If this file opens in Compatibility Mode using Microsoft Word, convert to the latest document format to avoid potential formatting issues.	

IP BENDAMUSTINE / BORTEZOMIB / PREDNISONE	

Types:      ONCOLOGY TREATMENT
Synonyms:  BORTEZOMIB, VELCADE, MM, BORETEZOMIB, MYELOMA, MULTIPLE, BENDEKA, VELC, PRED, DELT, BENDA

Cycle 1	Repeat 1 time	Cycle length: 21 days	Day 1	Perform every 1 day x1		Labs
☑	COMPREHENSIVE METABOLIC PANEL	Interval: Once	Occurrences: --		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: Once	Occurrences: --		☑	MAGNESIUM LEVEL	Interval: Once	Occurrences: --		☑	LDH	Interval: Once	Occurrences: --		☑	URIC ACID LEVEL	Interval: Once	Occurrences: --		☑	PHOSPHORUS LEVEL	Interval: Once	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION 5	Interval: Once	Occurrences: --	Comments:	Use baseline weight to calculate dose. Adjust dose for weight gains/losses of greater than or equal to 10%.
			Provider Communication
  	ONC PROVIDER COMMUNICATION 64	Interval: Once	Occurrences: --	Comments:	Verify Hep B panel status prior to cycle. Date *** of panel. Result positive/negative/pending/unknown:22867

The required components for the hepatitis B panel includes: Hepatitis B surface antigen (HBsAg), total hepatitis B core antibody (anti-HBc), and hepatitis B antibody (anti-HBs).
			Nursing Orders
  	TREATMENT CONDITIONS 7	Interval: Once	Occurrences: --	Comments:	HOLD and notify provider if ANC LESS than 1000; Platelets LESS than 100,000.
			Nursing Orders
  	ONC NURSING COMMUNICATION 51	Interval: Once	Occurrences: --	Comments:	HOLD Bortezomib and notify provider if Hgb is LESS than or equal to *** g/dL.
			Vitals
  	ONC NURSING COMMUNICATION 50	Interval: Once	Occurrences: --	Comments:	1) Check vital signs (BP, temperature, pulse, and respirations) prior to and 30 minutes after Bortezomib administration.

2) If systolic BP, 30 minutes after Bortezomib infusion, drops more than 30 mmHg, or if systolic BP is less than 90, please contact MD.
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
☑	ondansetron (ZOFRAN) IV 16 mg	Dose: 16 mg	Route: intravenous	once for 1 dose	Start: S				☐	ondansetron (ZOFRAN), dexamethasone (DECADRON) in sodium chloride 0.9% 50 mL IVPB	Dose: --	Route: intravenous	once over 10 Minutes for 1 dose	Start: S			Ingredients:	Name	Type	Dose	Selected	Adds Vol.	ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION	Medications	 	Main Ingredient	No	DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION	Medications	 	Yes	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	50 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	Base	50 mL	No	Yes			☐	ondansetron (ZOFRAN) tablet 16 mg	Dose: 16 mg	Route: oral	once for 1 dose	Start: S				☐	dexamethasone (DECADRON) tablet 12 mg	Dose: 12 mg	Route: oral	once for 1 dose	Start: S				☐	fosaprepitant (EMEND) IVPB 150 mg	Dose: 150 mg	Route: intravenous	once over 30 Minutes for 1 dose	Start: S					Supportive Care
  	predniSONE (DELTASONE) tablet 100 mg	Dose: 100 mg	Route: oral	daily						Chemotherapy
  	bendamustine (BENDEKA) 60 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 60 mg/m2	Route: intravenous	once over 10 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	VESICANT May cause QTc prolongation.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	BENDAMUSTINE 25 MG/ML INTRAVENOUS SOLUTION	Medications	60 mg/m2	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes				Chemotherapy
  	bortezomib (VelCADE) 1.3 mg/m2 in sodium chloride 0.9% chemo injection	Dose: 1.3 mg/m2	Route: subcutaneous	once for 1 dose			Offset: 45 Minutes	Instructions:	DRUG IS AN IRRITANT.  Administer drug slowly to prevent burning upon administration.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION	Medications	1.3 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: Until discontinued	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: Until discontinued	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: Until discontinued	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN	Start: S				  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.				Day 2	Perform every 1 day x1		Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
☑	ondansetron (ZOFRAN) IV 16 mg	Dose: 16 mg	Route: intravenous	once for 1 dose	Start: S				☐	ondansetron (ZOFRAN), dexamethasone (DECADRON) in sodium chloride 0.9% 50 mL IVPB	Dose: --	Route: intravenous	once over 10 Minutes for 1 dose	Start: S			Ingredients:	Name	Type	Dose	Selected	Adds Vol.	ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION	Medications	 	Main Ingredient	No	DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION	Medications	 	Yes	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	50 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	Base	50 mL	No	Yes			☐	ondansetron (ZOFRAN) tablet 16 mg	Dose: 16 mg	Route: oral	once for 1 dose	Start: S				☐	dexamethasone (DECADRON) tablet 12 mg	Dose: 12 mg	Route: oral	once for 1 dose	Start: S				☐	fosaprepitant (EMEND) IVPB 150 mg	Dose: 150 mg	Route: intravenous	once over 30 Minutes for 1 dose	Start: S					Chemotherapy
  	bendamustine (BENDEKA) 60 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 60 mg/m2	Route: intravenous	once over 10 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	VESICANT May cause QTc prolongation.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	BENDAMUSTINE 25 MG/ML INTRAVENOUS SOLUTION	Medications	60 mg/m2	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes					Day 4	Perform every 1 day x1		Vitals
  	ONC NURSING COMMUNICATION 50	Interval: Once	Occurrences: --	Comments:	1) Check vital signs (BP, temperature, pulse, and respirations) prior to and 30 minutes after Bortezomib administration.

2) If systolic BP, 30 minutes after Bortezomib infusion, drops more than 30 mmHg, or if systolic BP is less than 90, please contact MD.
			Chemotherapy
  	bortezomib (VelCADE) 1.3 mg/m2 in sodium chloride 0.9% chemo injection	Dose: 1.3 mg/m2	Route: subcutaneous	once for 1 dose			Offset: 45 Minutes	Instructions:	DRUG IS AN IRRITANT.  Administer drug slowly to prevent burning upon administration.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION	Medications	1.3 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INJECTION SOLUTION	Base	 	Always	Yes					Day 8	Perform every 1 day x1		Vitals
  	ONC NURSING COMMUNICATION 50	Interval: Once	Occurrences: --	Comments:	1) Check vital signs (BP, temperature, pulse, and respirations) prior to and 30 minutes after Bortezomib administration.

2) If systolic BP, 30 minutes after Bortezomib infusion, drops more than 30 mmHg, or if systolic BP is less than 90, please contact MD.
			Chemotherapy
  	bortezomib (VelCADE) 1.3 mg/m2 in sodium chloride 0.9% chemo injection	Dose: 1.3 mg/m2	Route: subcutaneous	once for 1 dose			Offset: 45 Minutes	Instructions:	DRUG IS AN IRRITANT.  Administer drug slowly to prevent burning upon administration.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION	Medications	1.3 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INJECTION SOLUTION	Base	 	Always	Yes					Day 11	Perform every 1 day x1		Vitals
  	ONC NURSING COMMUNICATION 50	Interval: Once	Occurrences: --	Comments:	1) Check vital signs (BP, temperature, pulse, and respirations) prior to and 30 minutes after Bortezomib administration.

2) If systolic BP, 30 minutes after Bortezomib infusion, drops more than 30 mmHg, or if systolic BP is less than 90, please contact MD.
			Chemotherapy
  	bortezomib (VelCADE) 1.3 mg/m2 in sodium chloride 0.9% chemo injection	Dose: 1.3 mg/m2	Route: subcutaneous	once for 1 dose			Offset: 45 Minutes	Instructions:	DRUG IS AN IRRITANT.  Administer drug slowly to prevent burning upon administration.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION	Medications	1.3 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INJECTION SOLUTION	Base	 	Always	Yes