/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/delegationpractice-protocols/,/clinical/cckm-tools/content/delegationpractice-protocols/ambulatory-delegation-protocols/,/clinical/cckm-tools/content/delegationpractice-protocols/ambulatory-delegation-protocols/related/,

/clinical/cckm-tools/content/delegationpractice-protocols/ambulatory-delegation-protocols/related/name-97412-en.cckm

201605126

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Delegation/Practice Protocols,Ambulatory Delegation Protocols,Related

IP-Transplant-Immunosuppression - Rituximab - Adult - Supplemental

IP-Transplant-Immunosuppression - Rituximab - Adult - Supplemental - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols, Related


IP - Transplant - Immunosuppression - Rituximab - Adult - Supplemental [773]
Intended for Adult Patients Only
Patient Care Orders
Vital Signs [8448]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today with First Occurrence As
Scheduled, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 15 minutes times 4, then every hour until completed.
Respiratory [8449]
Pulse Oximetry [NURMON0009] ONCE, Starting today For 1 Occurrences, Routine, Assess
baseline pre-infusion.
Pulse Oximetry [NURMON0009] ONCE, Starting today For 1 Occurrences, Routine, Assess 30
minutes after infusion started.
Prescriber Contact Information [128247]
NOTE - If the patient has an acute reaction to the infusion, the infusion will be stopped and treatment for the acute
reaction will be given. The infusion WILL NOT be re-started until you (the original prescriber) or your designee can be
reached to authorize the re-challenge, or provide further instructions. If you cannot be reached, the medication will not be
restarted and the patient will be sent home to follow-up with you, and future doses will not be administered until re-
ordered by you. We will page/call you 3 times in 30 minutes. If we have not received a response from you at the end of 30
minutes, the patient will be discharged.
Notify Provider - Infusion Reaction [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg):
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C):
If temperature < (C):
If heart rate > (bpm):
If heart rate < (bpm):
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other:
During business hours, I can be reached at this number: ***
After hours, I can be reached at this number: ***
If unable to reach me, please contact the following physician:
*** at this number: ***
Medications - General
Pre-infusion [13831]
acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, Oral, ONCE For 1 Doses
Give 60 minutes prior to rituximab administration
diphenhydramine (BENADRYL) cap [36791] 25 mg, Oral, ONCE For 1 Doses
Give 60 minutes prior to rituximab administration
Medications - Immunosuppression
Rituximab [13835]
rituximab (RITUXAN) in sodium chloride 0.9 % bag -
NOTE: Dose using actual weight (Maximum 750
mg/dose) [700074]
375 mg/m2, Intravenous, ONCE For 1 Doses
Run first infusion at 50 mg/hr for 30 minutes, then 100 mg/hr
for 30 minutes, then 200 mg/hr for 30 minutes, then 400
Page 1 of 2
Pr i nted by STRAKA, KEVIN F [KFS1] at 9/5/2013 10:46:51 AM
Copyright © 2013 University of Wisconsin Hospital and Clinics Authority


mg/hr until completed. For subsequent infusions, give 20% of
dose for 30 minutes and the remaining 80% of dose for 30
minutes. For adverse reactions, temporarily decrease or
interrupt the infusion. Then continue at one-half the previous
rate after improvement of symptoms.
Dose using actual weight (Maximum 750 mg/dose)
Laboratory
Laboratory [8450]
CD 19 AND 20 [HCF1920] ONCE, Starting today For 1 Occurrences, Routine
If Conditional, What Condition? Prior to giving Rituximab
If add on test, what should lab do if unable to add test to
previous specimen?
CD 19 AND 20 [HCF1920] ONCE, Starting today For 1 Occurrences, Routine
If Conditional, What Condition? Two days after giving
Rituximab.
If add on test, what should lab do if unable to add test to
previous specimen?
Page 2 of 2
Pr i nted by STRAKA, KEVIN F [KFS1] at 9/5/2013 10:46:51 AM
Copyright © 2013 University of Wisconsin Hospital and Clinics Authority