Bisphosphonate IV (AREDIA/ZOMETA) - Group Health Cooperative

Name: ______________________________________IV Bisphosphonate (Pamidronate or Zoledronic Acid)Infusion Therapy Plan OrdersPage 2 of 2Group Health Member I.D. # ____________________Date of Birth ________________________________Lab Review for Nursing Baseline labs and labs before each treatment: SCr and CalciumLab Parameters to Assess: CrCl greater than 29 mL/min. For patient with BASELINE SCR LESS THAN 1.4 mg/dL, notify provider if there is an increase in SCr frombaseline of less than or equal to 0.5 mg/dL. For patient with BASELINE SCR GREATER THAN OR EQUAL TO 1.4 mg/dL, notify provider if there is anincrease in SCr from baseline of less than or equal to 1 mg/dL.Nursing Orders Discontinue IV line when therapy complete and patient stabilized.References de Lemos M et al. J Oncol Pharm Practice. 2006 Dec;12(4):193-9 Pamidronate information - Daily Med Berenson J, et al. Cancer, 2001;91:1191-1200 Kyle RA et al. JCO 2007;25:2464-2472. Zometa® Prescribing Information. Revised November 2012.Group Health Infusion LocationsBellevue Medical Center11511 NE 10 th St, Bellevue, WA 98004Fax: 425-502-3512 Phone: 425-502-3510Capitol Hill Medical Center201 16 th Ave E, Seattle WA 98112Fax: 206-326-2104 Phone: 206-326-3109Everett Medical Center2930 Maple St, Everett, WA 98201Fax: 425-261-1659 Phone: 425-261-1681Olympia Medical Center700 Lily Road N.E., Olympia, WA 98506Fax: 360-923-7106 Phone: 360-923-7164Riverfront Medical Center – SpokaneW 322 North River Drive, Spokane, WA 99201Fax: 509-324-7168 Phone: 509-241-2073Silverdale Medical Center10452 Silverdale Way NW, Silverdale, WA 98383Fax: 360-307-7493 Phone: 360-307-7444Tacoma Medical Center209 Martin Luther King Jr Way, Tacoma, WA 98405Fax: 253-383-6262 Phone: 253-596-3666Provider Signature: ____________________________________________ Date: _______________Printed Name: ______________________________________ Phone: ___________ Fax: ___________HIM Revision Date: 3/20/2013 Group Health Cooperative