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

RESEARCH PRO00020441 ABDELRAHIM CCAT REPLIMUNE RPL-001-16 PHASE 2	

Types:      Research Oncology Treatment
Synonyms:  ADVANCED, SOLID, TUMOR, PRO20441, 20441

Screening	Repeat 1 time	Cycle length: 14 days	Day 1	Perform every 1 day x1		Nursing Orders
  	ONC NURSING COMMUNICATION 75	Interval: --	Occurrences: --	Comments:	Baseline ECG without evidence of acute ischemia or prolonged QT interval GREATER than 440 ms in men and GREATER than 460 ms in women
		  	ONC NURSING COMMUNICATION 80	Interval: --	Occurrences: --	Comments:	Baseline troponin LESS than 0.06 ng/mL
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Obtain Informed Consent
		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Ensure full physical exam w/ ECOG score completed
		  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Obtain medical history and demographics
		  	ONC NURSING COMMUNICATION 8	Interval: --	Occurrences: --	Comments:	Review Inclusion/Exclusion criteria
		  	ONC NURSING COMMUNICATION 9	Interval: --	Occurrences: --	Comments:	Ensure Brain MRI ordered per protocol
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	Ensure CT scans ordered per protocol
		  	ONC NURSING COMMUNICATION 11	Interval: --	Occurrences: --	Comments:	Ensure archival tumor/biopsy sample submitted to central lab; if no archival tissue available fresh biopsy must be collected
		  	ONC NURSING COMMUNICATION 52	Interval: --	Occurrences: --	Comments:	Obtain superficial lesion photography if indicated
		  	ONC NURSING COMMUNICATION 12	Interval: --	Occurrences: --	Comments:	Obtain Superficial Lesion Measurements
		  	ECG 12-LEAD	Interval: --	Occurrences: --		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Nursing Orders
  	PULSE OXIMETRY	Interval: --	Occurrences: --			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		  	T3, FREE	Interval: --	Occurrences: --		  	T4, FREE	Interval: --	Occurrences: --		  	TROPONIN	Interval: --	Occurrences: --		  	PROTHROMBIN TIME WITH INR	Interval: --	Occurrences: --		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: --	Occurrences: --		  	URINALYSIS, AUTOMATED WITH MICROSCOPY	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
		  	HERPES SIMPLEX VIRUS 1 (HSV) IGG	Interval: --	Occurrences: --					
Cycle 1	Repeat 1 time	Cycle length: 14 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 12	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 8	Interval: --	Occurrences: --	Comments:	Review Inclusion/Exclusion criteria
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions prior to RP1 dosing
		  	ONC NURSING COMMUNICATION 30	Interval: --	Occurrences: --	Comments:	Ensure Deep/Visceral Lesions measured via CT scan - coordinate with radiology to ensure completion a few days prior to dosing
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --			Pre-Medications
  	lidocaine-prilocaine (EMLA) cream	Dose: --	Route: Topical	once for 1 dose	Start: S			Instructions:	Prior to RP1 dosing		  	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	every 6 hours	Start: S			Instructions:	Prior to RP1 injection. Please instruct patient to continue taking Tylenol every 6 hour for 24 hours.		  	ondansetron (ZOFRAN) tablet	Dose: --	Route: oral	PRN	Start: S					Nursing Orders
  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	The RP1 study drug will be reconstituted at Texas Children Hospital. The CCAT staff will communicate with Texas Children Hospital to ensure the proper dose / amount of RP1 is reconstituted and delivered to HMH.
			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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		Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
				Day 3	Perform every 1 day x1		Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
					
Cycle 2	Repeat 1 time	Cycle length: 14 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 12	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions prior to RP1 dosing
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Labs
  	HERPES SIMPLEX VIRUS 1 (HSV) IGG	Interval: --	Occurrences: --			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --			Pre-Medications
  	lidocaine-prilocaine (EMLA) cream	Dose: --	Route: Topical	once for 1 dose	Start: S			Instructions:	Prior to RP1 dosing		  	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	every 6 hours	Start: S			Instructions:	Prior to RP1 injection. Please instruct patient to continue taking Tylenol every 6 hour for 24 hours.		  	ondansetron (ZOFRAN) tablet	Dose: --	Route: oral	PRN	Start: S					Nursing Orders
  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	The RP1 study drug will be reconstituted at Texas Children Hospital. The CCAT staff will communicate with Texas Children Hospital to ensure the proper dose / amount of RP1 is reconstituted and delivered to HMH.
			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 240 mg in sodium chloride 0.9% 100 mL (2.4 mg/mL) IVPB	Dose: 240 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 1 Hours	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	240 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	76 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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		Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
				Day 3	Perform every 1 day x1		Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
					
Cycle 3	Repeat 1 time	Cycle length: 14 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 12	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions prior to RP1 dosing
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Labs
  	HERPES SIMPLEX VIRUS 1 (HSV) IGG	Interval: --	Occurrences: --			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --			Pre-Medications
  	lidocaine-prilocaine (EMLA) cream	Dose: --	Route: Topical	once for 1 dose	Start: S			Instructions:	Prior to RP1 dosing		  	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	every 6 hours	Start: S			Instructions:	Prior to RP1 injection. Please instruct patient to continue taking Tylenol every 6 hour for 24 hours.		  	ondansetron (ZOFRAN) tablet	Dose: --	Route: oral	PRN	Start: S					Nursing Orders
  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	The RP1 study drug will be reconstituted at Texas Children Hospital. The CCAT staff will communicate with Texas Children Hospital to ensure the proper dose / amount of RP1 is reconstituted and delivered to HMH.
			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 240 mg in sodium chloride 0.9% 100 mL (2.4 mg/mL) IVPB	Dose: 240 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 1 Hours	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	240 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	76 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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		Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
				Day 3	Perform every 1 day x1		Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
					
Cycle 4	Repeat 1 time	Cycle length: 14 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 12	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions prior to RP1 dosing
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Procedures
  	BIOPSY	Interval: --	Occurrences: --	Comments:	Fresh biopsy to send to central lab (may be obtained 3 days prior to C4D1 visit)
			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Labs
  	HERPES SIMPLEX VIRUS 1 (HSV) IGG	Interval: --	Occurrences: --			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --			Pre-Medications
  	lidocaine-prilocaine (EMLA) cream	Dose: --	Route: Topical	once for 1 dose	Start: S			Instructions:	Prior to RP1 dosing		  	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	every 6 hours	Start: S			Instructions:	Prior to RP1 injection. Please instruct patient to continue taking Tylenol every 6 hour for 24 hours.		  	ondansetron (ZOFRAN) tablet	Dose: --	Route: oral	PRN	Start: S					Nursing Orders
  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	The RP1 study drug will be reconstituted at Texas Children Hospital. The CCAT staff will communicate with Texas Children Hospital to ensure the proper dose / amount of RP1 is reconstituted and delivered to HMH.
			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 240 mg in sodium chloride 0.9% 100 mL (2.4 mg/mL) IVPB	Dose: 240 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 1 Hours	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	240 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	76 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.					
Cycle 5	Repeat 1 time	Cycle length: 14 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 12	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions prior to RP1 dosing
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 12	Interval: --	Occurrences: --	Comments:	Obtain Superficial Lesion Measurements
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	Ensure CT scans ordered per protocol
		  	ONC NURSING COMMUNICATION 36	Interval: --	Occurrences: --	Comments:	Ensure Deep/Visceral Lesions measured via CT scan - coordinate with radiology to ensure completion a few days prior to dosing
			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Labs
  	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		  	T3, FREE	Interval: --	Occurrences: --		  	T4, FREE	Interval: --	Occurrences: --			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --			Pre-Medications
  	lidocaine-prilocaine (EMLA) cream	Dose: --	Route: Topical	once for 1 dose	Start: S			Instructions:	Prior to RP1 dosing		  	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	every 6 hours	Start: S			Instructions:	Prior to RP1 injection. Please instruct patient to continue taking Tylenol every 6 hour for 24 hours.		  	ondansetron (ZOFRAN) tablet	Dose: --	Route: oral	PRN	Start: S					Nursing Orders
  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	The RP1 study drug will be reconstituted at Texas Children Hospital. The CCAT staff will communicate with Texas Children Hospital to ensure the proper dose / amount of RP1 is reconstituted and delivered to HMH.
			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 240 mg in sodium chloride 0.9% 100 mL (2.4 mg/mL) IVPB	Dose: 240 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 1 Hours	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	240 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	76 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.					
Cycle 6	Repeat 1 time	Cycle length: 14 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 12	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions prior to RP1 dosing
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --			Pre-Medications
  	lidocaine-prilocaine (EMLA) cream	Dose: --	Route: Topical	once for 1 dose	Start: S			Instructions:	Prior to RP1 dosing		  	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	every 6 hours	Start: S			Instructions:	Prior to RP1 injection. Please instruct patient to continue taking Tylenol every 6 hour for 24 hours.		  	ondansetron (ZOFRAN) tablet	Dose: --	Route: oral	PRN	Start: S					Nursing Orders
  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	The RP1 study drug will be reconstituted at Texas Children Hospital. The CCAT staff will communicate with Texas Children Hospital to ensure the proper dose / amount of RP1 is reconstituted and delivered to HMH.
			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 240 mg in sodium chloride 0.9% 100 mL (2.4 mg/mL) IVPB	Dose: 240 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 1 Hours	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	240 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	76 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.					
Cycle 7	Repeat 1 time	Cycle length: 14 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 12	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions prior to RP1 dosing
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --			Pre-Medications
  	lidocaine-prilocaine (EMLA) cream	Dose: --	Route: Topical	once for 1 dose	Start: S			Instructions:	Prior to RP1 dosing		  	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	every 6 hours	Start: S			Instructions:	Prior to RP1 injection. Please instruct patient to continue taking Tylenol every 6 hour for 24 hours.		  	ondansetron (ZOFRAN) tablet	Dose: --	Route: oral	PRN	Start: S					Nursing Orders
  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	The RP1 study drug will be reconstituted at Texas Children Hospital. The CCAT staff will communicate with Texas Children Hospital to ensure the proper dose / amount of RP1 is reconstituted and delivered to HMH.
			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 240 mg in sodium chloride 0.9% 100 mL (2.4 mg/mL) IVPB	Dose: 240 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 1 Hours	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	240 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	76 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.					
Cycle 8	Repeat 1 time	Cycle length: 14 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 12	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions prior to RP1 dosing
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Labs
  	ECG 12-LEAD	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Labs
  	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		  	T3, FREE	Interval: --	Occurrences: --		  	T4, FREE	Interval: --	Occurrences: --			Labs
  	TROPONIN	Interval: --	Occurrences: --			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --			Pre-Medications
  	lidocaine-prilocaine (EMLA) cream	Dose: --	Route: Topical	once for 1 dose	Start: S			Instructions:	Prior to RP1 dosing		  	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	every 6 hours	Start: S			Instructions:	Prior to RP1 injection. Please instruct patient to continue taking Tylenol every 6 hour for 24 hours.		  	ondansetron (ZOFRAN) tablet	Dose: --	Route: oral	PRN	Start: S					Nursing Orders
  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	The RP1 study drug will be reconstituted at Texas Children Hospital. The CCAT staff will communicate with Texas Children Hospital to ensure the proper dose / amount of RP1 is reconstituted and delivered to HMH.
			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 240 mg in sodium chloride 0.9% 100 mL (2.4 mg/mL) IVPB	Dose: 240 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 1 Hours	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	240 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	76 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.					
Cycle 9	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 8	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	ONC NURSING COMMUNICATION 12	Interval: --	Occurrences: --	Comments:	Obtain Superficial Lesion Measurements
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions if not reliably measured by imaging
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	Ensure CT scans ordered per protocol
		  	ONC NURSING COMMUNICATION 36	Interval: --	Occurrences: --	Comments:	Ensure Deep/Visceral Lesions measured via CT scan - coordinate with radiology to ensure completion a few days prior to dosing
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 240 mg in sodium chloride 0.9% 100 mL (2.4 mg/mL) IVPB	Dose: 240 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	240 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	76 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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 16	Perform every 1 day x1		Nursing Orders
  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	C9D16 visit to occur 30 days after last dose of RP1 (+ 7 days)
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
					
Cycle 10	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 8	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Labs
  	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		  	T3, FREE	Interval: --	Occurrences: --		  	T4, FREE	Interval: --	Occurrences: --			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 480 mg in sodium chloride 0.9% 100 mL (4.8 mg/mL) IVPB	Dose: 480 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	480 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	52 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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 18	Perform every 1 day x1		Nursing Orders
  	ONC NURSING COMMUNICATION 38	Interval: --	Occurrences: --	Comments:	C10 D18 visit to occur 60 days after last dose of RP1 (+ 7 days)
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --	Comments:	For select patients ONLY - please confer with sponsor regarding the labs prior to collection
					
Cycle 11	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 8	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions if not reliably measured by imaging
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	Ensure CT scans ordered per protocol
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Labs
  	ECG 12-LEAD	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Labs
  	TROPONIN	Interval: --	Occurrences: --			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 480 mg in sodium chloride 0.9% 100 mL (4.8 mg/mL) IVPB	Dose: 480 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	480 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	52 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.					
Cycle 12	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 8	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions if not reliably measured by imaging
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Labs
  	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		  	T3, FREE	Interval: --	Occurrences: --		  	T4, FREE	Interval: --	Occurrences: --			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 480 mg in sodium chloride 0.9% 100 mL (4.8 mg/mL) IVPB	Dose: 480 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	480 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	52 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.					
Cycle 13	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 8	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions if not reliably measured by imaging
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	Ensure CT scans ordered per protocol
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 480 mg in sodium chloride 0.9% 100 mL (4.8 mg/mL) IVPB	Dose: 480 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	480 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	52 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.					
Cycle 14	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 8	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions if not reliably measured by imaging
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Labs
  	ECG 12-LEAD	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Labs
  	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		  	T3, FREE	Interval: --	Occurrences: --		  	T4, FREE	Interval: --	Occurrences: --			Labs
  	TROPONIN	Interval: --	Occurrences: --			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 480 mg in sodium chloride 0.9% 100 mL (4.8 mg/mL) IVPB	Dose: 480 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	480 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	52 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.					
Cycle 15	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 8	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions if not reliably measured by imaging
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	Ensure CT scans ordered per protocol
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 480 mg in sodium chloride 0.9% 100 mL (4.8 mg/mL) IVPB	Dose: 480 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	480 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	52 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.					
Cycle 16	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 8	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions if not reliably measured by imaging
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Labs
  	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		  	T3, FREE	Interval: --	Occurrences: --		  	T4, FREE	Interval: --	Occurrences: --			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 480 mg in sodium chloride 0.9% 100 mL (4.8 mg/mL) IVPB	Dose: 480 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	480 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	52 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.					
Cycle 17	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 8	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions if not reliably measured by imaging
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	Ensure CT scans ordered per protocol
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Labs
  	ECG 12-LEAD	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Labs
  	TROPONIN	Interval: --	Occurrences: --			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 480 mg in sodium chloride 0.9% 100 mL (4.8 mg/mL) IVPB	Dose: 480 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	480 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	52 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.					
Cycle 18	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 8	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions if not reliably measured by imaging
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Labs
  	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		  	T3, FREE	Interval: --	Occurrences: --		  	T4, FREE	Interval: --	Occurrences: --			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 480 mg in sodium chloride 0.9% 100 mL (4.8 mg/mL) IVPB	Dose: 480 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	480 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	52 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.					
Cycle 19	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 8	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions if not reliably measured by imaging
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	Ensure CT scans ordered per protocol
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 480 mg in sodium chloride 0.9% 100 mL (4.8 mg/mL) IVPB	Dose: 480 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	480 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	52 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.					
Cycle 20	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 8	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions if not reliably measured by imaging
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Labs
  	ECG 12-LEAD	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Labs
  	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		  	T3, FREE	Interval: --	Occurrences: --		  	T4, FREE	Interval: --	Occurrences: --			Labs
  	TROPONIN	Interval: --	Occurrences: --			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 480 mg in sodium chloride 0.9% 100 mL (4.8 mg/mL) IVPB	Dose: 480 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	480 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	52 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.					
Cycle 21	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 8	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions if not reliably measured by imaging
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	Ensure CT scans ordered per protocol
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 480 mg in sodium chloride 0.9% 100 mL (4.8 mg/mL) IVPB	Dose: 480 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	480 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	52 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.					
Cycle 22	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 8	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions if not reliably measured by imaging
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Labs
  	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		  	T3, FREE	Interval: --	Occurrences: --		  	T4, FREE	Interval: --	Occurrences: --			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 480 mg in sodium chloride 0.9% 100 mL (4.8 mg/mL) IVPB	Dose: 480 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	480 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	52 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.					
Cycle 23	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 8	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions if not reliably measured by imaging
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	Ensure CT scans ordered per protocol
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Labs
  	ECG 12-LEAD	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Labs
  	TROPONIN	Interval: --	Occurrences: --			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 480 mg in sodium chloride 0.9% 100 mL (4.8 mg/mL) IVPB	Dose: 480 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	480 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	52 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.					
Cycle 24	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 8	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions if not reliably measured by imaging
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Labs
  	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		  	T3, FREE	Interval: --	Occurrences: --		  	T4, FREE	Interval: --	Occurrences: --			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 480 mg in sodium chloride 0.9% 100 mL (4.8 mg/mL) IVPB	Dose: 480 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	480 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	52 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.					
Cycle 25	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 8	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions if not reliably measured by imaging
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	Ensure CT scans ordered per protocol
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 480 mg in sodium chloride 0.9% 100 mL (4.8 mg/mL) IVPB	Dose: 480 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	480 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	52 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.					
Cycle 26	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 8	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions if not reliably measured by imaging
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Labs
  	ECG 12-LEAD	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Labs
  	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		  	T3, FREE	Interval: --	Occurrences: --		  	T4, FREE	Interval: --	Occurrences: --			Labs
  	TROPONIN	Interval: --	Occurrences: --			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 480 mg in sodium chloride 0.9% 100 mL (4.8 mg/mL) IVPB	Dose: 480 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	480 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	52 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.					
Cycle 27	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 8	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions if not reliably measured by imaging
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	Ensure CT scans ordered per protocol
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 480 mg in sodium chloride 0.9% 100 mL (4.8 mg/mL) IVPB	Dose: 480 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	480 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	52 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.					
Cycle 28	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 8	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions if not reliably measured by imaging
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Labs
  	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		  	T3, FREE	Interval: --	Occurrences: --		  	T4, FREE	Interval: --	Occurrences: --			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 480 mg in sodium chloride 0.9% 100 mL (4.8 mg/mL) IVPB	Dose: 480 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	480 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	52 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.					
Cycle 29	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 8	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions if not reliably measured by imaging
		  	ONC NURSING COMMUNICATION 10	Interval: --	Occurrences: --	Comments:	Ensure CT scans ordered per protocol
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Labs
  	ECG 12-LEAD	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Labs
  	TROPONIN	Interval: --	Occurrences: --			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 480 mg in sodium chloride 0.9% 100 mL (4.8 mg/mL) IVPB	Dose: 480 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	480 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	52 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.					
Cycle 30	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 8	Interval: --	Occurrences: --			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.			Nursing Orders
  	ONC NURSING COMMUNICATION 14	Interval: --	Occurrences: --	Comments:	o WBC GREATER than or EQUAL to 2.0 x 10^9/L  
o Absolute neutrophil count (ANC) GREATER than or EQUAL to 1.5 x 10^9/L 
o Platelet count GREATER than or EQUAL to 100 x 10^9/L
o Hemoglobin GREATER than or EQUAL to 9 g/dL or GREATER than or EQUAL to 5.6 mmol/L (without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within 2 weeks of dosing)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	o Total bilirubin LESS than or EQUAL to 1.5 x upper limit of normal (ULN) 
o Aspartate amino transferase (AST) and Alanine amino transferase (ALT) LESS than or EQUAL to 3.0 x ULN
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Blood creatinine LESS than or EQUAL to 1.5 x ULN or measured or calculated (using Cockroft) creatinine clearance GREATER than or EQUAL to 40cc/min for participant with creatinine levels GREATER than 1.5 x institutional ULN
		  	ONC NURSING COMMUNICATION 20	Interval: --	Occurrences: --	Comments:	o Prothrombin time (PT) LESS than or EQUAL to 1.5 x ULN (or international normalization ratio [INR] LESS than or EQUAL to 1.3) 
o Partial thromboplastin time (PTT) or activated PTT (aPTT) LESS than or EQUAL to 1.5 x ULN
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: --	Occurrences: --	Comments:	Ensure Symptom Directed Physical Exam and ECOG completed
		  	ONC NURSING COMMUNICATION 32	Interval: --	Occurrences: --	Comments:	Optional sample collection for possible herpetic infection - see protocol for details
		  	ONC NURSING COMMUNICATION 33	Interval: --	Occurrences: --	Comments:	Review concomitant medications and AE/SAE
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Obtain photos of superficial lesions if not reliably measured by imaging
		  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	Interval: --	Occurrences: --	Comments:	Unless otherwise specified, please perform all labs and procedures prior to administration of study med
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		  	LDH	Interval: --	Occurrences: --		  	BILIRUBIN DIRECT	Interval: --	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: --	Occurrences: --		  	AMYLASE LEVEL	Interval: --	Occurrences: --		  	LIPASE LEVEL	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --	Comments:	For women of child bearing age. Please order serum screen if urine screen is positive.
			Labs
  	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		  	T3, FREE	Interval: --	Occurrences: --		  	T4, FREE	Interval: --	Occurrences: --			Chemotherapy
  	INV-Nivolumab (RP1/Pro00020441/Abdelrahim) 480 mg in sodium chloride 0.9% 100 mL (4.8 mg/mL) IVPB	Dose: 480 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Prepared dose contains open label active Nivolumab. Administer intravenously via pump, using 0.2 to 1.2 micron inline filter, over 30 minutes. Do not shake. Do not mix with other medications. Flush IV line with NS at the end of infusion.
Stability of prepared dose: Room temperature, including infusion time: 8 hours. Refrigerated: 24 hours.  HAZARDOUS	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION (RP1/PRO00020441/ABDELRAHIM)	Medications	480 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	52 mL	Yes	Yes	DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	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 4	Interval: --	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 83	Interval: --	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	once 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					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.