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Oncology Treatment Plan Laboratory Ordering - Pediatric - Ambulatory [124]

Oncology Treatment Plan Laboratory Ordering - Pediatric - Ambulatory [124] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols


Delegation Protocol Number: 124

Delegation Protocol Title: Oncology Treatment Plan Laboratory Ordering - Pediatric - Ambulatory

Delegation Protocol Applies To:
AFCH Pediatric Oncology Clinic, Pediatric Day Treatment

Target Patient Population:
UW Health pediatric patients with an oncology treatment plan

Delegation Protocol Champion:
Ken DeSantes, MD, Department of Pediatrics – Hematology/Oncology

Delegation Protocol Reviewers:
Megan Grotheer, BSN, RN – American Family Children’s Hospital
Leanne Hammerschmitt, MSN, RN, CPNP – Manager Pediatric Specialties Clinic
Kathleen Montgomery, PhD, RN, PCNS-BC, CPHON – AFCH – Hematology/Oncology
Abigail Roth, BSN, RN, CPOP – Pediatric Specialties Clinic

Responsible Department:
Department of Pediatrics – Hematology/Oncology

Purpose Statement:
To delegate the authority from the provider signing the treatment plan orders to Registered Nurses (RNs) to
place (1) laboratory orders identified as treatment parameters or (2) laboratory orders for results requiring
verification prior to beginning treatment as specified in approved Beacon protocols.

Who May Carry Out This Delegation Protocol:
Chemotherapy certified Registered Nurses (RNs) trained in the use of this protocol.

Guidelines for Implementation:
1. This protocol is initiated when patients with signed oncology treatment plans are due for chemotherapy.
Only laboratory orders explicitly listed in the Verify Labs or Treatment Parameters sections of approved
Beacon treatment plan are authorized for delegated action.
2. The RN will review the Verify Labs or Treatment Parameters sections of the treatment plan to identify
required labs.
3. If laboratory tests are needed, the RN will check the medical record to identify any previously ordered
laboratory orders to avoid duplicates and will enter orders for any of the lab tests specified in the treatment
plan that have not previously been ordered.
4. The RN will sign the orders with an order mode of Cosign Required Protocol/Policy. Orders may be carried
out before cosigning.

Order Mode: Cosign Required, Protocol/Policy

References: N/A

Collateral Documents: N/A


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

Approved By:
UW Health Ambulatory Protocol Committee: August 2015
UW Health Laboratory Practices Committee: September 2015
UW Health Clinical Knowledge Management Council: September 2015
UWHC Medical Board: October 2015
UW Health Chief Medical Officer: October 2015

Effective Date: October 2015
Scheduled for Review: October 2018

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