Protocol Index	

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RESEARCH PRO00021863 / ZHANG / PACIFIC 4	

Types:      Research Oncology Treatment
Synonyms:  21863, PRO21863, PACIFIC-4

Screening	Repeat 1 time	Cycle length: 28 days	(Day –28 to Day –1)	Perform every 1 day x1		Imaging
  	CT CHEST W WO CONTRAST	Interval: --	Occurrences: --		  	CT ABDOMEN W WO CONTRAST	Interval: --	Occurrences: --			Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --		  	RESEARCH - HEIGHT AND WEIGHT	Interval: --	Occurrences: --		  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	ECOG
		  	ECG 12-LEAD	Interval: --	Occurrences: --		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Questionnaire to be performed by research staff
			Nursing Orders
  	SPIROMETRY PRE AND POST WITH BRONCHILATOR	Interval: --	Occurrences: --		  	BODY PLETHYSMOGRAPHIC LUNG VOLUMES	Interval: --	Occurrences: --		  	DIFFUSION CAPACITY	Interval: --	Occurrences: --			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	GGT	Interval: --	Occurrences: --		☑	MAGNESIUM LEVEL	Interval: --	Occurrences: --		☑	AMYLASE LEVEL	Interval: --	Occurrences: --		☑	LIPASE LEVEL	Interval: --	Occurrences: --		☑	LDH	Interval: --	Occurrences: --		☑	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		☑	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		☐	T3, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☐	T4, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☑	URINALYSIS, AUTOMATED WITH MICROSCOPY	Interval: --	Occurrences: --		☑	HEPATITIS B SURFACE ANTIGEN	Interval: --	Occurrences: --		☑	HEPATITIS C ANTIBODY	Interval: --	Occurrences: --		☑	HIV 1/2 ANTIGEN/ANTIBODY, FOURTH GENERATION, WITH REFLEXES	Interval: --	Occurrences: --			Labs
  	MISCELLANEOUS REFERRAL TEST	Interval: --	Occurrences: --	Comments:	ctDNA
		  	MISCELLANEOUS REFERRAL TEST	Interval: --	Occurrences: --	Comments:	Genetic sampling (if patient consented)
				(within 72 hours of C1D1)	Perform every 1 day x1		Labs
  	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --					
Cycle 1	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 5	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	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
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --		  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	ECOG
		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Questionnaire to be performed by research staff
			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	GGT	Interval: --	Occurrences: --		☑	MAGNESIUM LEVEL	Interval: --	Occurrences: --		☑	AMYLASE LEVEL	Interval: --	Occurrences: --		☑	LIPASE LEVEL	Interval: --	Occurrences: --		☑	LDH	Interval: --	Occurrences: --		☑	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		☑	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		☐	T3, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☐	T4, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
			Labs
  	MISCELLANEOUS REFERRAL TEST	Interval: --	Occurrences: --	Comments:	ctDNA
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --			Chemotherapy
  	INV-Durvalumab or Placebo (PACIFIC-4/Pro00021863/Bernicker) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 60 Minutes for 1 dose	Start: S			Instructions:	Infuse using a 0.2 micron inline filter.  Do not infuse other medications through the same IV line.  Stable for 4 hours at room temperature, 24 hours refrigerated.	Rule-Based Template: RULE ONCBCN INV-DURVALUMAB 20 MG/KG	  Conditions:	  Modifications:	  If TP WT < 30 KG	  Set dose to 20 mg/kg	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-DURVALUMAB OR PLACEBO 50 MG/ML IV SOLN (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Supportive Care
☐	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	famotidine (PEPCID) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	fexofenadine (ALLEGRA) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	hydrocortisone sodium succinate (Solu-CORTEF) injection	Dose: --	Route: intravenous	one-time Injection for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	INV-Infliximab (PACIFIC-4/Pro00021863/Zhang) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 120 Minutes for 1 dose	Start: S			Instructions:	Use an in-line, sterile, non-pyrogenic, low protein-binding filter with 1.2 micron pore size or less.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFLIXIMAB 100 MG INTRAVENOUS SOLUTION (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Always	Yes			☐	INV-mycophenolate (PACIFIC-4/PRO00021863/ZHANG) capsule/tablet	Dose: --	Route: oral	2 times daily	Start: S			Instructions:	Do not crush or chew. Swallow whole. Store at room temperature and keep away from children.			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 Fexofenadine 180 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), Fexofenadine 180 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				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	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 15	Perform every 1 day x1		Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Questionnaire to be performed by research staff
					
Cycle 2	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 5	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	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
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Questionnaire to be performed by research staff
			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	AMYLASE LEVEL	Interval: --	Occurrences: --		☑	LIPASE LEVEL	Interval: --	Occurrences: --		☑	LDH	Interval: --	Occurrences: --		☑	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		☑	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		☐	T3, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☐	T4, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
			Labs
  	MISCELLANEOUS REFERRAL TEST	Interval: --	Occurrences: --	Comments:	ctDNA
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --			Chemotherapy
  	INV-Durvalumab or Placebo (PACIFIC-4/Pro00021863/Bernicker) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 60 Minutes for 1 dose	Start: S			Instructions:	Infuse using a 0.2 micron inline filter.  Do not infuse other medications through the same IV line.  Stable for 4 hours at room temperature, 24 hours refrigerated.	Rule-Based Template: RULE ONCBCN INV-DURVALUMAB 20 MG/KG	  Conditions:	  Modifications:	  If TP WT < 30 KG	  Set dose to 20 mg/kg	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-DURVALUMAB OR PLACEBO 50 MG/ML IV SOLN (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Supportive Care
☐	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	famotidine (PEPCID) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	fexofenadine (ALLEGRA) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	hydrocortisone sodium succinate (Solu-CORTEF) injection	Dose: --	Route: intravenous	one-time Injection for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	INV-Infliximab (PACIFIC-4/Pro00021863/Zhang) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 120 Minutes for 1 dose	Start: S			Instructions:	Use an in-line, sterile, non-pyrogenic, low protein-binding filter with 1.2 micron pore size or less.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFLIXIMAB 100 MG INTRAVENOUS SOLUTION (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Always	Yes			☐	INV-mycophenolate (PACIFIC-4/PRO00021863/ZHANG) capsule/tablet	Dose: --	Route: oral	2 times daily	Start: S			Instructions:	Do not crush or chew. Swallow whole. Store at room temperature and keep away from children.			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 Fexofenadine 180 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), Fexofenadine 180 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				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	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 15	Perform every 1 day x1		Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Questionnaire to be performed by research staff
					
Cycle 3	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 5	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	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.			Imaging
  	CT CHEST W WO CONTRAST	Interval: --	Occurrences: --		  	CT ABDOMEN W WO CONTRAST	Interval: --	Occurrences: --			Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Questionnaire to be performed by research staff
			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	AMYLASE LEVEL	Interval: --	Occurrences: --		☑	LIPASE LEVEL	Interval: --	Occurrences: --		☑	LDH	Interval: --	Occurrences: --		☑	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		☑	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		☐	T3, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☐	T4, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
			Labs
  	MISCELLANEOUS REFERRAL TEST	Interval: --	Occurrences: --	Comments:	ctDNA
		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --			Chemotherapy
  	INV-Durvalumab or Placebo (PACIFIC-4/Pro00021863/Bernicker) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 60 Minutes for 1 dose	Start: S			Instructions:	Infuse using a 0.2 micron inline filter.  Do not infuse other medications through the same IV line.  Stable for 4 hours at room temperature, 24 hours refrigerated.	Rule-Based Template: RULE ONCBCN INV-DURVALUMAB 20 MG/KG	  Conditions:	  Modifications:	  If TP WT < 30 KG	  Set dose to 20 mg/kg	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-DURVALUMAB OR PLACEBO 50 MG/ML IV SOLN (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Supportive Care
☐	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	famotidine (PEPCID) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	fexofenadine (ALLEGRA) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	hydrocortisone sodium succinate (Solu-CORTEF) injection	Dose: --	Route: intravenous	one-time Injection for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	INV-Infliximab (PACIFIC-4/Pro00021863/Zhang) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 120 Minutes for 1 dose	Start: S			Instructions:	Use an in-line, sterile, non-pyrogenic, low protein-binding filter with 1.2 micron pore size or less.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFLIXIMAB 100 MG INTRAVENOUS SOLUTION (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Always	Yes			☐	INV-mycophenolate (PACIFIC-4/PRO00021863/ZHANG) capsule/tablet	Dose: --	Route: oral	2 times daily	Start: S			Instructions:	Do not crush or chew. Swallow whole. Store at room temperature and keep away from children.			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 Fexofenadine 180 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), Fexofenadine 180 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				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	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.					
Cycles 4,5	Repeat 2 times	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 5	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	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
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Questionnaire to be performed by research staff
			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	AMYLASE LEVEL	Interval: --	Occurrences: --		☑	LIPASE LEVEL	Interval: --	Occurrences: --		☑	LDH	Interval: --	Occurrences: --		☑	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		☑	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		☐	T3, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☐	T4, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
			Chemotherapy
  	INV-Durvalumab or Placebo (PACIFIC-4/Pro00021863/Bernicker) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 60 Minutes for 1 dose	Start: S			Instructions:	Infuse using a 0.2 micron inline filter.  Do not infuse other medications through the same IV line.  Stable for 4 hours at room temperature, 24 hours refrigerated.	Rule-Based Template: RULE ONCBCN INV-DURVALUMAB 20 MG/KG	  Conditions:	  Modifications:	  If TP WT < 30 KG	  Set dose to 20 mg/kg	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-DURVALUMAB OR PLACEBO 50 MG/ML IV SOLN (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Supportive Care
☐	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	famotidine (PEPCID) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	fexofenadine (ALLEGRA) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	hydrocortisone sodium succinate (Solu-CORTEF) injection	Dose: --	Route: intravenous	one-time Injection for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	INV-Infliximab (PACIFIC-4/Pro00021863/Zhang) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 120 Minutes for 1 dose	Start: S			Instructions:	Use an in-line, sterile, non-pyrogenic, low protein-binding filter with 1.2 micron pore size or less.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFLIXIMAB 100 MG INTRAVENOUS SOLUTION (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Always	Yes			☐	INV-mycophenolate (PACIFIC-4/PRO00021863/ZHANG) capsule/tablet	Dose: --	Route: oral	2 times daily	Start: S			Instructions:	Do not crush or chew. Swallow whole. Store at room temperature and keep away from children.			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 Fexofenadine 180 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), Fexofenadine 180 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				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	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: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 5	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	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.			Imaging
  	CT CHEST W WO CONTRAST	Interval: --	Occurrences: --		  	CT ABDOMEN W WO CONTRAST	Interval: --	Occurrences: --			Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Questionnaire to be performed by research staff
			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	AMYLASE LEVEL	Interval: --	Occurrences: --		☑	LIPASE LEVEL	Interval: --	Occurrences: --		☑	LDH	Interval: --	Occurrences: --		☑	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		☑	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		☐	T3, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☐	T4, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
			Labs
  	MISCELLANEOUS REFERRAL TEST	Interval: --	Occurrences: --	Comments:	ctDNA
			Chemotherapy
  	INV-Durvalumab or Placebo (PACIFIC-4/Pro00021863/Bernicker) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 60 Minutes for 1 dose	Start: S			Instructions:	Infuse using a 0.2 micron inline filter.  Do not infuse other medications through the same IV line.  Stable for 4 hours at room temperature, 24 hours refrigerated.	Rule-Based Template: RULE ONCBCN INV-DURVALUMAB 20 MG/KG	  Conditions:	  Modifications:	  If TP WT < 30 KG	  Set dose to 20 mg/kg	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-DURVALUMAB OR PLACEBO 50 MG/ML IV SOLN (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Supportive Care
☐	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	famotidine (PEPCID) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	fexofenadine (ALLEGRA) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	hydrocortisone sodium succinate (Solu-CORTEF) injection	Dose: --	Route: intravenous	one-time Injection for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	INV-Infliximab (PACIFIC-4/Pro00021863/Zhang) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 120 Minutes for 1 dose	Start: S			Instructions:	Use an in-line, sterile, non-pyrogenic, low protein-binding filter with 1.2 micron pore size or less.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFLIXIMAB 100 MG INTRAVENOUS SOLUTION (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Always	Yes			☐	INV-mycophenolate (PACIFIC-4/PRO00021863/ZHANG) capsule/tablet	Dose: --	Route: oral	2 times daily	Start: S			Instructions:	Do not crush or chew. Swallow whole. Store at room temperature and keep away from children.			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 Fexofenadine 180 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), Fexofenadine 180 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				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	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: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 5	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	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
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	AMYLASE LEVEL	Interval: --	Occurrences: --		☑	LIPASE LEVEL	Interval: --	Occurrences: --		☑	LDH	Interval: --	Occurrences: --		☑	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		☑	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		☐	T3, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☐	T4, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
			Chemotherapy
  	INV-Durvalumab or Placebo (PACIFIC-4/Pro00021863/Bernicker) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 60 Minutes for 1 dose	Start: S			Instructions:	Infuse using a 0.2 micron inline filter.  Do not infuse other medications through the same IV line.  Stable for 4 hours at room temperature, 24 hours refrigerated.	Rule-Based Template: RULE ONCBCN INV-DURVALUMAB 20 MG/KG	  Conditions:	  Modifications:	  If TP WT < 30 KG	  Set dose to 20 mg/kg	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-DURVALUMAB OR PLACEBO 50 MG/ML IV SOLN (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Supportive Care
☐	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	famotidine (PEPCID) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	fexofenadine (ALLEGRA) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	hydrocortisone sodium succinate (Solu-CORTEF) injection	Dose: --	Route: intravenous	one-time Injection for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	INV-Infliximab (PACIFIC-4/Pro00021863/Zhang) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 120 Minutes for 1 dose	Start: S			Instructions:	Use an in-line, sterile, non-pyrogenic, low protein-binding filter with 1.2 micron pore size or less.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFLIXIMAB 100 MG INTRAVENOUS SOLUTION (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Always	Yes			☐	INV-mycophenolate (PACIFIC-4/PRO00021863/ZHANG) capsule/tablet	Dose: --	Route: oral	2 times daily	Start: S			Instructions:	Do not crush or chew. Swallow whole. Store at room temperature and keep away from children.			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 Fexofenadine 180 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), Fexofenadine 180 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				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	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: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 5	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	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
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Questionnaire to be performed by research staff
			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	AMYLASE LEVEL	Interval: --	Occurrences: --		☑	LIPASE LEVEL	Interval: --	Occurrences: --		☑	LDH	Interval: --	Occurrences: --		☑	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		☑	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		☐	T3, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☐	T4, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --			Chemotherapy
  	INV-Durvalumab or Placebo (PACIFIC-4/Pro00021863/Bernicker) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 60 Minutes for 1 dose	Start: S			Instructions:	Infuse using a 0.2 micron inline filter.  Do not infuse other medications through the same IV line.  Stable for 4 hours at room temperature, 24 hours refrigerated.	Rule-Based Template: RULE ONCBCN INV-DURVALUMAB 20 MG/KG	  Conditions:	  Modifications:	  If TP WT < 30 KG	  Set dose to 20 mg/kg	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-DURVALUMAB OR PLACEBO 50 MG/ML IV SOLN (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Supportive Care
☐	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	famotidine (PEPCID) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	fexofenadine (ALLEGRA) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	hydrocortisone sodium succinate (Solu-CORTEF) injection	Dose: --	Route: intravenous	one-time Injection for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	INV-Infliximab (PACIFIC-4/Pro00021863/Zhang) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 120 Minutes for 1 dose	Start: S			Instructions:	Use an in-line, sterile, non-pyrogenic, low protein-binding filter with 1.2 micron pore size or less.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFLIXIMAB 100 MG INTRAVENOUS SOLUTION (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Always	Yes			☐	INV-mycophenolate (PACIFIC-4/PRO00021863/ZHANG) capsule/tablet	Dose: --	Route: oral	2 times daily	Start: S			Instructions:	Do not crush or chew. Swallow whole. Store at room temperature and keep away from children.			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 Fexofenadine 180 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), Fexofenadine 180 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				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	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 5	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	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.			Imaging
  	CT CHEST W WO CONTRAST	Interval: --	Occurrences: --		  	CT ABDOMEN W WO CONTRAST	Interval: --	Occurrences: --			Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	AMYLASE LEVEL	Interval: --	Occurrences: --		☑	LIPASE LEVEL	Interval: --	Occurrences: --		☑	LDH	Interval: --	Occurrences: --		☑	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		☑	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		☐	T3, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☐	T4, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
			Labs
  	MISCELLANEOUS REFERRAL TEST	Interval: --	Occurrences: --	Comments:	ctDNA
			Chemotherapy
  	INV-Durvalumab or Placebo (PACIFIC-4/Pro00021863/Bernicker) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 60 Minutes for 1 dose	Start: S			Instructions:	Infuse using a 0.2 micron inline filter.  Do not infuse other medications through the same IV line.  Stable for 4 hours at room temperature, 24 hours refrigerated.	Rule-Based Template: RULE ONCBCN INV-DURVALUMAB 20 MG/KG	  Conditions:	  Modifications:	  If TP WT < 30 KG	  Set dose to 20 mg/kg	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-DURVALUMAB OR PLACEBO 50 MG/ML IV SOLN (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Supportive Care
☐	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	famotidine (PEPCID) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	fexofenadine (ALLEGRA) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	hydrocortisone sodium succinate (Solu-CORTEF) injection	Dose: --	Route: intravenous	one-time Injection for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	INV-Infliximab (PACIFIC-4/Pro00021863/Zhang) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 120 Minutes for 1 dose	Start: S			Instructions:	Use an in-line, sterile, non-pyrogenic, low protein-binding filter with 1.2 micron pore size or less.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFLIXIMAB 100 MG INTRAVENOUS SOLUTION (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Always	Yes			☐	INV-mycophenolate (PACIFIC-4/PRO00021863/ZHANG) capsule/tablet	Dose: --	Route: oral	2 times daily	Start: S			Instructions:	Do not crush or chew. Swallow whole. Store at room temperature and keep away from children.			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 Fexofenadine 180 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), Fexofenadine 180 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				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	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 10	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 5	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	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
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Questionnaire to be performed by research staff
			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	AMYLASE LEVEL	Interval: --	Occurrences: --		☑	LIPASE LEVEL	Interval: --	Occurrences: --		☑	LDH	Interval: --	Occurrences: --		☑	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		☑	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		☐	T3, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☐	T4, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
			Chemotherapy
  	INV-Durvalumab or Placebo (PACIFIC-4/Pro00021863/Bernicker) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 60 Minutes for 1 dose	Start: S			Instructions:	Infuse using a 0.2 micron inline filter.  Do not infuse other medications through the same IV line.  Stable for 4 hours at room temperature, 24 hours refrigerated.	Rule-Based Template: RULE ONCBCN INV-DURVALUMAB 20 MG/KG	  Conditions:	  Modifications:	  If TP WT < 30 KG	  Set dose to 20 mg/kg	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-DURVALUMAB OR PLACEBO 50 MG/ML IV SOLN (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Supportive Care
☐	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	famotidine (PEPCID) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	fexofenadine (ALLEGRA) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	hydrocortisone sodium succinate (Solu-CORTEF) injection	Dose: --	Route: intravenous	one-time Injection for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	INV-Infliximab (PACIFIC-4/Pro00021863/Zhang) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 120 Minutes for 1 dose	Start: S			Instructions:	Use an in-line, sterile, non-pyrogenic, low protein-binding filter with 1.2 micron pore size or less.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFLIXIMAB 100 MG INTRAVENOUS SOLUTION (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Always	Yes			☐	INV-mycophenolate (PACIFIC-4/PRO00021863/ZHANG) capsule/tablet	Dose: --	Route: oral	2 times daily	Start: S			Instructions:	Do not crush or chew. Swallow whole. Store at room temperature and keep away from children.			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 Fexofenadine 180 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), Fexofenadine 180 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				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	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 11	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 5	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	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
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	AMYLASE LEVEL	Interval: --	Occurrences: --		☑	LIPASE LEVEL	Interval: --	Occurrences: --		☑	LDH	Interval: --	Occurrences: --		☑	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		☑	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		☐	T3, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☐	T4, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
			Chemotherapy
  	INV-Durvalumab or Placebo (PACIFIC-4/Pro00021863/Bernicker) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 60 Minutes for 1 dose	Start: S			Instructions:	Infuse using a 0.2 micron inline filter.  Do not infuse other medications through the same IV line.  Stable for 4 hours at room temperature, 24 hours refrigerated.	Rule-Based Template: RULE ONCBCN INV-DURVALUMAB 20 MG/KG	  Conditions:	  Modifications:	  If TP WT < 30 KG	  Set dose to 20 mg/kg	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-DURVALUMAB OR PLACEBO 50 MG/ML IV SOLN (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Supportive Care
☐	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	famotidine (PEPCID) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	fexofenadine (ALLEGRA) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	hydrocortisone sodium succinate (Solu-CORTEF) injection	Dose: --	Route: intravenous	one-time Injection for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	INV-Infliximab (PACIFIC-4/Pro00021863/Zhang) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 120 Minutes for 1 dose	Start: S			Instructions:	Use an in-line, sterile, non-pyrogenic, low protein-binding filter with 1.2 micron pore size or less.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFLIXIMAB 100 MG INTRAVENOUS SOLUTION (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Always	Yes			☐	INV-mycophenolate (PACIFIC-4/PRO00021863/ZHANG) capsule/tablet	Dose: --	Route: oral	2 times daily	Start: S			Instructions:	Do not crush or chew. Swallow whole. Store at room temperature and keep away from children.			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 Fexofenadine 180 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), Fexofenadine 180 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				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	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 5	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	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.			Imaging
  	CT CHEST W WO CONTRAST	Interval: --	Occurrences: --		  	CT ABDOMEN W WO CONTRAST	Interval: --	Occurrences: --			Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Questionnaire to be performed by research staff
			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	AMYLASE LEVEL	Interval: --	Occurrences: --		☑	LIPASE LEVEL	Interval: --	Occurrences: --		☑	LDH	Interval: --	Occurrences: --		☑	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		☑	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		☐	T3, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☐	T4, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
			Labs
  	MISCELLANEOUS REFERRAL TEST	Interval: --	Occurrences: --	Comments:	ctDNA
			Chemotherapy
  	INV-Durvalumab or Placebo (PACIFIC-4/Pro00021863/Bernicker) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 60 Minutes for 1 dose	Start: S			Instructions:	Infuse using a 0.2 micron inline filter.  Do not infuse other medications through the same IV line.  Stable for 4 hours at room temperature, 24 hours refrigerated.	Rule-Based Template: RULE ONCBCN INV-DURVALUMAB 20 MG/KG	  Conditions:	  Modifications:	  If TP WT < 30 KG	  Set dose to 20 mg/kg	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-DURVALUMAB OR PLACEBO 50 MG/ML IV SOLN (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Supportive Care
☐	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	famotidine (PEPCID) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	fexofenadine (ALLEGRA) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	hydrocortisone sodium succinate (Solu-CORTEF) injection	Dose: --	Route: intravenous	one-time Injection for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	INV-Infliximab (PACIFIC-4/Pro00021863/Zhang) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 120 Minutes for 1 dose	Start: S			Instructions:	Use an in-line, sterile, non-pyrogenic, low protein-binding filter with 1.2 micron pore size or less.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFLIXIMAB 100 MG INTRAVENOUS SOLUTION (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Always	Yes			☐	INV-mycophenolate (PACIFIC-4/PRO00021863/ZHANG) capsule/tablet	Dose: --	Route: oral	2 times daily	Start: S			Instructions:	Do not crush or chew. Swallow whole. Store at room temperature and keep away from children.			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 Fexofenadine 180 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), Fexofenadine 180 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				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	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 5	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	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
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	AMYLASE LEVEL	Interval: --	Occurrences: --		☑	LIPASE LEVEL	Interval: --	Occurrences: --		☑	LDH	Interval: --	Occurrences: --		☑	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		☑	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		☐	T3, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☐	T4, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
			Chemotherapy
  	INV-Durvalumab or Placebo (PACIFIC-4/Pro00021863/Bernicker) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 60 Minutes for 1 dose	Start: S			Instructions:	Infuse using a 0.2 micron inline filter.  Do not infuse other medications through the same IV line.  Stable for 4 hours at room temperature, 24 hours refrigerated.	Rule-Based Template: RULE ONCBCN INV-DURVALUMAB 20 MG/KG	  Conditions:	  Modifications:	  If TP WT < 30 KG	  Set dose to 20 mg/kg	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-DURVALUMAB OR PLACEBO 50 MG/ML IV SOLN (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Supportive Care
☐	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	famotidine (PEPCID) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	fexofenadine (ALLEGRA) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	hydrocortisone sodium succinate (Solu-CORTEF) injection	Dose: --	Route: intravenous	one-time Injection for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	INV-Infliximab (PACIFIC-4/Pro00021863/Zhang) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 120 Minutes for 1 dose	Start: S			Instructions:	Use an in-line, sterile, non-pyrogenic, low protein-binding filter with 1.2 micron pore size or less.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFLIXIMAB 100 MG INTRAVENOUS SOLUTION (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Always	Yes			☐	INV-mycophenolate (PACIFIC-4/PRO00021863/ZHANG) capsule/tablet	Dose: --	Route: oral	2 times daily	Start: S			Instructions:	Do not crush or chew. Swallow whole. Store at room temperature and keep away from children.			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 Fexofenadine 180 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), Fexofenadine 180 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				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	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 5	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	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
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Questionnaire to be performed by research staff
			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	AMYLASE LEVEL	Interval: --	Occurrences: --		☑	LIPASE LEVEL	Interval: --	Occurrences: --		☑	LDH	Interval: --	Occurrences: --		☑	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		☑	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		☐	T3, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☐	T4, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --			Chemotherapy
  	INV-Durvalumab or Placebo (PACIFIC-4/Pro00021863/Bernicker) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 60 Minutes for 1 dose	Start: S			Instructions:	Infuse using a 0.2 micron inline filter.  Do not infuse other medications through the same IV line.  Stable for 4 hours at room temperature, 24 hours refrigerated.	Rule-Based Template: RULE ONCBCN INV-DURVALUMAB 20 MG/KG	  Conditions:	  Modifications:	  If TP WT < 30 KG	  Set dose to 20 mg/kg	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-DURVALUMAB OR PLACEBO 50 MG/ML IV SOLN (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Supportive Care
☐	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	famotidine (PEPCID) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	fexofenadine (ALLEGRA) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	hydrocortisone sodium succinate (Solu-CORTEF) injection	Dose: --	Route: intravenous	one-time Injection for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	INV-Infliximab (PACIFIC-4/Pro00021863/Zhang) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 120 Minutes for 1 dose	Start: S			Instructions:	Use an in-line, sterile, non-pyrogenic, low protein-binding filter with 1.2 micron pore size or less.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFLIXIMAB 100 MG INTRAVENOUS SOLUTION (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Always	Yes			☐	INV-mycophenolate (PACIFIC-4/PRO00021863/ZHANG) capsule/tablet	Dose: --	Route: oral	2 times daily	Start: S			Instructions:	Do not crush or chew. Swallow whole. Store at room temperature and keep away from children.			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 Fexofenadine 180 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), Fexofenadine 180 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				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	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 5	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	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.			Imaging
  	CT CHEST W WO CONTRAST	Interval: --	Occurrences: --		  	CT ABDOMEN W WO CONTRAST	Interval: --	Occurrences: --			Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	AMYLASE LEVEL	Interval: --	Occurrences: --		☑	LIPASE LEVEL	Interval: --	Occurrences: --		☑	LDH	Interval: --	Occurrences: --		☑	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		☑	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		☐	T3, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☐	T4, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
			Labs
  	MISCELLANEOUS REFERRAL TEST	Interval: --	Occurrences: --	Comments:	ctDNA
			Chemotherapy
  	INV-Durvalumab or Placebo (PACIFIC-4/Pro00021863/Bernicker) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 60 Minutes for 1 dose	Start: S			Instructions:	Infuse using a 0.2 micron inline filter.  Do not infuse other medications through the same IV line.  Stable for 4 hours at room temperature, 24 hours refrigerated.	Rule-Based Template: RULE ONCBCN INV-DURVALUMAB 20 MG/KG	  Conditions:	  Modifications:	  If TP WT < 30 KG	  Set dose to 20 mg/kg	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-DURVALUMAB OR PLACEBO 50 MG/ML IV SOLN (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Supportive Care
☐	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	famotidine (PEPCID) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	fexofenadine (ALLEGRA) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	hydrocortisone sodium succinate (Solu-CORTEF) injection	Dose: --	Route: intravenous	one-time Injection for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	INV-Infliximab (PACIFIC-4/Pro00021863/Zhang) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 120 Minutes for 1 dose	Start: S			Instructions:	Use an in-line, sterile, non-pyrogenic, low protein-binding filter with 1.2 micron pore size or less.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFLIXIMAB 100 MG INTRAVENOUS SOLUTION (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Always	Yes			☐	INV-mycophenolate (PACIFIC-4/PRO00021863/ZHANG) capsule/tablet	Dose: --	Route: oral	2 times daily	Start: S			Instructions:	Do not crush or chew. Swallow whole. Store at room temperature and keep away from children.			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 Fexofenadine 180 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), Fexofenadine 180 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				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	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 5	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	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
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Questionnaire to be performed by research staff
			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	AMYLASE LEVEL	Interval: --	Occurrences: --		☑	LIPASE LEVEL	Interval: --	Occurrences: --		☑	LDH	Interval: --	Occurrences: --		☑	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		☑	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		☐	T3, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☐	T4, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
			Chemotherapy
  	INV-Durvalumab or Placebo (PACIFIC-4/Pro00021863/Bernicker) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 60 Minutes for 1 dose	Start: S			Instructions:	Infuse using a 0.2 micron inline filter.  Do not infuse other medications through the same IV line.  Stable for 4 hours at room temperature, 24 hours refrigerated.	Rule-Based Template: RULE ONCBCN INV-DURVALUMAB 20 MG/KG	  Conditions:	  Modifications:	  If TP WT < 30 KG	  Set dose to 20 mg/kg	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-DURVALUMAB OR PLACEBO 50 MG/ML IV SOLN (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Supportive Care
☐	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	famotidine (PEPCID) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	fexofenadine (ALLEGRA) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	hydrocortisone sodium succinate (Solu-CORTEF) injection	Dose: --	Route: intravenous	one-time Injection for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	INV-Infliximab (PACIFIC-4/Pro00021863/Zhang) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 120 Minutes for 1 dose	Start: S			Instructions:	Use an in-line, sterile, non-pyrogenic, low protein-binding filter with 1.2 micron pore size or less.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFLIXIMAB 100 MG INTRAVENOUS SOLUTION (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Always	Yes			☐	INV-mycophenolate (PACIFIC-4/PRO00021863/ZHANG) capsule/tablet	Dose: --	Route: oral	2 times daily	Start: S			Instructions:	Do not crush or chew. Swallow whole. Store at room temperature and keep away from children.			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 Fexofenadine 180 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), Fexofenadine 180 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				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	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 5	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	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
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	AMYLASE LEVEL	Interval: --	Occurrences: --		☑	LIPASE LEVEL	Interval: --	Occurrences: --		☑	LDH	Interval: --	Occurrences: --		☑	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		☑	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		☐	T3, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☐	T4, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
			Chemotherapy
  	INV-Durvalumab or Placebo (PACIFIC-4/Pro00021863/Bernicker) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 60 Minutes for 1 dose	Start: S			Instructions:	Infuse using a 0.2 micron inline filter.  Do not infuse other medications through the same IV line.  Stable for 4 hours at room temperature, 24 hours refrigerated.	Rule-Based Template: RULE ONCBCN INV-DURVALUMAB 20 MG/KG	  Conditions:	  Modifications:	  If TP WT < 30 KG	  Set dose to 20 mg/kg	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-DURVALUMAB OR PLACEBO 50 MG/ML IV SOLN (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Supportive Care
☐	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	famotidine (PEPCID) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	fexofenadine (ALLEGRA) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	hydrocortisone sodium succinate (Solu-CORTEF) injection	Dose: --	Route: intravenous	one-time Injection for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	INV-Infliximab (PACIFIC-4/Pro00021863/Zhang) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 120 Minutes for 1 dose	Start: S			Instructions:	Use an in-line, sterile, non-pyrogenic, low protein-binding filter with 1.2 micron pore size or less.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFLIXIMAB 100 MG INTRAVENOUS SOLUTION (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Always	Yes			☐	INV-mycophenolate (PACIFIC-4/PRO00021863/ZHANG) capsule/tablet	Dose: --	Route: oral	2 times daily	Start: S			Instructions:	Do not crush or chew. Swallow whole. Store at room temperature and keep away from children.			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 Fexofenadine 180 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), Fexofenadine 180 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				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	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 5	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	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.			Imaging
  	CT CHEST W WO CONTRAST	Interval: --	Occurrences: --		  	CT ABDOMEN W WO CONTRAST	Interval: --	Occurrences: --			Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Questionnaire to be performed by research staff
			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	AMYLASE LEVEL	Interval: --	Occurrences: --		☑	LIPASE LEVEL	Interval: --	Occurrences: --		☑	LDH	Interval: --	Occurrences: --		☑	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		☑	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		☐	T3, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☐	T4, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
			Labs
  	MISCELLANEOUS REFERRAL TEST	Interval: --	Occurrences: --	Comments:	ctDNA
			Chemotherapy
  	INV-Durvalumab or Placebo (PACIFIC-4/Pro00021863/Bernicker) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 60 Minutes for 1 dose	Start: S			Instructions:	Infuse using a 0.2 micron inline filter.  Do not infuse other medications through the same IV line.  Stable for 4 hours at room temperature, 24 hours refrigerated.	Rule-Based Template: RULE ONCBCN INV-DURVALUMAB 20 MG/KG	  Conditions:	  Modifications:	  If TP WT < 30 KG	  Set dose to 20 mg/kg	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-DURVALUMAB OR PLACEBO 50 MG/ML IV SOLN (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Supportive Care
☐	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	famotidine (PEPCID) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	fexofenadine (ALLEGRA) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	hydrocortisone sodium succinate (Solu-CORTEF) injection	Dose: --	Route: intravenous	one-time Injection for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	INV-Infliximab (PACIFIC-4/Pro00021863/Zhang) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 120 Minutes for 1 dose	Start: S			Instructions:	Use an in-line, sterile, non-pyrogenic, low protein-binding filter with 1.2 micron pore size or less.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFLIXIMAB 100 MG INTRAVENOUS SOLUTION (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Always	Yes			☐	INV-mycophenolate (PACIFIC-4/PRO00021863/ZHANG) capsule/tablet	Dose: --	Route: oral	2 times daily	Start: S			Instructions:	Do not crush or chew. Swallow whole. Store at room temperature and keep away from children.			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 Fexofenadine 180 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), Fexofenadine 180 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				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	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 5	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	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
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	AMYLASE LEVEL	Interval: --	Occurrences: --		☑	LIPASE LEVEL	Interval: --	Occurrences: --		☑	LDH	Interval: --	Occurrences: --		☑	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		☑	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		☐	T3, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☐	T4, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
			Chemotherapy
  	INV-Durvalumab or Placebo (PACIFIC-4/Pro00021863/Bernicker) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 60 Minutes for 1 dose	Start: S			Instructions:	Infuse using a 0.2 micron inline filter.  Do not infuse other medications through the same IV line.  Stable for 4 hours at room temperature, 24 hours refrigerated.	Rule-Based Template: RULE ONCBCN INV-DURVALUMAB 20 MG/KG	  Conditions:	  Modifications:	  If TP WT < 30 KG	  Set dose to 20 mg/kg	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-DURVALUMAB OR PLACEBO 50 MG/ML IV SOLN (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Supportive Care
☐	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	famotidine (PEPCID) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	fexofenadine (ALLEGRA) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	hydrocortisone sodium succinate (Solu-CORTEF) injection	Dose: --	Route: intravenous	one-time Injection for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	INV-Infliximab (PACIFIC-4/Pro00021863/Zhang) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 120 Minutes for 1 dose	Start: S			Instructions:	Use an in-line, sterile, non-pyrogenic, low protein-binding filter with 1.2 micron pore size or less.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFLIXIMAB 100 MG INTRAVENOUS SOLUTION (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Always	Yes			☐	INV-mycophenolate (PACIFIC-4/PRO00021863/ZHANG) capsule/tablet	Dose: --	Route: oral	2 times daily	Start: S			Instructions:	Do not crush or chew. Swallow whole. Store at room temperature and keep away from children.			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 Fexofenadine 180 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), Fexofenadine 180 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				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	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 5	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	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
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Questionnaire to be performed by research staff
			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	AMYLASE LEVEL	Interval: --	Occurrences: --		☑	LIPASE LEVEL	Interval: --	Occurrences: --		☑	LDH	Interval: --	Occurrences: --		☑	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		☑	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		☐	T3, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☐	T4, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --			Chemotherapy
  	INV-Durvalumab or Placebo (PACIFIC-4/Pro00021863/Bernicker) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 60 Minutes for 1 dose	Start: S			Instructions:	Infuse using a 0.2 micron inline filter.  Do not infuse other medications through the same IV line.  Stable for 4 hours at room temperature, 24 hours refrigerated.	Rule-Based Template: RULE ONCBCN INV-DURVALUMAB 20 MG/KG	  Conditions:	  Modifications:	  If TP WT < 30 KG	  Set dose to 20 mg/kg	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-DURVALUMAB OR PLACEBO 50 MG/ML IV SOLN (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Supportive Care
☐	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	famotidine (PEPCID) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	fexofenadine (ALLEGRA) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	hydrocortisone sodium succinate (Solu-CORTEF) injection	Dose: --	Route: intravenous	one-time Injection for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	INV-Infliximab (PACIFIC-4/Pro00021863/Zhang) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 120 Minutes for 1 dose	Start: S			Instructions:	Use an in-line, sterile, non-pyrogenic, low protein-binding filter with 1.2 micron pore size or less.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFLIXIMAB 100 MG INTRAVENOUS SOLUTION (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Always	Yes			☐	INV-mycophenolate (PACIFIC-4/PRO00021863/ZHANG) capsule/tablet	Dose: --	Route: oral	2 times daily	Start: S			Instructions:	Do not crush or chew. Swallow whole. Store at room temperature and keep away from children.			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 Fexofenadine 180 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), Fexofenadine 180 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				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	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 5	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	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.			Imaging
  	CT CHEST W WO CONTRAST	Interval: --	Occurrences: --		  	CT ABDOMEN W WO CONTRAST	Interval: --	Occurrences: --			Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	AMYLASE LEVEL	Interval: --	Occurrences: --		☑	LIPASE LEVEL	Interval: --	Occurrences: --		☑	LDH	Interval: --	Occurrences: --		☑	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		☑	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		☐	T3, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☐	T4, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
			Labs
  	MISCELLANEOUS REFERRAL TEST	Interval: --	Occurrences: --	Comments:	ctDNA
			Chemotherapy
  	INV-Durvalumab or Placebo (PACIFIC-4/Pro00021863/Bernicker) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 60 Minutes for 1 dose	Start: S			Instructions:	Infuse using a 0.2 micron inline filter.  Do not infuse other medications through the same IV line.  Stable for 4 hours at room temperature, 24 hours refrigerated.	Rule-Based Template: RULE ONCBCN INV-DURVALUMAB 20 MG/KG	  Conditions:	  Modifications:	  If TP WT < 30 KG	  Set dose to 20 mg/kg	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-DURVALUMAB OR PLACEBO 50 MG/ML IV SOLN (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Supportive Care
☐	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	famotidine (PEPCID) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	fexofenadine (ALLEGRA) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	hydrocortisone sodium succinate (Solu-CORTEF) injection	Dose: --	Route: intravenous	one-time Injection for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	INV-Infliximab (PACIFIC-4/Pro00021863/Zhang) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 120 Minutes for 1 dose	Start: S			Instructions:	Use an in-line, sterile, non-pyrogenic, low protein-binding filter with 1.2 micron pore size or less.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFLIXIMAB 100 MG INTRAVENOUS SOLUTION (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Always	Yes			☐	INV-mycophenolate (PACIFIC-4/PRO00021863/ZHANG) capsule/tablet	Dose: --	Route: oral	2 times daily	Start: S			Instructions:	Do not crush or chew. Swallow whole. Store at room temperature and keep away from children.			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 Fexofenadine 180 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), Fexofenadine 180 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				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	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 5	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	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
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Questionnaire to be performed by research staff
			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	AMYLASE LEVEL	Interval: --	Occurrences: --		☑	LIPASE LEVEL	Interval: --	Occurrences: --		☑	LDH	Interval: --	Occurrences: --		☑	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		☑	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		☐	T3, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☐	T4, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
			Chemotherapy
  	INV-Durvalumab or Placebo (PACIFIC-4/Pro00021863/Bernicker) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 60 Minutes for 1 dose	Start: S			Instructions:	Infuse using a 0.2 micron inline filter.  Do not infuse other medications through the same IV line.  Stable for 4 hours at room temperature, 24 hours refrigerated.	Rule-Based Template: RULE ONCBCN INV-DURVALUMAB 20 MG/KG	  Conditions:	  Modifications:	  If TP WT < 30 KG	  Set dose to 20 mg/kg	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-DURVALUMAB OR PLACEBO 50 MG/ML IV SOLN (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Supportive Care
☐	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	famotidine (PEPCID) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	fexofenadine (ALLEGRA) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	hydrocortisone sodium succinate (Solu-CORTEF) injection	Dose: --	Route: intravenous	one-time Injection for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	INV-Infliximab (PACIFIC-4/Pro00021863/Zhang) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 120 Minutes for 1 dose	Start: S			Instructions:	Use an in-line, sterile, non-pyrogenic, low protein-binding filter with 1.2 micron pore size or less.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFLIXIMAB 100 MG INTRAVENOUS SOLUTION (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Always	Yes			☐	INV-mycophenolate (PACIFIC-4/PRO00021863/ZHANG) capsule/tablet	Dose: --	Route: oral	2 times daily	Start: S			Instructions:	Do not crush or chew. Swallow whole. Store at room temperature and keep away from children.			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 Fexofenadine 180 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), Fexofenadine 180 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				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	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 5	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	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
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	AMYLASE LEVEL	Interval: --	Occurrences: --		☑	LIPASE LEVEL	Interval: --	Occurrences: --		☑	LDH	Interval: --	Occurrences: --		☑	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		☑	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		☐	T3, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☐	T4, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
			Chemotherapy
  	INV-Durvalumab or Placebo (PACIFIC-4/Pro00021863/Bernicker) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 60 Minutes for 1 dose	Start: S			Instructions:	Infuse using a 0.2 micron inline filter.  Do not infuse other medications through the same IV line.  Stable for 4 hours at room temperature, 24 hours refrigerated.	Rule-Based Template: RULE ONCBCN INV-DURVALUMAB 20 MG/KG	  Conditions:	  Modifications:	  If TP WT < 30 KG	  Set dose to 20 mg/kg	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-DURVALUMAB OR PLACEBO 50 MG/ML IV SOLN (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Supportive Care
☐	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	famotidine (PEPCID) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	fexofenadine (ALLEGRA) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	hydrocortisone sodium succinate (Solu-CORTEF) injection	Dose: --	Route: intravenous	one-time Injection for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	INV-Infliximab (PACIFIC-4/Pro00021863/Zhang) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 120 Minutes for 1 dose	Start: S			Instructions:	Use an in-line, sterile, non-pyrogenic, low protein-binding filter with 1.2 micron pore size or less.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFLIXIMAB 100 MG INTRAVENOUS SOLUTION (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Always	Yes			☐	INV-mycophenolate (PACIFIC-4/PRO00021863/ZHANG) capsule/tablet	Dose: --	Route: oral	2 times daily	Start: S			Instructions:	Do not crush or chew. Swallow whole. Store at room temperature and keep away from children.			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 Fexofenadine 180 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), Fexofenadine 180 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				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	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: 30 days	Day 1	Perform every 1 day x1		Appointment Requests
  	ONC INFUSION APPOINTMENT REQUEST 5	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	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.			Imaging
  	CT CHEST W WO CONTRAST	Interval: --	Occurrences: --		  	CT ABDOMEN W WO CONTRAST	Interval: --	Occurrences: --			Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --		  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Questionnaire to be performed by research staff
			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	AMYLASE LEVEL	Interval: --	Occurrences: --		☑	LIPASE LEVEL	Interval: --	Occurrences: --		☑	LDH	Interval: --	Occurrences: --		☑	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		☑	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		☐	T3, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☐	T4, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
			Labs
  	MISCELLANEOUS REFERRAL TEST	Interval: --	Occurrences: --	Comments:	ctDNA
			Chemotherapy
  	INV-Durvalumab or Placebo (PACIFIC-4/Pro00021863/Bernicker) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 60 Minutes for 1 dose	Start: S			Instructions:	Infuse using a 0.2 micron inline filter.  Do not infuse other medications through the same IV line.  Stable for 4 hours at room temperature, 24 hours refrigerated.	Rule-Based Template: RULE ONCBCN INV-DURVALUMAB 20 MG/KG	  Conditions:	  Modifications:	  If TP WT < 30 KG	  Set dose to 20 mg/kg	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-DURVALUMAB OR PLACEBO 50 MG/ML IV SOLN (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes				Supportive Care
☐	acetaminophen (TYLENOL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	diphenhydrAMINE (BENADRYL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	famotidine (PEPCID) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	fexofenadine (ALLEGRA) tablet	Dose: --	Route: oral	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	hydrocortisone sodium succinate (Solu-CORTEF) injection	Dose: --	Route: intravenous	one-time Injection for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Give 30 minutes prior to start of Inflixmab infusion		☐	INV-Infliximab (PACIFIC-4/Pro00021863/Zhang) in sodium chloride 0.9% 250 mL IVPB	Dose: --	Route: intravenous	once over 120 Minutes for 1 dose	Start: S			Instructions:	Use an in-line, sterile, non-pyrogenic, low protein-binding filter with 1.2 micron pore size or less.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-INFLIXIMAB 100 MG INTRAVENOUS SOLUTION (PACIFIC-4/PRO00021863/ZHANG)	Medications	 	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Always	Yes			☐	INV-mycophenolate (PACIFIC-4/PRO00021863/ZHANG) capsule/tablet	Dose: --	Route: oral	2 times daily	Start: S			Instructions:	Do not crush or chew. Swallow whole. Store at room temperature and keep away from children.			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 Fexofenadine 180 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), Fexofenadine 180 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				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	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.					
End of Treatment (30 days after last treatment)	Repeat 1 time	Cycle length: 30 days	Day 1	Perform every 1 day x1		Nursing Orders
  	RESEARCH - VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	AMYLASE LEVEL	Interval: --	Occurrences: --		☑	LIPASE LEVEL	Interval: --	Occurrences: --		☑	LDH	Interval: --	Occurrences: --		☑	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		☑	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		☐	T3, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☐	T4, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --					
Follow-up (2-month)	Repeat 1 time	Cycle length: 30 days	Day 1	Perform every 1 day x1		Nursing Orders
  	RESEARCH - MEASURE WEIGHT	Interval: --	Occurrences: --			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	AMYLASE LEVEL	Interval: --	Occurrences: --		☑	LIPASE LEVEL	Interval: --	Occurrences: --		☑	LDH	Interval: --	Occurrences: --		☑	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		☐	T3, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☐	T4, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
					
Follow-up (3-month)	Repeat 1 time	Cycle length: 30 days	Day 1	Perform every 1 day x1		Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	AMYLASE LEVEL	Interval: --	Occurrences: --		☑	LIPASE LEVEL	Interval: --	Occurrences: --		☑	LDH	Interval: --	Occurrences: --		☑	THYROID STIMULATING HORMONE	Interval: --	Occurrences: --		☐	T3, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
		☐	T4, FREE	Interval: --	Occurrences: --	Comments:	Only if TSH is abnormal
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --