Treatment Plans - Frequently Asked Questions

This quick guide answers frequently asked questions about Treatment Plans in VieCure. It covers changing an existing plan from the Treatment Plan Flowsheet, adding cycles, holding or delaying treatment, changing doses, obsolete drugs, printing, and multi-location care.

 How do I find and start a chemotherapy treatment plan?

Treatment plans are ordered through Treatment Plans & Results in the left-side navigation. The provider selects a plan, reviews and edits its items, and places the order.

Once ordered, the plan appears on the patient's Treatment Plans & Results (also known as the Flowsheet). Items that need appointments are sent to the scheduling queue for the front desk to schedule. If a new plan needs provider approval, a provider approval task is created.

 How do I modify treatment plans?

Open the patient's Treatment Plan Flowsheet. Changes can be made at four levels:

1. Whole plan — Use the action menu on the plan header row and select Edit Plan. The left-hand options are: Add Cycles, Change Start Date, Delay Plan, Hold Plan, Discontinue Plan.
2. One row (all occurrences of an item) — Use Edit Row to change the fields of one line item and, for Activities, move, add or discontinue occurrences.
3. One occurrence (one cell) — Right-click an eligible cell and select Edit Item. Cells that are already completed, administered, collected, or resulted cannot be edited. Verified cells can still be edited.
4. One date column — Right-click the date header and select Edit to move that day's items (choose Apply To: One Time, Current + X Additional Cycles, or Remainder of Phase).

Nurses and MAs must also choose an Ordering Provider (defaults to the patient's primary oncologist) and an Order Method (Verbal or Written) when saving plan-level changes.

 How do I add cycles to the end of a patient's plan, including when no dates are left?

1. On the Treatment Plan Flowsheet, open the action menu on the plan header row and select Edit Plan.
2. Select Add Cycles.
3. Select the number of cycles to add and the existing cycle to use as a template. Each new cycle will copy the items from the selected cycle.
4. Click Save. Nurses and MAs must first choose an Ordering Provider and Order Method.
5. Where they go — New cycles are added to the end of the current phase only. Inserting cycles in the middle of a plan or across phases is not supported.
6. Limit — Up to 12 cycles can be added in a single operation. You can add more later with another Add Cycles action.
7. When it is unavailable — Add Cycles is greyed out (with a tooltip) when the plan is Discontinued, Completed or Inactive. It is available for Active, Hold, Delay, and Pending Provider Approval plans.

 How do I change the dose in a plan when the physician wants a dose other than the calculated dose (including rounding and toxicity- or weight-driven changes)?

Dose changes are made on the specific item. Right-click the dose cell on the Treatment Plan Flowsheet and select Edit Item to change that one occurrence or use Edit Row to change the line item across occurrences. Verified items stay verified when the Edit Item tab opens, and verification is only removed by actions that require it.

 How do I hold treatment for an elevated toxicity grade until it improves?

Use Hold. Both options need a Hold Reason. Choose Toxicities (the list also includes Allergic Response, Disease Progression, Patient Choice, Test Results Unavailable, Other and more). If you choose Other, a comment is required.

1. Hold one occurrence — Hold a single item on a single day. Hold does not shift the plan. The held cell shows a triangle marker, and hovering shows Held.
2. Hold the plan — Open Edit Plan and select Hold Plan. Enter Hold Duration (number of cycles to skip), Start Hold On (today or later) and Hold Reason. This skips those cycles and does not shift later dates.
3. Delay instead of skip — To push everything forward until the patient is ready, use Delay Plan (Delay Duration in Days or Weeks, Start Delay On, Delay Reason). All upcoming incomplete items shift forward.

If verified items are affected, a warning window will appear explaining that holding or delaying them will remove their verification status and asking you to confirm the action. A medication that was already dispensed cannot be held until it is returned (internal) or handled with the external pharmacy.

 Lab results aren't appropriate for treatment - how do I hold, order follow-up labs and reschedule?

1. Hold the treatment: on the Treatment Plan Flowsheet, hold the affected occurrence (right-click the cell, Edit Item tab, Hold) or use Edit Plan > Hold Plan. Choose a Hold Reason such as Test Results Unavailable or Toxicities.
2. Order follow-up: Order the follow-up labs through the order form or add them to the plan as a new item.
3. Reschedule: use Delay Plan to move upcoming incomplete items forward by days or weeks or move a single day with the column date Edit.

Held or delayed items that were linked to appointments are updated in Scheduling. See the Scheduling article for rescheduling visits.

 A patient is on two plans with different cycle lengths - how do I sync them?

Use Edit Plan > Change Plan Start Date or Delay Plan on one plan so its cycles line up with the other plan and use column date Edit to move individual days.

 A patient has an active plan containing an obsolete drug, or a plan uses a drug not in the customer drug list - what happens and how do I fix it?

Administrators can find and fix these in System Configuration on the Obsolete Drug Management tab. Access depends on the Clinical section role permission.

1. Open System Configuration and select Obsolete Drug Management, then the Plans sub-view. It lists every plan containing an obsolete drug with the plan name, status (use the Plan Status filter for Active, Inactive or All), last date used, number of times used, medication name, and obsolete date.
2. Click Edit Drug on the row.
3. Review the obsolete medication details, then search the candidate replacement list (filters include Display Medication Name, Route, Form, UOM, Status, Customer Drug List, Formulary, JCode, Billing unit).
4. Select the replacement and click Update.

The replacement updates all plans, rules, and favorites using the obsolete drug, removing the affected rows from the list. The same process applies to the Rules and Favorites tabs.

 A patient is on concurrent chemotherapy and radiation, but only one plan displays - what do I check?

On the Treatment Plan Flowsheet, check the plan dropdown and the filters, since the flowsheet keeps your filter choices during the patient session. Also check the plan status (a discontinued or completed plan may be hidden: the filter controls include Show Discontinued Meds).

 A patient has a plan with 20+ cycles - how do I navigate it and search for another patient?

1. Navigate — Use the flowsheet filters (for example Hide Empty Days, Show Discontinued Meds), and the Phase filter.
2. Choose a date — The day picker in the edit forms can show calendar dates for each cycle (Show Dates).
3. Search for another patient — Use the patient search in the main navigation.

 When a new plan is created, do all visits drop to the schedule, and can I print the patient's full treatment schedule?

Visits for a new plan appear in the scheduling queue so they can be scheduled. See the Scheduling article for how queue entries become appointments.

Printing and reporting features for the Flowsheet and Treatment Plan Ordering are planned for future development.

 A patient had their first treatment in the hospital (or clinic) and continues at another location - how do I set that up?

Treatment items on the flowsheet have a Destination field that can be set when ordering or edited later (Bulk updates to the Destination field are planned for future development but are not currently available).