Hi all,

I wanted to make you aware of some updates for adult patients receiving high-dose methotrexate (this does NOT apply to pediatric patients). We are optimizing our high-dose methotrexate process to decrease length of stay and streamline the administration process. Attached is a tip sheet that reviews the change in workflow for pharmacists. This process is officially going live on Monday, March 20th.

Key points to keep in mind:

Bicarbonate orders:

- Bicarbonate orders are supportive care medications that are required to be administered prior to methotrexate administration to prevent toxicity. If you have chemotherapy powerplans come across with bicarbonate orders within them, you are allowed to verify the bicarbonate orders, especially if nursing staff contacts you regarding these orders. If there are any questions or concerns, please do not hesitate to contact one of the oncology pharmacists.

Re-timing orders:

- Since the methotrexate is a one-time order, pharmacists will not re-time the order sets. If nursing calls about re-timing, inform them to chart early/late on the methotrexate and that the oncology pharmacist will retime the leucovorin and methotrexate levels in the morning. 

Methotrexate levels:

- With this new process, 2nd and 3rd shift pharmacists will not be required to follow methotrexate levels. Nursing has been educated that if a methotrexate level results > 10 they are to contact the oncologist on call. If you are contacted regarding a level, you may refer to the leucovorin dosing table (attached in this email and on FormWeb) for guidance. 

The attached document goes into more detail regarding the process changes and the leucovorin dosing table. These documents can also be found on FormWeb. 

If there are any questions or concerns regarding this process, please do not hesitate to reach out!