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Name | Existing Y/N | Database Field | Values | Comments |
Drug | Y | Drug.Name |
|
|
Dose | Y | Drug_Order.Dose |
| Need to add additional units in the form of mg/m2 and mg/kg (as the actual dose given at a visit is based on the patients weight) |
Route | Y | Drug.Route | IV, PO |
|
Infusion volume |
|
| Numeric | Values such as 250ml |
Infusion volume units |
|
| Standard liquid units |
|
Infusion liquid |
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|
| Values need to be configurable via settings (formerly global properties 1.8 and below) |
Time/Infusion Rate |
|
| Free text because values include ranges (ie 15-30) minutes |
|
Frequency | Y | Drug.Frequency |
| Current values plus the addition of as needed |
Cycle |
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|
| Chemotherapy treatment is administered in cycles, so knowing which cycle a given drug order is for will be useful. |
Classification |
|
| Premedication, Chemotherapy, Postmedication | The classification is necessary for display purposes so that we can prepare sensible patient summaries |
Start Date | Y | Order.start_date |
| For many of the actual chemotherapy drugs the start and stop dates will be on the same day. |
Stop Date | Y | Order.auto_expire_date |
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|
Notes: for the majority of the chemotherapy drugs the dose administered is determined based on the patient’s weight at the time of treatment. Therefore when the drug order is created the dosage will read something similar to 50mg/m2, the actual dose the patient receives will be based on body surface area (calculated based on height and weight at visit).
This is an example of a common chemotherapy (CHOP) cycle administered in Rwanda
1.PREMEDICATION
Date and time | Drug and dose/ m² or/ kg | Actual dose | Route | Infusion fluid and final volume | Time /infusion Rate |
| NS 500mL |
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| Ondansetron | 8mg | PO |
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| Promethazine | 25mg | IV |
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| Cimetidine | 300mg | IV |
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| Prednisolone | 100mg | PO | For five days |
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2. CHEMOTHERAPY
Date and time | Drug and dose/ m² or/ kg | Actual dose | Route | Infusion fluid and final volume | Time /infusion Rate |
| Doxorubicin 50mg/m2 |
| IV | 250 mL NS | 15-30 minutes |
| Cyclophosphamide 750mg/m2 |
| IV | 500mL NS | One hour |
| Vincristine 1.4mg/m2 |
| IV | 100mL NS | 15 minutes |
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3. POST CHEMO
Date and time | Drug and dose/ m² or/ kg | Actual dose | Route | Infusion volume | Time /infusion Rate |
| NS 500mL |
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Examples of more complicated treatment plans.
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- Each regimen template will be assigned a display name.
- The user can also opt to denote the template as being cyclical in nature (for example the CHOP is generally administered for 6 cycles). If the cycle option is ticked the user will need to specify the length of the cycle in days.
- Functionality will exist to edit exiting regimen templates.
- A Regimen template will consist of one or more drugs.
For each drug the following information will be saved into the template
Drug – A drop down box listing all the concept drugs held within the system.
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The patient dashboard will also offer a calendar view. The calendar view will display all completed, current and future drug orders in the system in calendar format. Different colors will be used to denote current and continuing drug orders, completed drug orders and future drug orders.
Concept Drug Screen
The Concept Drug Management screen will need to be altered to allow for the Route field to be configurable for Concept Drugs.
Global properties Additions
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Settings (formerly global properties 1.8 and below) Additions
settings (formerly global properties 1.8 and below) (or other configuration mechanisms) will need to be added to store the following.
Routes – to store the valid Route values that can be assigned to a drug via the concept drug screen.
Classification – to store the valid Drug classifications that can be assigned to a drug either by a regimen template or through the patient dashboard. Each classification will need to have an order so that we can display it in the correct order on the patient dashboard and summaries.
Infusion Volumes – to store the valid infusion liquids that can be used in conjunction with IV route drugs. The infusion liquids will be created as concepts within the concept dictionary.