Table 4.

Chemotherapy Administration Data Elements

Patient name	Diluent, amount, mix and time given
Name of protocol	Administration route, IV push or infusion
Number of protocol	Drug sequence and time
Diagnosis	Need for pump, special tubing and filter
Patient height	Acute side effects of drugs
Patient weight BSA (calculated)	Number of office visits required to complete therapy
Drug procurement source	Central line placement (if needed)
Drug authorization obtained if needed	Fatigue 1-4
Pre-treatment tests and results	Nausea & vomiting 1-4
Supportive drugs - pre- & post therapy	Pain 1-4
Chemotherapy drugs - automated dose calculation	Co-signatures for dose calculations Physician signature