FORM-Doctors-Order-Sheet-Pharmacy-Entyvio-vedolizumab-Mainten

Sep 12, 2026

Doctors’ order sheet for Entyvio (vedolizumab) IV infusion includes allergy status and patient identifiers, premedication options (normal saline flush and optional methylprednisolone, diphenhydramine, or acetaminophen), and the ordered infusion regimen with dose, route, frequency, and 30-minute infusion duration. It specifies management steps for infusion-related reactions (stop infusion, increase NS rate, administer PRN reaction medications, call the unit coordinator, and notify the provider) and lists infusion reaction emergency medications with dosing. Nursing orders cover TB screening verification, recent lab requirements, vaccine avoidance precautions, line flushing instructions, monitoring for hypersensitivity and infection signs, and documentation and signature requirements for the qualified provider.

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Premedications

Medication options and timing

Medication Order: Entyvio (Vedolizumab)

Dose, route, frequency, and infusion duration

Infusion-Related Reaction Management

Stepwise response and PRN medications

Infusion Reaction Medications

Emergency medication list and dosing

Nursing Orders

Pre-infusion requirements and monitoring

| Allergies: NKA
Height Weight kg | | | | | | | | | | | | | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | ****UNAPPROVED ABBREVIATIONS****
QD, QOD, MgSO4, MSO4, MS, IU, U or-u, ug, Use of a Trailing Zero (X.0mg), Lack of a Leading Zero( Xmg) | | | | | | | | | | | | | | DATE | TIME | ORDERS | | | | | | | | | | NURSE
SIGNATURE | | | | | | Assign to Outpatient status | | | | | | | | | | | | PREMEDICATIONS: | | | | | | | | | | | | | | 0.9% sodium chloride (NS) IV at KVO | | | | | | | | | | | | | | | | | No pre-medications necessary | | | | | | | | | | | | | | methylprednisolone sodium succinate injection mg IV x 1 dose 30 mins prior to infusion | | | | | | | | | | | | | | diphenhydramine mg IV x1 dose 30 mins prior to infusion | | | | | | | | | | | | | | diphenhydramine mg PO x 1 dose 30 mins prior to infusion | | | | | | | | | | | | | | acetaminophen 650mg PO x 1 dose 30 mins prior to infusion | | | | | | | | | | | MEDICATION: | | | | | | | | | | | | | | Entyvio (Vedolizumab) in 0.9% NS 250ml IV infusion | | | | | | | | | | | | | | Dose: | | | | | 300mg | | | | | | | | | | | | | | 600mg | | | | | | | | | Route: Intravenous | | | | | | | | | | | | | | Frequency: | | | | | | | | every 4 weeks | | | | | | | | | | | | | every 6 weeks | | | | | | | | | | | | | | every 8 weeks | | | | | | | Infusion Duration: 30 minutes | | | | | | | | | | | | | | If infusion-related reaction: | | | | | | | | | | | | | | 1.) STOP infusion immediately;
2.) Increase 0. 9% sodium chloride (NS)
infusion to wide open rate; | | | | | | | | | 3.) Administer PRN medications per infusion reaction medication ordered;
4.) Call Max Cart;
5.) Notify MD | | | | | INFUSION REACTION MEDICATIONS: | | | | | | | | | | | | | | albuterol inhalation nebulizer solution 2.5mg/0 .5ml (concentrated solution) | | | | | | | | | | | | | | (Note: dilute with 2.5ml of NS for an albuterol 2.5mg/3ml dose) | | | | | | | | | | | | | | Dose: 2.5mg via nebulizer as needed for shortness of breath/wheezing | | | | | | | | | | | | | | diphenhydrAMINE injectable | | | | | | | | | | | | | | Dose: 25mg IV x 1 dose for uticaria, pruitis, shortness of breath. May repeat in 15 minutes if symptoms not resolved | | | | | | | | | | | | | | EPINEPHrine 1mg/ml (1:1000) injectable | | | | | | | | | | | | | | Dose: 0.3mg IM x1 dose as needed for anaphylaxis | | | | | | | | | | | | | | methylPREDNISolone sodium succinate 125mg injection | | | | | | | | | | | | | | Dose: 125mg IV x1 dose as needed for hypersensitivity | | | | | | | | | | | | | | NURSING ORDERS: | | | | | | | | | | | | | | 􀁸 Initial Dose only: Verify PPD or quanti-FERON-TB assay for latent TB results are negative for TB | | | | | | | | | | | | | | 􀁸 Ensure CBC, AST, and ALT have been drawn within the last 8 weeks. If labs have not been drawn within 8 weeks, proceed with infusion and instruct patient to receive lab draw today. Notify provider if patient is more than 12 weeks overdue for labs. | | | | | | | | | | | | | | 􀁸 Ensure patient has not received MMR vaccine (measles, mumps, rubella vaccine), Rotavirus vaccine, Smallpox vaccine, YF-Vax (Yellow Fever) vaccine, MMRV (measles, mumps, rubella, and chickenpox) vaccine, or chickenpox vaccine concurrently with vedolizumab (Document in Meditech Intervention) | | | | | | | | | | | | | | 􀁸 Flush vedolizumab tubing with ONLY 0.9% NS (never D5W) . Do not infuse any other agents in the same line | | | | | | | | | | | | | | 􀁸 Do not administer vedolizumab and notify provider if patient has a temperature

FAQs

What premedications may be ordered before an Entyvio infusion?

Orders may include 0.9% sodium chloride (NS) IV at KVO, with optional methylprednisolone sodium succinate, diphenhydramine (IV or PO), and/or acetaminophen given 30 minutes prior to infusion.

How should an infusion-related reaction be handled?

Stop the infusion immediately, increase 0.9% NS to a wide open rate, administer PRN infusion reaction medications per the ordered plan, call Max Cart, and notify the provider.

What nursing checks are required prior to infusion?

Verify latent TB results (PPD or quanti-FERON-TB) are negative, ensure CBC/AST/ALT were drawn within the last 8 weeks, confirm the patient has not received specified vaccines concurrently with vedolizumab, flush the tubing only with 0.9% NS, and monitor for hypersensitivity and infection signs.

Sep 12, 2026

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