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Parenteral Chemotherapy Rounding – Adult/Pediatric – Inpatient/Ambulatory [100]

Parenteral Chemotherapy Rounding – Adult/Pediatric – Inpatient/Ambulatory [100] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols






Delegation Protocol Number: 100

Delegation Protocol Title:
Parenteral Chemotherapy Rounding – Adult/Pediatric – Inpatient/Ambulatory

Delegation Protocol Applies To:
UW Health inpatient and ambulatory patients—adult and pediatric, greater than or equal to five
kilograms

Target Patient Population:
All adult and pediatric patients greater than or equal to five kilograms who receive
chemotherapy —cytotoxic and/or biologic agents—for the treatment of a malignant or
hematologic disorder, exempting research, non-formulary and intrathecal
chemotherapy.

Delegation Protocol Champions:
Daniel L. Mulkerin, MD – Department of Medicine, Hematology/Oncology
Kenneth B. De Santes, MD – Department of Pediatrics, Hematology/Oncology

Delegation Protocol Reviewers:
Sara Koth, PharmD – Pharmacy Department
Mary Mably, RPh, BCOP- Pharmacy Department
Mike Reed, RPh, BCOP, BCPS – Pharmacy Department

Responsible Department:
Pharmacy Department

Purpose Statement:
To delegate authority from the oncology/hematology provider that wrote the prescription to
pharmacists (RPh) in order to round prescribed doses of chemotherapy up or down, to the
nearest vial size or measurable unit, as outlined in the UW Health Clinical Practice Guideline for
the Rounding of Parenteral Chemotherapy.

Who May Carry Out this Delegation Protocol:
UW Health inpatient and ambulatory pharmacists who verify chemotherapy orders and
are trained in the use of this delegation protocol.

Guidelines for Implementation:
1. A medication is ordered by a prescribing provider for administration of a parenteral
chemotherapy medication.
2. The clinical pharmacist reviews the appropriateness of rounding the dose to the nearest
vial size or measureable unit.
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

3. If rounding the dose is indicated, the pharmacist will round the dose as outlined in the
UW Health Clinical Practice Guideline for the Rounding of Parenteral Chemotherapy.
The dose will be rounded within 5% of the prescribed dose for cytotoxic chemotherapy
and 10% for biologic chemotherapy.
4. The pharmacist documents in the medical record that the medication has been changed
per protocol.
5. This protocol may be overridden at any time by the prescriber indicating “do not modify
per protocol” or other equivalent wording on the medication order.

Order Mode: Protocol/Policy, Without Cosign

References:
1. Chatelut E, White-Koning ML, Mathijssen RHJ, Puisset F, Baker SD,
Sparreboom A. Dose banding as an alternative to body surface area-based
dosing of chemotherapeutic agents. Br J Cancer. 2012;107:1100-1106.
2. Dooley M, Singh S, Michael M. Implications of dose rounding of chemotherapy to
the nearest vial size. Support Care Cancer. 2004;12:653-656.
Jenkins P, Wallis R. Dose-rounding of adjuvant chemotherapy for breast cancer:
an audit of toxicity. J Oncol Pharm Practice. 2010; 16:251-255.
3. Johnson K, Lee C, Spooner, A, et al. Automated dose-rounding
recommendations for pediatric medications. Pediatrics. 2011; 128:e422-e428.
4. Winger B, Clements E, DeYoung J, et al. Cost savings from dose rounding of
biologic anticancer agents in adults. J Oncol Pharm Practice. 2010; 17(3):246-
251.
5. Fasola G, Aita M, Marini L, et al. Drug waste minimization and cost-containment
in Medical Oncology; two-year results of a feasibility study. BMT Health Serv
Res. 2008 Apr1;8:70.
6. Field K, Zelenko A, Kosmider S, et al. Dose rounding of chemotherapy in
colorectal cancer: an analysis of clinician attitudes and the potential impact on
treatment costs. Asia–Pac J Clin Oncol. 2010; 6:203–209.
7. Plumridge RJ, Sewell GJ. Dose-banding of cytotoxic drugs: a new concept in
cancer chemotherapy. Am J Health-Syst Pharm. 2001;58:1760-1764.
8. Gillian A. Toolkit: How to Implement Dose banding of Chemotherapy 2008.
Cancer Network Pharmacists Forum. Aug 2010.
http://www.bopawebsite.org/contentimages/publications/Toolkit_Ver_3.0_FINAL.
pdf. Accessed 23. June 2013.







9. Smith DB. CCO Chemotherapy Protocols. Clatterbridge Centre for Oncology:
NHS Foundation Trust. 30 October 2012;10.0.
http://www.clatterbridgecc.nhs.uk/document_uploads/Guidance/ChemotherapyProtoc
olsV10.0.pdf. Accessed 23 June 2013.
10. Kaestner SA, Sewell GJ. Chemotherapy dosing Part I; Scientific basis for current
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

practice and the use of body surface area. Clinical Oncology. 2007;19:23-37
Kaestner SA, Sewell GJ. Chemotherapy dosing Part II; Alternative approaches
and future prospects. Clinical Oncology. 2007;19:99-107

Collateral Documents/Tools:
UW Health Clinical Practice Guideline for the Rounding of Parenteral Chemotherapy

Approved By:
UW Health Ambulatory Protocol Committee: February 2014, April 2016 (expedited process)
UWHC Pharmacy & Therapeutics Committee: February 2014, April 2016 (expedited process)
UWHC Medical Board: April 2014, April 2016 (expedited process)
UW Health Chief Medical Officer: April 2014, April 2016 (expedited process)

Effective Date: April 2016

Scheduled for Review: April 2019
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org