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CSC SARCOMA OUTPT Doxorubicin(21D:1) Olaratumab(21D:1,8) VER 2-6-18 (HL 5992)

CSC SARCOMA OUTPT Doxorubicin(21D:1) Olaratumab(21D:1,8) VER 2-6-18 (HL 5992) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Sarcoma


CSC SARCOMA OUTPT DOXORUBICIN(21D:1)/OLARATUMAB(21D:1,8) VER: 2-6-18 –  Properties
Pre-Cycle –  1/31/2018 through 2/6/2018 (7 days), Planned
Day 1, Pre-Cycle –  Planned for 1/31/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2 IV Day 1; CYCLE
LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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+365, Routine
GLUCOSE
Expected: S Approximate, Expires: S+365, Routine
BUN
Expected: S Approximate, Expires: S+365, Routine
CREATININE
Expected: S Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S Approximate, Expires: S+365, Routine
ALKALINE PHOSPHATASE
Expected: S Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S Approximate, Expires: S+365, Routine
PHOSPHATE
Expected: S Approximate, Expires: S+365, Routine
MAGNESIUM
Expected: S Approximate, Expires: S+365, Routine
PTT
Expected: S Approximate, Expires: S+365, Routine
Pre-Labs (delete all that do not apply)
HCG, QUALITATIVE, URINE
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 1 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2018CCKM@uwhealth.org

Expected: S Approximate, Expires: S+122, Routine
Take Home Medications
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
aprepitant (EMEND) 80 MG cap
Take 1 cap by mouth one time daily. Take for 2 days following doxorubicin chemotherapy., 80 mg, Disp-2 cap, R-7, 1
X DAILY starting S
dexamethasone (DECADRON) 4 MG tab
Take 2 tabs by mouth one time daily. Take for 3 days following doxorubicin chemotherapy., 8 mg, Disp-24 tab, R-5, 1 X
DAILY starting S, Local Printer
ondansetron (ZOFRAN) 8 MG tab
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, E-Prescribe
Cycle 1 –  2/7/2018 through 2/27/2018 (21 days), Planned
Day 1, Cycle 1 –  Planned for 2/7/2018
Treatment Plan Information
Reference Information (1)
SOFT TISSUE SARCOMA: Tap WD, et al. Lancet 2016;388(10043):488-97.
Reference Information (2)
SOFT TISSUE SARCOMA: Mack LA, et al. Ann Surg Oncol 2005;12(8):646-53.
Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2 IV Day 1; CYCLE
LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 100K/µL.
Treatment Condition A
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...
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]
2/7/2018 11:58:55 AM Page 2 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Verify patient has obtained pretreatment MUGA or ECHO.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
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 250-500 mL/hr, Intravenous, ONCE, 1 dose Starting when released
Infuse 1000 mL throughout treatment.
Pre-Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, ONCE, 1 dose Starting when released, Administer over 1 Minutes
Administer prior to chemotherapy.
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
aprepitant (EMEND) cap 125 mg
125 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
ondansetron (ZOFRAN) tab 24 mg
24 mg, Oral, ONCE, 1 dose Starting when released
Administer 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 (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 3 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
doxorubicin CONVENTIONAL (ADRIAMYCIN) injection 75 mg/m2 (Treatment Plan)
75 mg/m2, Intravenous, ONCE, 1 dose Starting when released
IV side arm push 3-5 mL/minute into running IV.
Conditional Orders (delete all that do not apply)
dexrazoxane (ZINECARD) bag 750 mg/m2 (Treatment Plan)
750 mg/m2, Intravenous, ONCE, 1 dose Starting when released, Administer over 15 Minutes
Administer prior to doxorubicin.
Follow-Up
DAY 8 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally);CHEMOTHERAPY ROOM APPOINTMENT: olaratumab for 90 minutes.
DAY 15 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally).
DAY 22 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC, Electrolytes, Glucose, PTT,
Magnesium, Phosphate, BUN, Creatinine, Total Bilirubin, AST, ALT, Alkaline  Phosphatase; CHEMOTHERAPY ROOM
APPOINTMENT: olaratumab and doxorubicin for 120 minutes.
Day 8, Cycle 1 –  Planned for 2/14/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2 IV Day 1; CYCLE
LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 4 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
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.
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 (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Lab Only - Day 15, Cycle 1 –  Planned for 2/21/2018
Treatment Plan Information
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 5 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2
IV Day 1; CYCLE LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of
doxorubicin).
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+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 2 –  2/28/2018 through 3/20/2018 (21 days), Planned
Day 1, Cycle 2 –  Planned for 2/28/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2 IV Day 1; CYCLE
LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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+14 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+14 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+14 Approximate, Expires: S+365, Routine
GLUCOSE
Expected: S+14 Approximate, Expires: S+365, Routine
BUN
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 6 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Expected: S+14 Approximate, Expires: S+365, Routine
CREATININE
Expected: S+14 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+14 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+14 Approximate, Expires: S+365, Routine
ALKALINE PHOSPHATASE
Expected: S+14 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+14 Approximate, Expires: S+365, Routine
PHOSPHATE
Expected: S+14 Approximate, Expires: S+365, Routine
MAGNESIUM
Expected: S+14 Approximate, Expires: S+365, Routine
PTT
Expected: S+14 Approximate, Expires: S+365, Routine
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.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
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]
2/7/2018 11:58:55 AM Page 7 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@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 250-500 mL/hr, Intravenous, ONCE, 1 dose Starting when released
Infuse 1000 mL throughout treatment.
Pre-Medications
aprepitant (EMEND) cap 125 mg
125 mg, Oral, ONCE, 1 dose Starting when released
ondansetron (ZOFRAN) tab 24 mg
24 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
dexamethasone (DECADRON) tab 12 mg
12 mg, Oral, ONCE, 1 dose Starting when released
Administer 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 (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
doxorubicin CONVENTIONAL (ADRIAMYCIN) injection 75 mg/m2 (Treatment Plan)
75 mg/m2, Intravenous, ONCE, 1 dose Starting when released
IV side arm push 3-5 mL/minute into running IV.
Conditional Orders (delete all that do not apply)
dexrazoxane (ZINECARD) bag 750 mg/m2 (Treatment Plan)
750 mg/m2, Intravenous, ONCE, 1 dose Starting when released, Administer over 15 Minutes
Administer prior to doxorubicin.
Follow-Up
DAY 8 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally);CHEMOTHERAPY ROOM APPOINTMENT: olaratumab for 90 minutes.
DAY 15 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally).
DAY 22 FOLLOW-UP
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 8 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC, Electrolytes, Glucose, PTT,
Magnesium, Phosphate, BUN, Creatinine, Total Bilirubin, AST, ALT, Alkaline  Phosphatase; CHEMOTHERAPY ROOM
APPOINTMENT: olaratumab and doxorubicin for 120 minutes.
Day 8, Cycle 2 –  Planned for 3/7/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2 IV Day 1; CYCLE
LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
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.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
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]
2/7/2018 11:58:55 AM Page 9 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
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 (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Lab Only - Day 15, Cycle 2 –  Planned for 3/14/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2 IV Day 1; CYCLE
LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 3 –  3/21/2018 through 4/10/2018 (21 days), Planned
Day 1, Cycle 3 –  Planned for 3/21/2018
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 10 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2 IV Day 1; CYCLE
LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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+14 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+14 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+14 Approximate, Expires: S+365, Routine
GLUCOSE
Expected: S+14 Approximate, Expires: S+365, Routine
BUN
Expected: S+14 Approximate, Expires: S+365, Routine
CREATININE
Expected: S+14 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+14 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+14 Approximate, Expires: S+365, Routine
ALKALINE PHOSPHATASE
Expected: S+14 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+14 Approximate, Expires: S+365, Routine
PHOSPHATE
Expected: S+14 Approximate, Expires: S+365, Routine
MAGNESIUM
Expected: S+14 Approximate, Expires: S+365, Routine
PTT
Expected: S+14 Approximate, Expires: S+365, Routine
IV Access
Insert and Maintain Peripheral IV
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 11 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@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.
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
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 250-500 mL/hr, Intravenous, ONCE, 1 dose Starting when released
Infuse 1000 mL throughout treatment.
Pre-Medications
aprepitant (EMEND) cap 125 mg
125 mg, Oral, ONCE, 1 dose Starting when released
ondansetron (ZOFRAN) tab 24 mg
24 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
dexamethasone (DECADRON) tab 12 mg
12 mg, Oral, ONCE, 1 dose Starting when released
Administer 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
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 12 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
doxorubicin CONVENTIONAL (ADRIAMYCIN) injection 75 mg/m2 (Treatment Plan)
75 mg/m2, Intravenous, ONCE, 1 dose Starting when released
IV side arm push 3-5 mL/minute into running IV.
Conditional Orders (delete all that do not apply)
dexrazoxane (ZINECARD) bag 750 mg/m2 (Treatment Plan)
750 mg/m2, Intravenous, ONCE, 1 dose Starting when released, Administer over 15 Minutes
Administer prior to doxorubicin.
Follow-Up
DAY 8 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally);CHEMOTHERAPY ROOM APPOINTMENT: olaratumab for 90 minutes.
DAY 15 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally).
DAY 22 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC, Electrolytes, Glucose, PTT,
Magnesium, Phosphate, BUN, Creatinine, Total Bilirubin, AST, ALT, Alkaline  Phosphatase; CHEMOTHERAPY ROOM
APPOINTMENT: olaratumab and doxorubicin for 120 minutes.
Day 8, Cycle 3 –  Planned for 3/28/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2 IV Day 1; CYCLE
LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
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.
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 13 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
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.
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 (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
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]
2/7/2018 11:58:55 AM Page 14 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Lab Only - Day 15, Cycle 3 –  Planned for 4/4/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2 IV Day 1; CYCLE
LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 4 –  4/11/2018 through 5/1/2018 (21 days), Planned
Day 1, Cycle 4 –  Planned for 4/11/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2 IV Day 1; CYCLE
LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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+14 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+14 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+14 Approximate, Expires: S+365, Routine
GLUCOSE
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 15 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Expected: S+14 Approximate, Expires: S+365, Routine
BUN
Expected: S+14 Approximate, Expires: S+365, Routine
CREATININE
Expected: S+14 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+14 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+14 Approximate, Expires: S+365, Routine
ALKALINE PHOSPHATASE
Expected: S+14 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+14 Approximate, Expires: S+365, Routine
PHOSPHATE
Expected: S+14 Approximate, Expires: S+365, Routine
MAGNESIUM
Expected: S+14 Approximate, Expires: S+365, Routine
PTT
Expected: S+14 Approximate, Expires: S+365, Routine
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.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
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]
2/7/2018 11:58:55 AM Page 16 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@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 250-500 mL/hr, Intravenous, ONCE, 1 dose Starting when released
Infuse 1000 mL throughout treatment.
Pre-Medications
aprepitant (EMEND) cap 125 mg
125 mg, Oral, ONCE, 1 dose Starting when released
ondansetron (ZOFRAN) tab 24 mg
24 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
dexamethasone (DECADRON) tab 12 mg
12 mg, Oral, ONCE, 1 dose Starting when released
Administer 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 (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
doxorubicin CONVENTIONAL (ADRIAMYCIN) injection 75 mg/m2 (Treatment Plan)
75 mg/m2, Intravenous, ONCE, 1 dose Starting when released
IV side arm push 3-5 mL/minute into running IV.
Conditional Orders (delete all that do not apply)
dexrazoxane (ZINECARD) bag 750 mg/m2 (Treatment Plan)
750 mg/m2, Intravenous, ONCE, 1 dose Starting when released, Administer over 15 Minutes
Administer prior to doxorubicin.
Follow-Up
DAY 8 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally);CHEMOTHERAPY ROOM APPOINTMENT: olaratumab for 90 minutes.
DAY 15 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally).
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 17 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

DAY 22 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC, Electrolytes,
Glucose, PTT, Magnesium, Phosphate, BUN, Creatinine, Total Bilirubin, AST, ALT, Alkaline  Phosphatase;
CHEMOTHERAPY ROOM APPOINTMENT: olaratumab and doxorubicin for 120 minutes.
Day 8, Cycle 4 –  Planned for 4/18/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2 IV Day 1; CYCLE
LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
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.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
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]
2/7/2018 11:58:55 AM Page 18 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
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 (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Lab Only - Day 15, Cycle 4 –  Planned for 4/25/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2 IV Day 1; CYCLE
LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 5 –  5/2/2018 through 5/22/2018 (21 days), Planned
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 19 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Day 1, Cycle 5 –  Planned for 5/2/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2 IV Day 1; CYCLE
LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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+14 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+14 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+14 Approximate, Expires: S+365, Routine
GLUCOSE
Expected: S+14 Approximate, Expires: S+365, Routine
BUN
Expected: S+14 Approximate, Expires: S+365, Routine
CREATININE
Expected: S+14 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+14 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+14 Approximate, Expires: S+365, Routine
ALKALINE PHOSPHATASE
Expected: S+14 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+14 Approximate, Expires: S+365, Routine
PHOSPHATE
Expected: S+14 Approximate, Expires: S+365, Routine
MAGNESIUM
Expected: S+14 Approximate, Expires: S+365, Routine
PTT
Expected: S+14 Approximate, Expires: S+365, Routine
IV Access
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 20 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@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.
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
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 250-500 mL/hr, Intravenous, ONCE, 1 dose Starting when released
Infuse 1000 mL throughout treatment.
Pre-Medications
aprepitant (EMEND) cap 125 mg
125 mg, Oral, ONCE, 1 dose Starting when released
ondansetron (ZOFRAN) tab 24 mg
24 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
dexamethasone (DECADRON) tab 12 mg
12 mg, Oral, ONCE, 1 dose Starting when released
Administer 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
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 21 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
doxorubicin CONVENTIONAL (ADRIAMYCIN) injection 75 mg/m2 (Treatment Plan)
75 mg/m2, Intravenous, ONCE, 1 dose Starting when released
IV side arm push 3-5 mL/minute into running IV.
Conditional Orders (delete all that do not apply)
dexrazoxane (ZINECARD) bag 750 mg/m2 (Treatment Plan)
750 mg/m2, Intravenous, ONCE, 1 dose Starting when released, Administer over 15 Minutes
Administer prior to doxorubicin.
Follow-Up
DAY 8 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally);CHEMOTHERAPY ROOM APPOINTMENT: olaratumab for 90 minutes.
DAY 15 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally).
DAY 22 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC, Electrolytes, Glucose, PTT,
Magnesium, Phosphate, BUN, Creatinine, Total Bilirubin, AST, ALT, Alkaline  Phosphatase; CHEMOTHERAPY ROOM
APPOINTMENT: olaratumab and doxorubicin for 120 minutes.
Day 8, Cycle 5 –  Planned for 5/9/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2 IV Day 1; CYCLE
LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
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
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 22 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
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.
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 (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
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]
2/7/2018 11:58:55 AM Page 23 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Lab Only - Day 15, Cycle 5 –  Planned for 5/16/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2 IV Day 1; CYCLE
LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 6 –  5/23/2018 through 6/12/2018 (21 days), Planned
Day 1, Cycle 6 –  Planned for 5/23/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2 IV Day 1; CYCLE
LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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+14 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+14 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+14 Approximate, Expires: S+365, Routine
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 24 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

GLUCOSE
Expected: S+14 Approximate, Expires: S+365, Routine
BUN
Expected: S+14 Approximate, Expires: S+365, Routine
CREATININE
Expected: S+14 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+14 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+14 Approximate, Expires: S+365, Routine
ALKALINE PHOSPHATASE
Expected: S+14 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+14 Approximate, Expires: S+365, Routine
PHOSPHATE
Expected: S+14 Approximate, Expires: S+365, Routine
MAGNESIUM
Expected: S+14 Approximate, Expires: S+365, Routine
PTT
Expected: S+14 Approximate, Expires: S+365, Routine
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.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
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]
2/7/2018 11:58:55 AM Page 25 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@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.
Hydration
sodium chloride 0.9 % infusion
at 250-500 mL/hr, Intravenous, ONCE, 1 dose Starting when released
Infuse 1000 mL throughout treatment.
Pre-Medications
aprepitant (EMEND) cap 125 mg
125 mg, Oral, ONCE, 1 dose Starting when released
ondansetron (ZOFRAN) tab 24 mg
24 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
dexamethasone (DECADRON) tab 12 mg
12 mg, Oral, ONCE, 1 dose Starting when released
Administer 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 (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
doxorubicin CONVENTIONAL (ADRIAMYCIN) injection 75 mg/m2 (Treatment Plan)
75 mg/m2, Intravenous, ONCE, 1 dose Starting when released
IV side arm push 3-5 mL/minute into running IV.
Conditional Orders (delete all that do not apply)
dexrazoxane (ZINECARD) bag 750 mg/m2 (Treatment Plan)
750 mg/m2, Intravenous, ONCE, 1 dose Starting when released, Administer over 15 Minutes
Administer prior to doxorubicin.
Follow-Up
DAY 8 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally);CHEMOTHERAPY ROOM APPOINTMENT: olaratumab for 90 minutes.
DAY 15 FOLLOW-UP
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 26 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

LABS: CBC, ANC (DIFF if done locally).
DAY 22 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC, Electrolytes, Glucose, PTT,
Magnesium, Phosphate, BUN, Creatinine, Total Bilirubin, AST, ALT, Alkaline  Phosphatase; CHEMOTHERAPY ROOM
APPOINTMENT: olaratumab and doxorubicin for 120 minutes.
Day 8, Cycle 6 –  Planned for 5/30/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2 IV Day 1; CYCLE
LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
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.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
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.
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 27 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
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 (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Lab Only - Day 15, Cycle 6 –  Planned for 6/6/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2 IV Day 1; CYCLE
LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 7 –  6/13/2018 through 7/3/2018 (21 days), Planned
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 28 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Day 1, Cycle 7 –  Planned for 6/13/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2 IV Day 1; CYCLE
LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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+14 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+14 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+14 Approximate, Expires: S+365, Routine
GLUCOSE
Expected: S+14 Approximate, Expires: S+365, Routine
BUN
Expected: S+14 Approximate, Expires: S+365, Routine
CREATININE
Expected: S+14 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+14 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+14 Approximate, Expires: S+365, Routine
ALKALINE PHOSPHATASE
Expected: S+14 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+14 Approximate, Expires: S+365, Routine
PHOSPHATE
Expected: S+14 Approximate, Expires: S+365, Routine
MAGNESIUM
Expected: S+14 Approximate, Expires: S+365, Routine
PTT
Expected: S+14 Approximate, Expires: S+365, Routine
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 29 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@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.
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
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 250-500 mL/hr, Intravenous, ONCE, 1 dose Starting when released
Infuse 1000 mL throughout treatment.
Pre-Medications
aprepitant (EMEND) cap 125 mg
125 mg, Oral, ONCE, 1 dose Starting when released
ondansetron (ZOFRAN) tab 24 mg
24 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
dexamethasone (DECADRON) tab 12 mg
12 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 30 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

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 (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
doxorubicin CONVENTIONAL (ADRIAMYCIN) injection 75 mg/m2 (Treatment Plan)
75 mg/m2, Intravenous, ONCE, 1 dose Starting when released
IV side arm push 3-5 mL/minute into running IV.
Conditional Orders (delete all that do not apply)
dexrazoxane (ZINECARD) bag 750 mg/m2 (Treatment Plan)
750 mg/m2, Intravenous, ONCE, 1 dose Starting when released, Administer over 15 Minutes
Administer prior to doxorubicin.
Follow-Up
DAY 8 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally);CHEMOTHERAPY ROOM APPOINTMENT: olaratumab for 90 minutes.
DAY 15 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally).
DAY 22 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC, Electrolytes, Glucose, PTT,
Magnesium, Phosphate, BUN, Creatinine, Total Bilirubin, AST, ALT, Alkaline  Phosphatase; CHEMOTHERAPY ROOM
APPOINTMENT: olaratumab and doxorubicin for 120 minutes.
Day 8, Cycle 7 –  Planned for 6/20/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2 IV Day 1; CYCLE
LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected: S+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
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]
2/7/2018 11:58:55 AM Page 31 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
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.
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 (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
Follow-Up
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 32 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Lab Only - Day 15, Cycle 7 –  Planned for 6/27/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2 IV Day 1; CYCLE
LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 8 –  7/4/2018 through 7/24/2018 (21 days), Planned
Day 1, Cycle 8 –  Planned for 7/4/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2 IV Day 1; CYCLE
LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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+14 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+14 Approximate, Expires: S+365, Routine
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 33 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

ELECTROLYTES
Expected: S+14 Approximate, Expires: S+365, Routine
GLUCOSE
Expected: S+14 Approximate, Expires: S+365, Routine
BUN
Expected: S+14 Approximate, Expires: S+365, Routine
CREATININE
Expected: S+14 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+14 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+14 Approximate, Expires: S+365, Routine
ALKALINE PHOSPHATASE
Expected: S+14 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+14 Approximate, Expires: S+365, Routine
PHOSPHATE
Expected: S+14 Approximate, Expires: S+365, Routine
MAGNESIUM
Expected: S+14 Approximate, Expires: S+365, Routine
PTT
Expected: S+14 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
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]
2/7/2018 11:58:55 AM Page 34 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@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 250-500 mL/hr, Intravenous, ONCE, 1 dose Starting when released
Infuse 1000 mL throughout treatment.
Pre-Medications
aprepitant (EMEND) cap 125 mg
125 mg, Oral, ONCE, 1 dose Starting when released
ondansetron (ZOFRAN) tab 24 mg
24 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
dexamethasone (DECADRON) tab 12 mg
12 mg, Oral, ONCE, 1 dose Starting when released
Administer 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 (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
doxorubicin CONVENTIONAL (ADRIAMYCIN) injection 75 mg/m2 (Treatment Plan)
75 mg/m2, Intravenous, ONCE, 1 dose Starting when released
IV side arm push 3-5 mL/minute into running IV.
Conditional Orders (delete all that do not apply)
dexrazoxane (ZINECARD) bag 750 mg/m2 (Treatment Plan)
750 mg/m2, Intravenous, ONCE, 1 dose Starting when released, Administer over 15 Minutes
Administer prior to doxorubicin.
Follow-Up
DAY 8 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally); CHEMOTHERAPY ROOM APPOINTMENT: olaratumab for 90 minutes.
DAY 15 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally).
DAY 22 FOLLOW-UP
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 35 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC, Electrolytes, Glucose, PTT,
Magnesium, Phosphate, BUN, Creatinine, Total Bilirubin, AST, ALT, Alkaline  Phosphatase; CHEMOTHERAPY ROOM
APPOINTMENT: olaratumab for 90 minutes
Day 8, Cycle 8 –  Planned for 7/11/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2 IV Day 1; CYCLE
LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
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]
2/7/2018 11:58:55 AM Page 36 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
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 (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Lab Only - Day 15, Cycle 8 –  Planned for 7/18/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2 IV Day 1; CYCLE
LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 9 –  7/25/2018 through 8/14/2018 (21 days), Planned
Day 1, Cycle 9 –  Planned for 7/25/2018
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 37 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2 IV Day 1; CYCLE
LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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+14 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+14 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+14 Approximate, Expires: S+365, Routine
GLUCOSE
Expected: S+14 Approximate, Expires: S+365, Routine
BUN
Expected: S+14 Approximate, Expires: S+365, Routine
CREATININE
Expected: S+14 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+14 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+14 Approximate, Expires: S+365, Routine
ALKALINE PHOSPHATASE
Expected: S+14 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+14 Approximate, Expires: S+365, Routine
PHOSPHATE
Expected: S+14 Approximate, Expires: S+365, Routine
MAGNESIUM
Expected: S+14 Approximate, Expires: S+365, Routine
PTT
Expected: S+14 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 38 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
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.
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 (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
Follow-Up
DAY 8 FOLLOW-UP
LABS: CBC, ANC (DIFF if done locally); CHEMOTHERAPY ROOM APPOINTMENT: olaratumab for 90 minutes.
DAY 15 FOLLOW-UP
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Zztestonc,Edward E [2435061]
2/7/2018 11:58:55 AM Page 39 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org

LABS: CBC, ANC (DIFF if done locally).
DAY 22 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC, Electrolytes, Glucose, PTT,
Magnesium, Phosphate, BUN, Creatinine, Total Bilirubin, AST, ALT, Alkaline  Phosphatase; CHEMOTHERAPY ROOM
APPOINTMENT: olaratumab for 90 minutes
Day 8, Cycle 9 –  Planned for 8/1/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2 IV Day 1; CYCLE
LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 100K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to olaratumab can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See emergency medications or follow emergency protocol. Monitor patient during and
following olaratumab infusion for signs and symptoms of infusion related reactions. Patients must be monitored for 30
minutes after the first two doses of olaratumab.
Vital Signs
ONCE Starting when released
Obtain baseline Blood Pressure.
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]
2/7/2018 11:58:55 AM Page 40 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@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.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
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 (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
olaratumab (LARTRUVO) 15 mg/kg = 1,125 mg in sodium chloride 0.9 % 250 mL bag
1,125 mg (15 mg/kg × 75 kg), Intravenous, ONCE, 1 dose Starting when released, Administer over 60 Minutes
Administer over 60 minutes. Flush line with normal saline prior to and at the end of infusion. Hypersensitivity risk. See
Emergency Medications. Patients must be monitored for 30 minutes after the first two doses of olaratumab.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Lab Only - Day 15, Cycle 9 –  Planned for 8/8/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcoma; THERAPY: olaratumab 15 mg/kg IV Day 1 and 8, doxorubicin 75 mg/m2 IV Day 1; CYCLE
LENGTH: 21 days; COURSE: until disease progression (maximum of 8 cycles of doxorubicin).
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+7 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+7 Approximate, Expires: S+365, Routine
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]
2/7/2018 11:58:55 AM Page 41 of 41
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2018CCKM@uwhealth.org