 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
Should be administered IV push over at least 2 minutes.
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bendamustine (BENDEKA) 70 mg/m2 in sodium chloride 0.9 % 50 mL bag
70 mg/m2, Intravenous, ONCE, 1 dose Starting when released
Administer over 10 minutes. Hypersensitivity reaction to bendamustine can occur. For first and second dose, patient
should be treated in a location to optimize emergency care. See emergency medications.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
DAY 4 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: bortezomib and bendamustine for 60 minutes.
DAY 8 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: bortezomib for 30 minutes.
DAY 11 FOLLOW-UP
LABS: CBC, ANC (DIFF if to be done locally); CHEMOTHERAPY ROOM APPOINTMENT: bortezomib for 30 minutes.
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if to be done locally),
Electrolytes, Glucose, Calcium, BUN, Creatinine, Total Bilirubin, AST, ALT and Alkaline Phosphatase; CHEMOTHERAPY
ROOM APPOINTMENT: bendamustine and bortezomib for 60 minutes.
Day 4, Cycle 5 –  Planned for 2/1/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to bendamustine can occur.  For first and second dose, patient should be treated in a location
to optimize emergency care. See Emergency Medications.
Flush Venous Access Device per Guidelines
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 26 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
Should be administered IV push over at least 2 minutes.
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bendamustine (BENDEKA) 70 mg/m2 in sodium chloride 0.9 % 50 mL bag
70 mg/m2, Intravenous, ONCE, 1 dose Starting when released
Administer over 10 minutes. Hypersensitivity reaction to bendamustine can occur. For first and second dose, patient
should be treated in a location to optimize emergency care. See emergency medications.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 8, Cycle 5 –  Planned for 2/5/2018
Treatment Plan Information
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 27 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4,
bortezomib 1.3 mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on
Days 1, 4, 8, and 11; CYCLE LENGTH: 28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 11, Cycle 5 –  Planned for 2/8/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
IV Access
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 28 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S+3 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+3 Approximate, Expires: S+365, Routine
Nursing Procedure, Assessment and Monitoring
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 6 –  2/26/2018 through 3/25/2018 (28 days), Planned
Day 1, Cycle 6 –  Planned for 2/26/2018
Treatment Plan Information
Reference Information (1)
MULTIPLE MYELOMA: Ludwig H, et al. Blood 2014;123(7):985-91.
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 29 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S+18 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+18 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+18 Approximate, Expires: S+397, Routine
GLUCOSE
Expected: S+18 Approximate, Expires: S+397, Routine
BUN
Expected: S+18 Approximate, Expires: S+397, Routine
CREATININE
Expected: S+18 Approximate, Expires: S+397, Routine
CALCIUM
Expected: S+18 Approximate, Expires: S+397, Routine
BILIRUBIN, TOTAL
Expected: S+18 Approximate, Expires: S+397, Routine
AST/SGOT
Expected: S+18 Approximate, Expires: S+397, Routine
ALT/SGPT
Expected: S+18 Approximate, Expires: S+397, Routine
ALKALINE PHOSPHATASE
Expected: S+18 Approximate, Expires: S+397, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC, Creatinine, AST, ALT and Total Bilirubin.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 50K/µL
or Creatinine Clearance less than or equal to 40 mL/min or AST greater than 2.5 X ULN or ALT greater than 2.5 X ULN or
Total Bilirubin greater than 1.5 X ULN.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to bendamustine can occur.  For first and second dose, patient should be treated in a location
to optimize emergency care. See Emergency Medications.
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 30 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
Should be administered IV push over at least 2 minutes.
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bendamustine (BENDEKA) 70 mg/m2 in sodium chloride 0.9 % 50 mL bag
70 mg/m2, Intravenous, ONCE, 1 dose Starting when released
Administer over 10 minutes. Hypersensitivity reaction to bendamustine can occur. For first and second dose, patient
should be treated in a location to optimize emergency care. See emergency medications.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
DAY 4 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: bortezomib and bendamustine for 60 minutes.
DAY 8 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: bortezomib for 30 minutes.
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 31 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

DAY 11 FOLLOW-UP
LABS: CBC, ANC (DIFF if to be done locally); CHEMOTHERAPY ROOM APPOINTMENT: bortezomib for
30 minutes.
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if to be done locally),
Electrolytes, Glucose, Calcium, BUN, Creatinine, Total Bilirubin, AST, ALT and Alkaline Phosphatase; CHEMOTHERAPY
ROOM APPOINTMENT: bendamustine and bortezomib for 60 minutes.
Day 4, Cycle 6 –  Planned for 3/1/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to bendamustine can occur.  For first and second dose, patient should be treated in a location
to optimize emergency care. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 32 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
Should be administered IV push over at least 2 minutes.
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bendamustine (BENDEKA) 70 mg/m2 in sodium chloride 0.9 % 50 mL bag
70 mg/m2, Intravenous, ONCE, 1 dose Starting when released
Administer over 10 minutes. Hypersensitivity reaction to bendamustine can occur. For first and second dose, patient
should be treated in a location to optimize emergency care. See emergency medications.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 8, Cycle 6 –  Planned for 3/5/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 33 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 11, Cycle 6 –  Planned for 3/8/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S+3 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+3 Approximate, Expires: S+365, Routine
Nursing Procedure, Assessment and Monitoring
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 34 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 7 –  3/26/2018 through 4/22/2018 (28 days), Planned
Day 1, Cycle 7 –  Planned for 3/26/2018
Treatment Plan Information
Reference Information (1)
MULTIPLE MYELOMA: Ludwig H, et al. Blood 2014;123(7):985-91.
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S+18 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+18 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+18 Approximate, Expires: S+397, Routine
GLUCOSE
Expected: S+18 Approximate, Expires: S+397, Routine
BUN
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 35 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

Expected: S+18 Approximate, Expires: S+397, Routine
CREATININE
Expected: S+18 Approximate, Expires: S+397, Routine
CALCIUM
Expected: S+18 Approximate, Expires: S+397, Routine
BILIRUBIN, TOTAL
Expected: S+18 Approximate, Expires: S+397, Routine
AST/SGOT
Expected: S+18 Approximate, Expires: S+397, Routine
ALT/SGPT
Expected: S+18 Approximate, Expires: S+397, Routine
ALKALINE PHOSPHATASE
Expected: S+18 Approximate, Expires: S+397, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC, Creatinine, AST, ALT and Total Bilirubin.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 50K/µL
or Creatinine Clearance less than or equal to 40 mL/min or AST greater than 2.5 X ULN or ALT greater than 2.5 X ULN or
Total Bilirubin greater than 1.5 X ULN.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to bendamustine can occur.  For first and second dose, patient should be treated in a location
to optimize emergency care. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 36 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
Should be administered IV push over at least 2 minutes.
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bendamustine (BENDEKA) 70 mg/m2 in sodium chloride 0.9 % 50 mL bag
70 mg/m2, Intravenous, ONCE, 1 dose Starting when released
Administer over 10 minutes. Hypersensitivity reaction to bendamustine can occur. For first and second dose, patient
should be treated in a location to optimize emergency care. See emergency medications.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
DAY 4 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: bortezomib and bendamustine for 60 minutes.
DAY 8 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: bortezomib for 30 minutes.
DAY 11 FOLLOW-UP
LABS: CBC, ANC (DIFF if to be done locally); CHEMOTHERAPY ROOM APPOINTMENT: bortezomib for 30 minutes.
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if to be done locally),
Electrolytes, Glucose, Calcium, BUN, Creatinine, Total Bilirubin, AST, ALT and Alkaline Phosphatase; CHEMOTHERAPY
ROOM APPOINTMENT: bendamustine and bortezomib for 60 minutes.
Day 4, Cycle 7 –  Planned for 3/29/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 37 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to bendamustine can occur.  For first and second dose, patient should be treated in a location
to optimize emergency care. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
Should be administered IV push over at least 2 minutes.
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bendamustine (BENDEKA) 70 mg/m2 in sodium chloride 0.9 % 50 mL bag
70 mg/m2, Intravenous, ONCE, 1 dose Starting when released
Administer over 10 minutes. Hypersensitivity reaction to bendamustine can occur. For first and second dose, patient
should be treated in a location to optimize emergency care. See emergency medications.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 38 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 8, Cycle 7 –  Planned for 4/2/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 11, Cycle 7 –  Planned for 4/5/2018
Treatment Plan Information
Treatment Plan Summary
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 39 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S+3 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+3 Approximate, Expires: S+365, Routine
Nursing Procedure, Assessment and Monitoring
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 8 –  4/23/2018 through 5/20/2018 (28 days), Planned
Day 1, Cycle 8 –  Planned for 4/23/2018
Treatment Plan Information
Reference Information (1)
MULTIPLE MYELOMA: Ludwig H, et al. Blood 2014;123(7):985-91.
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 40 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S+18 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+18 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+18 Approximate, Expires: S+397, Routine
GLUCOSE
Expected: S+18 Approximate, Expires: S+397, Routine
BUN
Expected: S+18 Approximate, Expires: S+397, Routine
CREATININE
Expected: S+18 Approximate, Expires: S+397, Routine
CALCIUM
Expected: S+18 Approximate, Expires: S+397, Routine
BILIRUBIN, TOTAL
Expected: S+18 Approximate, Expires: S+397, Routine
AST/SGOT
Expected: S+18 Approximate, Expires: S+397, Routine
ALT/SGPT
Expected: S+18 Approximate, Expires: S+397, Routine
ALKALINE PHOSPHATASE
Expected: S+18 Approximate, Expires: S+397, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC, Creatinine, AST, ALT and Total Bilirubin.
Treatment Parameters
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 41 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 50K/µL
or Creatinine Clearance less than or equal to 40 mL/min or AST greater than 2.5 X ULN or ALT greater than 2.5 X ULN or
Total Bilirubin greater than 1.5 X ULN.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to bendamustine can occur.  For first and second dose, patient should be treated in a location
to optimize emergency care. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
Should be administered IV push over at least 2 minutes.
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bendamustine (BENDEKA) 70 mg/m2 in sodium chloride 0.9 % 50 mL bag
70 mg/m2, Intravenous, ONCE, 1 dose Starting when released
Administer over 10 minutes. Hypersensitivity reaction to bendamustine can occur. For first and second dose, patient
should be treated in a location to optimize emergency care. See emergency medications.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 42 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

Follow-Up
DAY 4 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: bortezomib and bendamustine for 60 minutes.
DAY 8 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: bortezomib for 30 minutes.
DAY 11 FOLLOW-UP
LABS: CBC, ANC (DIFF if to be done locally); CHEMOTHERAPY ROOM APPOINTMENT: bortezomib for 30 minutes.
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider.
Day 4, Cycle 8 –  Planned for 4/26/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to bendamustine can occur.  For first and second dose, patient should be treated in a location
to optimize emergency care. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 43 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine in sodium chloride 0.9% (PEPCID) 2 MG/ML injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
Should be administered IV push over at least 2 minutes.
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bendamustine (BENDEKA) 70 mg/m2 in sodium chloride 0.9 % 50 mL bag
70 mg/m2, Intravenous, ONCE, 1 dose Starting when released
Administer over 10 minutes. Hypersensitivity reaction to bendamustine can occur. For first and second dose, patient
should be treated in a location to optimize emergency care. See emergency medications.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 8, Cycle 8 –  Planned for 4/30/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Flush Venous Access Device per Guidelines
Order details
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 44 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 11, Cycle 8 –  Planned for 5/3/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Multiple Myeloma (Advanced); THERAPY: bendamustine 70 mg/m2 IV on Days 1 and 4, bortezomib 1.3
mg/m2 subcutaneous on Days 1, 4, 8, and 11, dexamethasone 20 mg by mouth on Days 1, 4, 8, and 11; CYCLE LENGTH:
28 days; COURSE: 8 cycles
Note to All Staff (1)
Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN),
some fatal, have been reported when bendamustine was administered concomitantly with allopurinol and other
medications known to cause these syndromes.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S+3 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+3 Approximate, Expires: S+365, Routine
Nursing Procedure, Assessment and Monitoring
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 45 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org

heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
bortezomib (VELCADE) subcutaneous injection 1.3 mg/m2 (Treatment Plan)
1.3 mg/m2, Subcutaneous, ONCE, 1 dose Starting when released
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
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Zztestonc,Edward E [2435061]
10/9/2017 9:12:27 AM Page 46 of 46
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org