Protocols for pre-chemo labs?

[North Woods Nurse]

Hi, new to the group and I apologize if this has been discussed already. I am trying to find protocols on doing labs prior to infusing chemotherapies. We are an outpatient Infusion Center accepting orders from outside practitioners. My question is based on one facility that is now providing us with E-orders. In some cases, the orders include no lab orders, but do direct nursing to "Call provider if ANC is

What does your facility do in these cases? Does anyone have a policy or protocol I could 'borrow' to create a protocol for my own facility while supporting my nursing assessments?

Thank you!

[SoldierNurse22, BSN, RN]

A clinical indication isn't an order. Without an order, labs cannot be drawn and processed--at least in my facility and in all the others I've worked in. I'm not sure what about that requires a policy, unless you're trying to specify which labs need to be drawn prior to which drugs? In that case, ONS's guidelines should suffice to educate your staff.

[KelRN215, BSN, RN]

It sounds like what you need are standing orders. Not all chemotherapy requires labs prior. Methotrexate is the #1 chemo that I give in the home... most kids need pre-labs (CBC/Diff and liver enzymes) but some that are on the maximum dose with stable labs don't. For these kids it's written into the protocol and the provider simply checks "draw labs prior to administration" or "no labs needed".

[DatMurse]

https://www.ons.org/products/chemotherapy-and-biotherapy-guidelines-and-recommendations-practice-fourth-edition

Solid book. I look at contraindications and labs to monitor for prior to chemo admin. I am still new at giving chemotherapy but I have called and reported contraindications to the doctor before admin.

Ex. The last call before I got checked off on chemo was cytarabine. Contraindication was myelosupression, The patient's ANC was not calculatable because her neutrophil % was 0 and her WBC was 0.200's. He said thats why she is getting it and they are pinned. If she doesnt get it she will die. I told him I know it was just standard for me to give him a call and he said that is fine(he is a very nice guy)

So its safe to say that a lab that should be done for cytarabine should have been a CBC.