/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/beacon-protocols/,/clinical/cckm-tools/content/beacon-protocols/lung/,

/clinical/cckm-tools/content/beacon-protocols/lung/name-96925-en.cckm

201611333

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Beacon Protocols,Lung

CSC Lung Afatinib(28D:1-28) VER 10-3-16 (HL 5044)

CSC Lung Afatinib(28D:1-28) VER 10-3-16 (HL 5044) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Lung


CSC LUNG AFATINIB(28D:1-28) VER: 10-3-16 – Properties
Pre-Cycle – 11/21/2016 through 11/27/2016 (7 days), Planned
Day 1, Pre-Cycle – Planned for 11/21/2016
Treatment Plan Information
Treatment Plan Summary
DISEASE: Non-Small Cell Lung Cancer (Advanced); THERAPY: afatinib 40 mg by mouth once daily continuously; CYCLE LENGTH:
28 days; COURSE: until disease progression.
Note to All Staff (1)
Tumors must have epidermal growth factor receptor (EGFR) exon 19 deletion or exon 21 (L858R) substitution mutations detected.
Consent
Verify Consent
Verify informed consent has been obtained.
Pre-Labs
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
ALBUMIN
Expected-S Approximate, Expires-S+397, Routine
PROTEIN, TOTAL
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
Cycle 1 – 11/28/2016 through 12/25/2016 (28 days), Planned
Day 1, Cycle 1 – Planned for 11/28/2016
Treatment Plan Information
Reference Information (1)
NON-SMALL CELL LUNG CANCER: Sequist LV, et al. J Clin Oncol 2013;31(27):3327-34.
Treatment Plan Summary
DISEASE: Non-Small Cell Lung Cancer (Advanced); THERAPY: afatinib 40 mg by mouth once daily continuously; CYCLE LENGTH:
28 days; COURSE: until disease progression.
Note to All Staff (1)
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ZZtestonc,Andrew [2428787]
11/28/2016 1:29:18 PM Page 1 of 10
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Tumors must have epidermal growth factor receptor (EGFR) exon 19 deletion or exon 21 (L858R) substitution mutations detected.
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: Creatinine.
Treatment Parameters
Hold treatment and notify authorizing prescriber for Creatinine Clearance less than 50 mL/min or diarrhea persisting for longer than
48 hours.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Patient to take medication on an empty stomach at least one hour before or two hours after eating. Do not take missed dose within
12 hours of next dose.
Patient Instructions(2)
Advise patient that diarrhea occurs in nearly all of patients receiving afatinib.
Patient Instructions(3)
Advise patient to immediately report if they are experiencing eye problems or severe skin reactions.
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
See Take Home Medication(s)
Refer to the Take Home Medications section for the following treatment medication(s): afatinib (dispensed Day 1 of Cycle 1 only -
subsequent refills will be ordered through the medication activity).
Take Home Medications
afatinib dimaleate (GILOTRIF) 40 MG tab
Take 1 tab by mouth one time daily. Take on empty stomach, one hour before or two hours after meals., 40 mg, Disp-30 tab,
R-0, 1 X DAILY starting S
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of the next Cycle) RETURN TO THE CLINIC for an appointment with the provider; LABS: Electrolytes, Glucose, BUN,
Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT, and Alkaline Phosphatase.
Cycle 2 – 12/26/2016 through 1/22/2017 (28 days), Planned
Day 1, Cycle 2 – Planned for 12/26/2016
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ZZtestonc,Andrew [2428787]
11/28/2016 1:29:18 PM Page 2 of 10
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Treatment Plan Information
Treatment Plan Summary
DISEASE: Non-Small Cell Lung Cancer (Advanced); THERAPY: afatinib 40 mg by mouth once daily continuously; CYCLE LENGTH:
28 days; COURSE: until disease progression.
Note to All Staff (1)
Tumors must have epidermal growth factor receptor (EGFR) exon 19 deletion or exon 21 (L858R) substitution mutations detected.
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
ELECTROLYTES
Expected-S+28 Approximate, Expires-S+397, Routine
GLUCOSE
Expected-S+28 Approximate, Expires-S+397, Routine
BUN
Expected-S+28 Approximate, Expires-S+397, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+397, Routine
CALCIUM
Expected-S+28 Approximate, Expires-S+397, Routine
ALBUMIN
Expected-S+28 Approximate, Expires-S+397, Routine
PROTEIN, TOTAL
Expected-S+28 Approximate, Expires-S+397, Routine
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+397, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+397, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+397, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+397, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: Creatinine.
Treatment Parameters
Hold treatment and notify authorizing prescriber for Creatinine Clearance less than 50 mL/min or diarrhea persisting for longer than
48 hours.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Patient to take medication on an empty stomach at least one hour before or two hours after eating. Do not take missed dose within
12 hours of next dose.
Patient Instructions(2)
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ZZtestonc,Andrew [2428787]
11/28/2016 1:29:18 PM Page 3 of 10
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Advise patient that diarrhea occurs in nearly all of patients receiving afatinib.
Patient Instructions(3)
Advise patient to immediately report if they are experiencing eye problems or severe skin reactions.
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
Oral Chemotherapy Order Management
For this regimen, afatinib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of the next Cycle) RETURN TO THE CLINIC for an appointment with the provider; LABS: Electrolytes, Glucose, BUN,
Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT, and Alkaline Phosphatase.
Cycle 3 – 1/23/2017 through 2/19/2017 (28 days), Planned
Day 1, Cycle 3 – Planned for 1/23/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Non-Small Cell Lung Cancer (Advanced); THERAPY: afatinib 40 mg by mouth once daily continuously; CYCLE LENGTH:
28 days; COURSE: until disease progression.
Note to All Staff (1)
Tumors must have epidermal growth factor receptor (EGFR) exon 19 deletion or exon 21 (L858R) substitution mutations detected.
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
ELECTROLYTES
Expected-S+28 Approximate, Expires-S+397, Routine
GLUCOSE
Expected-S+28 Approximate, Expires-S+397, Routine
BUN
Expected-S+28 Approximate, Expires-S+397, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+397, Routine
CALCIUM
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ZZtestonc,Andrew [2428787]
11/28/2016 1:29:18 PM Page 4 of 10
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Expected-S+28 Approximate, Expires-S+397, Routine
ALBUMIN
Expected-S+28 Approximate, Expires-S+397, Routine
PROTEIN, TOTAL
Expected-S+28 Approximate, Expires-S+397, Routine
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+397, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+397, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+397, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+397, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: Creatinine.
Treatment Parameters
Hold treatment and notify authorizing prescriber for Creatinine Clearance less than 50 mL/min or diarrhea persisting for longer than
48 hours.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Patient to take medication on an empty stomach at least one hour before or two hours after eating. Do not take missed dose within
12 hours of next dose.
Patient Instructions(2)
Advise patient that diarrhea occurs in nearly all of patients receiving afatinib.
Patient Instructions(3)
Advise patient to immediately report if they are experiencing eye problems or severe skin reactions.
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
Oral Chemotherapy Order Management
For this regimen, afatinib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of the next Cycle) RETURN TO THE CLINIC for an appointment with the provider; LABS: Electrolytes, Glucose, BUN,
Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT, and Alkaline Phosphatase.
Cycle 4 – 2/20/2017 through 3/19/2017 (28 days), Planned
Day 1, Cycle 4 – Planned for 2/20/2017
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ZZtestonc,Andrew [2428787]
11/28/2016 1:29:18 PM Page 5 of 10
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Treatment Plan Information
Treatment Plan Summary
DISEASE: Non-Small Cell Lung Cancer (Advanced); THERAPY: afatinib 40 mg by mouth once daily continuously; CYCLE LENGTH:
28 days; COURSE: until disease progression.
Note to All Staff (1)
Tumors must have epidermal growth factor receptor (EGFR) exon 19 deletion or exon 21 (L858R) substitution mutations detected.
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
ELECTROLYTES
Expected-S+28 Approximate, Expires-S+397, Routine
GLUCOSE
Expected-S+28 Approximate, Expires-S+397, Routine
BUN
Expected-S+28 Approximate, Expires-S+397, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+397, Routine
CALCIUM
Expected-S+28 Approximate, Expires-S+397, Routine
ALBUMIN
Expected-S+28 Approximate, Expires-S+397, Routine
PROTEIN, TOTAL
Expected-S+28 Approximate, Expires-S+397, Routine
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+397, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+397, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+397, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+397, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: Creatinine.
Treatment Parameters
Hold treatment and notify authorizing prescriber for Creatinine Clearance less than 50 mL/min or diarrhea persisting for longer than
48 hours.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Patient to take medication on an empty stomach at least one hour before or two hours after eating. Do not take missed dose within
12 hours of next dose.
Patient Instructions(2)
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ZZtestonc,Andrew [2428787]
11/28/2016 1:29:18 PM Page 6 of 10
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Advise patient that diarrhea occurs in nearly all of patients receiving afatinib.
Patient Instructions(3)
Advise patient to immediately report if they are experiencing eye problems or severe skin reactions.
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
Oral Chemotherapy Order Management
For this regimen, afatinib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of the next Cycle) RETURN TO THE CLINIC for an appointment with the provider; LABS: Electrolytes, Glucose, BUN,
Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT, and Alkaline Phosphatase.
Cycle 5 – 3/20/2017 through 4/16/2017 (28 days), Planned
Day 1, Cycle 5 – Planned for 3/20/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Non-Small Cell Lung Cancer (Advanced); THERAPY: afatinib 40 mg by mouth once daily continuously; CYCLE LENGTH:
28 days; COURSE: until disease progression.
Note to All Staff (1)
Tumors must have epidermal growth factor receptor (EGFR) exon 19 deletion or exon 21 (L858R) substitution mutations detected.
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
ELECTROLYTES
Expected-S+28 Approximate, Expires-S+397, Routine
GLUCOSE
Expected-S+28 Approximate, Expires-S+397, Routine
BUN
Expected-S+28 Approximate, Expires-S+397, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+397, Routine
CALCIUM
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ZZtestonc,Andrew [2428787]
11/28/2016 1:29:18 PM Page 7 of 10
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Expected-S+28 Approximate, Expires-S+397, Routine
ALBUMIN
Expected-S+28 Approximate, Expires-S+397, Routine
PROTEIN, TOTAL
Expected-S+28 Approximate, Expires-S+397, Routine
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+397, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+397, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+397, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+397, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: Creatinine.
Treatment Parameters
Hold treatment and notify authorizing prescriber for Creatinine Clearance less than 50 mL/min or diarrhea persisting for longer than
48 hours.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Patient to take medication on an empty stomach at least one hour before or two hours after eating. Do not take missed dose within
12 hours of next dose.
Patient Instructions(2)
Advise patient that diarrhea occurs in nearly all of patients receiving afatinib.
Patient Instructions(3)
Advise patient to immediately report if they are experiencing eye problems or severe skin reactions.
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
Oral Chemotherapy Order Management
For this regimen, afatinib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of the next Cycle) RETURN TO THE CLINIC for an appointment with the provider; LABS: Electrolytes, Glucose, BUN,
Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT, and Alkaline Phosphatase.
Cycle 6 – 4/17/2017 through 5/14/2017 (28 days), Planned
Day 1, Cycle 6 – Planned for 4/17/2017
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ZZtestonc,Andrew [2428787]
11/28/2016 1:29:18 PM Page 8 of 10
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Treatment Plan Information
Treatment Plan Summary
DISEASE: Non-Small Cell Lung Cancer (Advanced); THERAPY: afatinib 40 mg by mouth once daily continuously; CYCLE LENGTH:
28 days; COURSE: until disease progression.
Note to All Staff (1)
Tumors must have epidermal growth factor receptor (EGFR) exon 19 deletion or exon 21 (L858R) substitution mutations detected.
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
ELECTROLYTES
Expected-S+28 Approximate, Expires-S+397, Routine
GLUCOSE
Expected-S+28 Approximate, Expires-S+397, Routine
BUN
Expected-S+28 Approximate, Expires-S+397, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+397, Routine
CALCIUM
Expected-S+28 Approximate, Expires-S+397, Routine
ALBUMIN
Expected-S+28 Approximate, Expires-S+397, Routine
PROTEIN, TOTAL
Expected-S+28 Approximate, Expires-S+397, Routine
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+397, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+397, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+397, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+397, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: Creatinine.
Treatment Parameters
Hold treatment and notify authorizing prescriber for Creatinine Clearance less than 50 mL/min or diarrhea persisting for longer than
48 hours.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Patient to take medication on an empty stomach at least one hour before or two hours after eating. Do not take missed dose within
12 hours of next dose.
Patient Instructions(2)
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ZZtestonc,Andrew [2428787]
11/28/2016 1:29:18 PM Page 9 of 10
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Advise patient that diarrhea occurs in nearly all of patients receiving afatinib.
Patient Instructions(3)
Advise patient to immediately report if they are experiencing eye problems or severe skin reactions.
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
Oral Chemotherapy Order Management
For this regimen, afatinib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of the next Cycle) RETURN TO THE CLINIC for an appointment with the provider; LABS: Electrolytes, Glucose, BUN,
Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT, and Alkaline Phosphatase.
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ZZtestonc,Andrew [2428787]
11/28/2016 1:29:18 PM Page 10 of 10
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org